A “Rock Star” in Patient-Reported Outcomes, Is Listening

Ethan M. Basch, MD, MSC is all about listening and improving how systems work. Not only is Basch a researcher and genitourinary oncologist, but he also moonlights as a jazz bass player. Although the 2 pursuits may seem dissimilar, Basch explained that they actually have plenty in common.
“I like to quietly chug along in the background and create an environment for other people to succeed and shine,” said Basch, the Richard M. Goldberg Distinguished Professor of Medicine and chief of the Division of Oncology at the University of North Carolina (UNC) School of Medicine in Chapel Hill.

“I’ve been fortunate to have my own moments presenting on the podium or publishing papers I thought were important, but my main MO is to create an underpinning for others to be successful, for example through a Division of Oncology or Cancer Hospital where people can feel gratified while delivering fantastic care, where patients feel supported, where world-class research happens, and where trainees thrive.”

“Playing jazz bass is a lot like that. You have to know the chords, stay in the groove, and be in synch with the drummer. Otherwise you want to stay somewhat invisible so others can shine. If you can accomplish that, it’s a meaningful achievement, success through others.... It’s collaborative, it’s communicative, you’re listening, and you’re part of a bigger process you couldn’t have achieved on your own.”

OncLive has named Basch the 2024 Giants of Cancer Care inductee in supportive, palliative, and/ or geriatric care, thanks to his work in the field of patient-reported outcomes (PROs). It’s a wonderful recognition of his commitment to patient care and his passion...for improving quality of life for people with cancer,” said his UNC colleague Lynne Wagner, PhD, a clinical psychologist and professor in the Department of Health Policy and Management at the UNC Gillings School of Global Public Health.

“Ethan Basch is a visionary leader in oncology,” said Deborah Schrag, MD, MPH, a 20-year collab- orator of Basch’s and chair of the Department of Medicine, George J. Bosl Chair at Memorial Sloan Kettering Cancer Center in New York, New York, as well as a 2023 OncLive Giants of Cancer Care honoree in the same category. “He is original, generous, and creative. He has done so much for the field, and he is so deserving of this honor and recognition.”

Along with being a married father of 2, Basch is also the physician-in-chief at North Carolina Cancer Hospital, a professor of health policy and management at the UNC Gillings School of Global Public Health, and both director of the Cancer Outcomes Research Program and co-leader of the Cancer Prevention and Control Program at the UNC Lineberger Comprehensive Cancer Center.

“I wear a few different hats these days,” Basch said. “I’m an oncologist focused on the care of patients with prostate cancer, and the balance of my time is divided between research, training, local administrative work, and national committees. I like that mix, and the different areas complement each other. Seeing patients informs my research and mentoring, and vice versa.”

Connecting with People, Improving Systems

A native of the Bronx in New York City, Basch took an unconventional path to the world of oncology as he earned his undergraduate degree from Brown University before attending Harvard Medical School. “I studied literature and literary theory, and then played music and worked in policy,” Basch said. “I went back to medical school 5 years after graduating from college. My experiences during those years helped me realize that I felt most gratified through direct service with individual relationships.”

“I also felt that direct interactions could inform a broader understanding of how systems work and can be improved... I’ve always been a person who enjoys the personal contact and individual relationships of medicine, and being able to scale that into health system interventions that can improve the patient experience has been highly gratifying.”

That guiding interest is apparent in what could be considered, in musical terms, one of Basch’s greatest hits, which was the paper “Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment.”1 This was presented in a plenary session at the 2017 American Society of Clinical Oncology Annual Meeting and published in JAMA, and stemmed from observations he made when first starting in practice years earlier.

“That trial built on years of foundational work,” said Basch. “When I started as an oncologist, I was bothered that patients often came into the office with poorly controlled symptoms and side effects that they had experienced at home, sometimes for weeks since their prior appointment, but we as providers were totally unaware. This seemed like an opportunity to do better for our patients.”

“So along with colleagues, we started by characterizing this problem through systematic research, and found that as clinicians, we miss more than half of our patients’ symptoms. To address this problem, we next developed a computer system for patients to self-report their own symptoms during cancer treatment, with alerts sent to their care team for concerning issues. This was back before the days of iPhones or apps so it all had to be created from scratch. We showed that the vast majority of patients were willing and able to self-report symptoms this way, and in fact were often enthusiastic to do so because it helped them feel more engaged in their own cancer care and more connected to the team. This approach came to be known as remote symptom monitoring with patient-reported outcomes or ‘PROs’.”

“But it remained unclear if this approach really made a difference to cancer outcomes. That’s what inspired the randomized trials. So we compared remote symptom monitoring with PROs versus usual care, and found multiple significant and meaningful benefits of PROs: improved symptom control and quality of life, reduced hospitalizations and emergency room visits, and in some cases even lengthened overall survival. These findings caught a lot of interest and led to the ASCO plenary in 2017. The discussant at the plenary noted that the PRO intervention led to greater clinical benefits than most of the cancer drugs approved that same year by the FDA.”

“This was an ‘aha’ moment for me and fed into the emerging field of digital health in general,” Basch said. “That a relatively simple intervention could impact measurable outcomes showed the power of changing care processes and harnessing technology to improve the patient experience. And for me, that represented a gratifying full circle back to the patient at the center.”

Schrag, who was one of Basch’s mentors and among his colleagues in that landmark research, described Basch as “a rock star” in the field of PROs. “He’s just had a meteoric rise in oncology,” Schrag said. “He had a vision. I worked with him when he was a fellow, and I’m privileged to say I participated in his mentorship and training. He had an idea. It was a risky idea. He went with it. He’s tenacious [and] fierce but also kind and generous. He embodies the best of the best in oncology.”

Basch has been the author or co-author of more than 350 published pieces of research. He is now developing an initiative to implement electronic PROs in oncology practices across the country, called OncoPRO, supported by the Patient-Centered Outcomes Research Institute, which is in partnership with ASCO and the American Cancer Society.

Wagner has known Basch for nearly 20 years and says that he was well ahead of the curve in his work centering the patient’s voice in cancer care. When commenting on another area of Basch’s focus, bringing PROs into adverse event evaluation in cancer drug development, she noted that, “he recognized that what he was seeing in his patients wasn’t represented in those published tables of grade 3 and higher adverse effects [in clinical trial results],” she said. “He...was one of the first, really, to recognize the power and potential for [PROs] to amplify the patient voice to help improve care. He very much has been an innovator and a leader in this area.”

Basch and Wagner are on the leadership team of the new UNC Lineberger Patient-Reported Outcomes Center of Excellence, which held its inaugural retreat this summer. “I’m excited about the new PRO Center of Excellence,” Basch said. “We have a critical mass at UNC of researchers and clinicians focused on PROs and there are a lot of opportunities now to move this field forward.” The Center of Excellence, Wagner said, “will span the continuum from the early bench science and PRO measurement science all the way to clinical trial application and clinical care integration, which is the tremendous hallmark of Ethan’s research.”

The Center of Excellence, Wagner said, “will span the continuum from the early bench science and [PROs] measurement science all the way to clinical trial application [and] clinical care integration, which is the tremendous hallmark of Ethan’s research.”

After decades of working in the field of care delivery research, Basch said, “We are on the verge of a golden age in quality cancer care delivery. There’s greater alignment of interests now than in the past,” Basch said. “Patients, caregivers, clinicians, researchers, practice leaders, and payers are all focused on delivering patient-centered care. Our motivations may differ, but the goal is the same to keep the patient at the center, which offers a tremendous opportunity for progress.”

“But we could easily squander this opportunity if we don’t stay on mission, train our teams and the next generation of leaders with purpose, harness data systems to develop better metrics, put meaningful programs in place, and continue to work on aligning interests. Digital health with PROs is just one of the smorgasbord of opportunities for care improvement available to us at this moment, and it complements other areas like navigation, survivorship care planning, avoidance of acute care utilization, optimizing access, improving provider experience, etcetera. These areas offer the promise of better meeting the needs of patients, reducing costs, and improving outcomes, but they require organizational commitment and investment.”

The work continues. Basch’s goal of elevating systems of care and centering patient voices may involve a bit of invisibility for himself, as in fundamentally sound jazz bass playing, but his colleagues and peers know that he and his work are deserving of the spotlight.

“The University of North Carolina is so lucky to have him on their faculty, but he is generous around the country, in particular to faculty who are interested in improving health care quality [and] cancer care delivery,” Schrag said. “This is a midcareer honor for Ethan, and I know a lot more is yet to come. I look forward to seeing what he gets up to next.”

Reference

1. Basch E, Deal AM, Dueck AC, et all. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/ jama.2017.7156