Mapping research priorities related to maternal and infant nutritional health in the context of climate change in Pakistan: a mixed-methods study.

Systematic electronic patient-reported outcome (ePRO) monitoring has emerged as a strategy to improve symptom management and health-related quality of life (HRQoL) in patients with cancer. Patients complete standardized symptom and functioning questionnaires at regular intervals, and clinically important deterioration can trigger clinical review. Growing evidence has suggested that digital patient-reported outcome (PRO) monitoring in advanced cancer improves symptom control and may prolong survival. However, early studies were largely conducted in research-intensive centers, and more recent multicenter trials have evaluated ePRO monitoring in broader settings; disease-specific multicenter evidence remains limited. Metastatic breast cancer (mBC) remains incurable, and treatment aims to prolong survival while maintaining daily functioning and HRQoL. Patients with mBC may receive prolonged, sequential systemic therapies across the metastatic disease course, during which disease burden and treatment-related toxic effects can accumulate. As a result, patients frequently experience worsening symptoms that may be underrecognized in routine care and negatively affect HRQoL. Therefore, a disease-specific ePRO study was warranted to evaluate whether structured symptom monitoring can support care in this clinical setting. Fatigue is a persistent and distressing sense of physical, emotional, and cognitive exhaustion that interferes with daily functioning. In patients with mBC, fatigue is among the most common and debilitating symptoms, often worsening during systemic treatment and affecting physical activity, work, social roles, and HRQoL. Because fatigue is highly prevalent, clinically meaningful, and potentially responsive to earlier symptom detection, we selected it as the primary outcome.