As reported at the ASCO20 Virtual Scientific Program by Robert Michael Daly, MD, MBA, and colleagues (Abstract 2027), use of a pilot program of intensive remote monitoring of high-risk outpatients receiving antineoplastic treatment has shown considerable promise in the ability to improve patient care and decrease use of hospital resources by promptly alerting practitioners to symptoms that require management and avoiding acute-care hospital visits. The study was simultaneously published in JCO Oncology Practice.
Robert Michael Daly, MD, MBA
As stated by the investigators, “Early detection and management of symptoms in patients with cancer improves outcomes, however, the optimal approach to symptom monitoring and management is unknown. This pilot program uses a mobile health intervention to capture and make accessible symptom data for high-risk patients to mitigate symptom escalation.”
Study Details
Patients initiating antineoplastic treatment at a Memorial Sloan Kettering Cancer Center regional location were eligible for the program. Daily remote monitoring of patients was managed by a dedicated team of registered nurses and nurse practitioners. Components of the program included:
- A predictive model that identified patients at high risk for potentially preventable acute care visits
- A patient portal enabling daily ecologic momentary assessments (EMAs; ie, daily assessment in real time in the patient’s natural environment)
- Alerts for symptoms prompting concern
- An application allowing staff to review and trend symptom data
- A secure messaging platform for communications and televisits between staff and patients.
Feasibility and acceptability were assessed via success of patient enrollment, with a goal of ≥ 25% of new treatment starts, and response rates, with a goal of patient completion of > 50% of daily symptom assessments; symptom alerts; perceived value of the program based on interviews with patients and providers; and acute care usage.
A total of 100 patients initiating antineoplastic treatment for solid tumors or lymphoma were enrolled in the program between October 15, 2018, and July 10, 2019, representing 29% of the total population starting antineoplastic treatment during this time period. Patients had a median age of 66 years, and 45% were female.
Key Findings
During 6 months of program deployment, the patient response rate to daily assessments was 56%. In total, 93% of patients generated a severe symptom alert. Proportions of patients generating moderate and severe symptom alerts one or more days during follow-up were: 73% and 74% for pain; 73% and 21% for anxiety; 70% and 14% for depression; 66% and 53% for functional status; 62% and 12% for diarrhea; 61% and 18% for decreased oral intake; 58% and 25%% for nausea; 38% and 22% for dyspnea; and 24% and 9% for emesis.
A total of 5,010 symptom-related secure messages were shared between staff and patients during the 6-month period. Patients and providers reported that the program provided value in care.
A 17% decrease in emergency department visits by patients in the program vs a cohort of high-risk nonenrolled patients was observed, suggesting the potential for such a program to reduce avoidable acute care usage of hospital resources.
The investigators concluded, “This pilot program of intensive monitoring of high-risk patients is feasible and holds significant potential to improve patient care and decrease hospital resources. Future work should focus on the optimal cadence of EMAs, the workforce to support remote symptom management, and how best to return symptom data to patients and clinical teams.”
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
