The Trigger project: Introducing electronic patient reported outcome measures into radiotherapy services


Session type:

Amy Sharkey1,Archie MacNair2,Kerlann Le Calvez3,Robert Walters4,Lesley Smith5,David Bloomfield6,Annmarie Nelson7,John Staffurth8,Matthew Williams3,Jane Maher9
1Macmillan Cancer Support, London, UK & Royal College of Radiologists, London, UK ,2Macmillan Cancer Support, London, UK & Royal College of Radiologists, London, UK,3Imperial College Healthcare NHS Trust, London, UK,4Pelvic Radiation Disease Association, Epsom, UK,5NHS England National Cancer Programme, London, UK,6Brighton and Sussex University Hospitals NHS Trust, Brighton, UK,7Marie Curie Research Centre, London, UK,8Velindre NHS Trust, Cardiff, UK,9Macmillan Cancer Support, London, UK



Patients receiving pelvic radiotherapy can experience long term gastrointestinal side effects post-radiotherapy. The Trigger project identifies patients experiencing symptoms of radiation-related bowel toxicity using the ALERT-B questionnaire, and directs them to the appropriate clinician.

Trigger is a service evaluation project, aiming to prove the utility of electronic patient reported outcome measures (PROMs), and to demonstrate the feasibility of a low-resource project as a model for collecting PROMs. It is a collaboration between Macmillan Cancer Support, the Royal College of Radiologists, and three NHS Trusts: Velindre, Imperial College Healthcare and Brighton and Sussex University Hospitals.


Patients register on the Trigger website, hosted by My Clinical Outcomes, and receive periodic emails to complete the short ALERT-B questionnaire electronically, to screen for long-term bowel symptoms which could have been caused by pelvic radiotherapy. If answering “yes” to any of the questions, patients are directed to appropriate services.


Six months following the completion of their radiotherapy, patients are sent a separate questionnaire to evaluate the utility of the project.



336 patients registered in first the 9 months across the 3 sites. Patients with a range of different cancers signed up: anal (2%), bladder (1%), prostate (87%), rectal (4%) and gynaecological (6%).


43 patients (of 65 eligible (uptake 66%)) have answered their 6-month post treatment questionnaire thus far, and 72% answered "yes" to at least one of the ALERT-B questions. 85% of responding patients reported they found the Trigger project helpful.


These promising results show that electronic PROMS can be introduced in radiotherapy departments using a low resource model. The Trigger project works as a feasibility model, showing patients engage with electronic PROMs projects, and find them useful. PROMs for other tumour types could be collected in a similar manner, based on the low-resource model used here, using site-specific PROMs based on the ALERT-B tool.