About the cancer PRMs system
Measuring what matters
Since 2017, the Cancer Institute NSW has led the development and implementation of the cancer PRMs system, enabling NSW cancer services to collect PRMs electronically.
The cancer PRMs system enables the electronic collection of both PROMs and PREMs across 15 local health districts and one specialty health network.
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Patient-reported measures (PRMs) |
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PROMs: Patient-reported outcome measures A person with cancer’s perspective on their wellbeing (including how cancer treatment is impacting them) and how distressed they are feeling |
PREMs: Patient-reported experience measures A person with cancer’s perception of their experiences within the healthcare system. |
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Measures available:
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Measures available:
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Why were these measures selected?
The patient-reported measures (PRMs) available in the cancer PRMs system were selected due to the strong research base supporting their reliability and relevance across diverse cancer care settings. They are designed to be relevant for people with any type of cancer and not too burdensome to complete.
There are many patient-reported measures available for use in cancer care, each designed to capture different aspects of a person’s experience, symptoms and wellbeing. When selecting PRMs for a statewide clinical program, it was important to identify tools that were evidence-based, clinically relevant, easy to interpret and practical to use in routine care. Consideration was also given to minimising burden for both patients and clinicians by selecting measures that are brief, straightforward to administer, and capable of supporting meaningful clinical action and referral pathways.
These measures were selected as they are internationally recognised and validated screening tools with a strong evidence base supporting their use in cancer populations to systematically identify distress, symptoms, and supportive care needs to ultimately enhance person-centred care [1,2]. In addition to their clinical usefulness, the DT/PL and ESAS are brief, easy for patients to complete, and feasible to integrate into routine clinical workflows and electronic medical records.
Together, the DT/PL and ESAS provide a practical and complementary approach to understanding the physical and emotional impacts of cancer and its treatment.
Distress Thermometer and Problem List (DT/PL): Detecting emotional and practical needs for timely support
The DT/PL is a validated and internationally endorsed screening tool widely used across oncology settings to identify psychosocial distress and supportive care needs in people affected by cancer [4].
Distress management is now recognised as an important component of comprehensive cancer care, yet research has shown that emotional and practical concerns often go undetected without routine screening, [6]. The DT provides a simple, standardised and evidence-based approach to identifying patients who may benefit from further assessment or intervention, supporting earlier recognition and more timely referral to appropriate services.
The accompanying PL strengthens the clinical usefulness of the tool by helping to identify the underlying contributors to distress across emotional, practical, family, spiritual and physical domains. This allows clinicians to move beyond just identifying distress alone and supports more targeted, person-centred care planning.
ESAS: Real-time symptom monitoring to enable timely intervention
The ESAS is a validated symptom assessment tool widely used in oncology and supportive care settings to support the routine screening and monitoring of symptom burden in people with cancer [7].
It enables patients to report the severity of common cancer-related symptoms, such as pain, fatigue, nausea and anxiety [7].
ESAS has a strong evidence base demonstrating its reliability, responsiveness and clinical usefulness for people affected by cancer, and has been integrated into routine care internationally. Importantly, the tool includes established symptom thresholds that help trigger clinical review and support, this can help ensure timely symptom management and integration into clinical workflows.
Combining ESAS and DT/PL enables better patient insight
Together, ESAS and the DT/PL provide a complimentary, evidence-based approach to routine symptom and distress screening in cancer care. Used in combination, these tools enable cancer services to systematically capture the patient voice, identify changing needs over time, and support timely, person-centred intervention across the cancer journey. Their brevity, clinical usefulness and ease of interpretability also make them suitable for integration into routine care across a range of oncology settings.
While ESAS focuses on symptom severity and the trajectory of physical and psychological symptoms, the DT/PL captures broader emotional, psychosocial and practical and family concerns that may influence a person’s wellbeing and ability to cope with cancer and its treatment. Using these tools together can provide a more holistic understanding of a person’s experience and support conversations that extend beyond the disease and treatment to the issues that matter most to patients.
How the cancer PRMs system works
Patient completes wellbeing survey on a Hospital iPad or their own device
Patient may elect to receive additional support information via email
Healthcare team review wellbeing survey results
Healthcare team discuss wellbeing survey responses with the patient
Healthcare team may refer the patient to support
Healthcare team may address the isues with the patient
Want to learn more about the cancer PRMs system development and implementation?
The below journal articles explore the development and statewide implementation of the cancer PRMs system.
- Statewide integration of electronic patient-reported outcome measures into routine oncology care: a mixed-methods implementation study (PDF)
- Driving statewide digital transformation in oncology care: a change management case study using ADKAR methodology for the implementation of patient-reported outcomes in cancer clinical care
Get in touch
If you would like more information on the PRMs Program, please email us at cinsw-prms@health.nsw.gov.au.
1. Ethan Basch, Deal, A. M., Dueck, A. C., Scher, H. I., Kris, M. G., Hudis, C., … Schrag, D. (2017). Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA, 318(2), 197–198. https://doi.org/10.1001/jama.2017.7156
2. Doris Howell, Molloy, S., Wilkinson, K., Green, E., Orchard, K., & Wang, K. (2015). Patient-reported outcomes in routine cancer clinical practice: A scoping review of use, impact on health outcomes, and implementation factors. Annals of Oncology, 26(9), 1846–1858. https://doi.org/10.1093/annonc/mdv181
3. Chochinov Nekolaichuk, Watanabe, S., Beaumont, C., & Johnson, L. (2008). A validation study of the Edmonton Symptom Assessment System in a multicentre palliative care population. Palliative Medicine, 22(6), 711–717.
4. Anne Snowden, White, C. A., Christie, Z., Murray, E., McGowan, C., & Scott, R. (2011). The clinical utility of the Distress Thermometer: A review. British Journal of Nursing, 20(4), 220–227.
5. Barry D. Bultz, & Linda E. Carlson (2005). Emotional distress: The sixth vital sign in cancer care. Journal of Clinical Oncology, 23(26), 6440–6441. https://doi.org/10.1200/JCO.2005.02.3259
6. Linda E. Carlson, Waller, A., Groff, S. L., Giese-Davis, J., Bultz, B. D., … (2012). Screening for distress, the sixth vital sign, in lung cancer patients: Effects on pain, fatigue, and common problems. Psycho-Oncology, 21(Suppl.), [pages vary by edition].
7. Eduardo Bruera, Kuehn, N., Miller, M. J., Selmser, P., & Macmillan, K. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6–9.
