Pilot Program Shows That Remote Intensive Monitoring in High-Risk Patients May Improve Outpatient Symptom Management

Remote intensive monitoring of high-risk patients is feasible and has the potential to improve patient care and reduce use of hospital resources. These findings were presented during the ASCO20 Virtual Scientific Program.

Early detection and management of symptoms in patients with cancer improves outcomes; however, the optimal approach to symptom monitoring and management is unknown. Therefore, a team at Memorial Sloan Kettering Cancer Center in New York, New York, developed a pilot program that uses a mobile health intervention to capture symptom data for high-risk patients to enable intervention to mitigate symptom escalation.

Patients initiating antineoplastic treatment at a regional location of the cancer center were eligible. Patients were managed remotely by a dedicated staff of nurses and nurse practitioners. Remote monitoring was supported with the following:

• A predictive model to identify patients at high risk for a potentially preventable acute-care visit;
• A patient portal enabling daily ecological momentary assessments (EMA);
• Alerts for concerning symptoms;
• An application that allows staff to review and trend symptom data; and
• A secure messaging platform to support communications and televisits between staff and patients.

The researchers evaluated feasibility and acceptability through enrollment in the program (with a goal to enroll 25% or more of patients initiating new treatments) and response rates (complete more than 50% of daily symptom assessments), symptom alerts, perceived value based on qualitative interviews with patients and providers, and acute care usage.

Between October 15, 2018, and July 10, 2019, 100 high-risk patients with solid tumors and lymphoma (median age, 66 years; 45% female) who were starting treatment were enrolled in the pilot program. Enrolled patients comprised 29% of patients initiating treatment at the facility. Over 6 months of follow-up, the response rate to the daily assessments was 56%, and 93% of patients generated a severe symptom alert.

Both patients and providers reported a perceived value in the program. Staff and enrolled patients exchanged 5010 symptom-related secure messages during the follow-up period. Compared with a cohort of high-risk patients not enrolled in the program, emergency department visits were reduced by 17% among participants in the pilot program.

“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,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Daly RM, Kuperman G, Zervoudakis A, et al. Pilot program of remote monitoring for high-risk patients on antineoplastic treatment. Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 2027.