Researchers have found that a text message–based program in combination with routine laboratory testing could safely accelerate patients to treatment with immune checkpoint inhibitors, eliminate the need for in-person assessments with their physicians, and save them about 1.5 hours in total wait and care time per visit to the health-care center, according to new findings presented by Bange et al at the 2023 ASCO Quality Care Symposium.
Background
Previous studies have shown that collecting patient-reported outcomes electronically could effectively screen patients for immunotherapy toxicities.
“The current standard of care for patients treated with immunotherapy is screening with laboratory testing and a visit with their [physicians] prior to each treatment dose. This can result in excessively long days in the clinic with wait times in between each step. Our hypothesis was that some patients could safely proceed to their infusions without having to wait to see their [physicians]—giving them the option for a shorter day,” explained lead study author Erin Mary Bange, MD, MSCE, of Memorial Sloan Kettering Cancer Center.
Study Methods and Results
In the new trial, the researchers assessed whether a text message–based questionnaire combined with laboratory testing (e-triage) could identify patients who could safely bypass their physician visits and proceed directly to immunotherapy treatment—with the goal of streamlining cancer care delivery. To participate in the study, the patients were required to speak English, have access to a mobile device with text messaging, and already be receiving treatment for a solid tumor with a single-agent immune checkpoint inhibitor. The patients in the study were a median age of 67.5 years; and 84.6%, 7.7%, 5.1%, and 2.6% of them identified as White, Black, Asian, and other, respectively.
Among the 152 eligible patients, 51 of them consented to the study (adoption rate 33.6%). After 11 of them chose not to partake in the study, 40 of them were randomly assigned to participate in the text message–based e-triage program (n = 19) or receive usual care (n = 21).
The patients in the e-triage arm of the study were assessed for symptoms of immune checkpoint inhibitor toxicity via two-way text messaging and routine laboratory testing 96 hours prior to scheduled treatment. The patients in the e-triage arm with normal bloodwork and no identifiable symptoms were eligible to bypass the pretreatment physician visits, whereas those in the usual care arm were required to attend the standard physician visits.
The primary endpoint of the study was total care time, which the researchers defined as the total time per encounter—including commute, wait, infusion, and lab times. The secondary endpoints were patient wait time per encounter, incident emergency department or hospital visits during follow-up, health-related quality of life, and patient satisfaction. Implementation outcomes were adoption and fidelity.
The researchers found that among the 52 encounters of the patients in the e-triage arm, 23 of them adhered to their e-triage assessment, with a fidelity rate 44.2%. Compared with the usual care arm, the patients in the e-triage arm had 66 minutes less care time and 30.1 minutes less wait time per encounter.
The researchers reported that the incidence of emergency department or hospital visits was not statistically significant between the treatment arms (12.5% in the usual care arm vs 20% in the intervention arm). Health-related quality of life and patient satisfaction scores were also similar between both arms.
Next Steps
“Based on feedback we got from [physicians] and patients, incorporating a human touch—even if just a post-triage phone call—would increase confidence in the program and make both parties feel the intervention is more acceptable,” emphasized co–study author Kerry Q. Coughlin, MSW, Innovation and Engagement Manager at the Penn Center for Cancer Care Innovation.
The researchers plan to further explore how to integrate oncology nursing into the text [message]–based symptom reporting workflow and expand the program to include home monitoring services.
“Both patients and physicians experience considerable time demands of cancer care, often referred to as time toxicity. Patients feel it in the waiting rooms and physicians feel it as they try and make room to attend to patients who need them. Interventions like this one are one way [for] patients [to] reduce the time burdens of cancer care, such as unnecessary office visits, thus allowing physicians to see [patients] who may be more in need. Something like this could be a win-win for patients and clinics,” concluded Toby Campbell, MD, MS, of ASCO, who was not involved in the study.
Disclosure: The research in this study was funded by the Conquer Cancer Foundation of ASCO. For full disclosures of the study authors, visit meetings.asco.org.
