Patients with cancer can experience severe and deteriorating symptoms between chemotherapy treatments. Remote monitoring of patients after receiving treatment shows great promise in improving patient outcomes, but has yet to be realized in real-world clinical oncology settings. Researchers are investigating a new technology that allows for remote monitoring of symptoms after outpatient cancer therapy.
Patients were monitored for symptoms according to the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List instrument via an electronic patient-reported outcome (ePRO) system integrated into an electronic medical records system. Researchers identified common symptoms and established specific guidelines to initiate a nursing consultation that might occur through a telephone call, an office visit, or referral to an emergency department.
Patients (n = 530) provided parenteral chemotherapy between June 2020 and January 2021 were enrolled in the ePRO system. The most common cancer types were heme (32.5%), breast (20%), thoracic (16.1%), and gastrointestinal (13.3%). Using either a mobile app (90.1%) or an interactive voice response interface (9.9%), patients reported symptoms 1 (12%), 2 (30%), 3 (35%), or 4 (35%) times a month. After 3 months, 68.9% of participants were still reporting symptoms via the ePRO system. The most common problems that met or exceeded the symptom threshold for nursing care included high NCCN Distress Thermometer score (17.1%), fatigue (16.1%), pain (11.5%), nausea (9.4%), and dyspnea (4.5%). The most common mode of interaction initiated by the nurses was a follow-up call (33%), and of these calls, 4.3% resulted in an urgent in-office assessment. Patients who stopped reporting did so primarily due to death, selection of hospice care, or completion of the treatment.
ePRO-based remote monitoring of patients receiving intravenous cancer therapy in routine clinical care is feasible. Patient enrollment and retention were high across all tumor types included in the study. Symptoms reported by patients were concordant with previous publications, and a small percentage required an office visit. The researchers conclude that office intervention may reduce the need for emergency and inpatient services for patients experiencing symptoms between chemotherapy sessions.
Source: Kolodziej MA, Kwiatkowsky L, Hunnicutt J, et al. Successful implementation of an ePRO remote monitoring system in patients receiving chemotherapy in a community oncology practice. American Society of Clinical Oncology Virtual Meeting; June 4-8, 2021. Abstract 1526.