Digital technology may help to safely reduce the amount of time some patients with cancer spend receiving care—also referred to as “time toxicity”—according to a recent study published by Bange et al in NEJM Catalyst.
Background
Patients with cancer often spend a large amount of time on activities related to treatment—including meeting with physicians and other members of their health-care team, undergoing laboratory and other tests, picking up prescriptions, receiving treatment, traveling to and from appointments, and sitting in the waiting room between appointments. Previous research has explored strategies to quantify this level of time toxicity.
“Patients with cancer spend an enormous amount of time engaging with the health-care system, and for patients with advanced cancer in particular, that time is precious,” stressed senior study author Ronac Mamtani, MD, MSCE, Section Chief of Genitourinary Cancers at the University of Pennsylvania “We developed a safe and effective platform that—for certain patients—could really challenge the status quo and give them quality time back,” he added.
Study Methods and Results
In a pilot study (ClinicalTrials.gov identifier NCT05134636), researchers developed a simple text messaging–based platform using the Center for Health Care Transformation and Innovation’s Way to Health Platform to obtain patient-reported symptoms and ensure that patients were prepared for immunotherapy. Those receiving immunotherapy for cancer treatment are currently required to complete blood tests and meet with their health-care providers prior to every infusion to determine whether they’ve developed concerning symptoms that might signal a reaction to the immunotherapy and a need to cease the drug regimen. However, there is a relatively low rate of side effects for immunotherapy compared with traditional chemotherapy.
The researchers randomly assigned the patients receiving single-agent immunotherapy for solid tumors to either undergo an in-person preinfusion symptom check with their health-care providers or complete a 16-question symptom check taking less than 5 minutes via the text message platform. If their laboratory results were negative and no symptoms were reported, the patients were given the option to bypass the in-person visit and proceed directly to their immunotherapy infusion. The 16 patients who were fast-tracked saved more than 1 hour per visit—including 30 minutes less time waiting—compared with the 15 patients who continued with the usual in-person visit. Of note, the fast-track system was found to be safe, with no differences in postinfusion hospital visits or health-related quality-of-life impacts compared with usual care.
“Considering that patients who consented for the study told us that saving even 45 minutes per visit would significantly impact their lives, we were excited to see that our first test of this tool surpassed expectations, giving patients even more time back each time they went in for treatment,” highlighted lead study author Erin M. Bange, MD, MSCE, Assistant Professor at Memorial Sloan Kettering Cancer Center.
Although patient-reported outcomes had been used in other studies to assess various quality-of-life measures, the researchers noted that their study used digital patient-reported outcomes to streamline cancer care delivery. They detailed that a total of 19 additional patients who reported their symptoms via the text message platform were eligible to fast-track their preinfusion appointments but chose to continue with the in-person visit instead as a result of patient preference, provider preference, or other care coordination issues. The researchers emphasized that some patients may prefer to continue in-person visits, but they hope their text message platform can provide an option for patients who want to use it rather than a one-size-fits-all approach.
The researchers conducted focus groups with health-care providers to better understand concerns related to the fast-track process and potential barriers to broader implementation.
Conclusions
“Our goal is to ultimately test this strategy in a pragmatic trial, where it’s used in a real-world setting and not the controlled setting of a traditional clinical trial, but we want to be sure that we have the best-designed tool to effectively meet both provider and patient needs—so we’re taking time to assess the feedback and refine our approach before moving forward,” Dr. Mamtani underscored. “[Patients with cancer] are repeatedly asked to hurry up and wait while getting care. What we’re trying to address is just the tip of the iceberg in terms of giving patients valuable time back to focus on living,” he concluded.
Disclosure: The research in this study was supported by an ASCO Conquer Cancer Young Investigator Award, the Marjorie and Bryan Weingarten Fellowship Grant, the Health Network Foundation, and the National Institutes of Health/National Cancer Institute. For full disclosures of the study authors, visit catalyst.nejm.org.
