COVID-19: Remote patient monitoring proves effective for outpatient management
medwireNews: A randomized trial and a cross-sectional analysis have found that remote patient monitoring (RPM) had a positive impact on people with cancer during the COVID-19 pandemic, while a survey suggests that patients also find the approach favorable.
This report outlines the key results from the three studies, which were presented at the 2021 ASCO Annual Meeting, with co-publications in JCO Oncology Practice for the cross-sectional study and the patient survey.
RPM linked to reduced symptom burden, improved QoL
Presenting author Kathi Mooney, from the Huntsman Cancer Institute in Salt Lake City, Utah, USA, said that “while there is always an interest in reducing avoidable health care utilization, during the COVID-19 pandemic, there was an imperative to decrease viral exposure and pivot care whenever possible to the home, through telehealth and remote monitoring.”
She and her colleagues therefore conducted a randomized trial at the institute in which 252 cancer patients who were receiving chemotherapy and/or radiotherapy were randomly assigned to receive the Symptom Care at Home (SCH) intervention or usual care between April and December 2020.
Patients in the intervention group reported daily on the presence and severity of nine symptoms and received immediate automated self-management coaching; oncology nurse practitioners were automatically notified for reports of moderate-to-severe symptoms and provided telephonic support and management. Patients in both groups completed quality of life (QoL) questionnaires at baseline and monthly for up to 5 months.
The participants were aged an average of around 61 years, the majority (around 92%) were White, and approximately two-thirds were female. Breast cancer was the most common tumor type, in around a fifth of the participants, and approximately a third had nonmetastatic disease.
As assessed by the MD Anderson Symptom Inventory (MDASI), patients in the SCH intervention group had a significantly lower symptom burden than those in the usual care group through the course of the study.
The intervention patients also reported significantly better health-related (HR)QoL on the Penedo COVID-19 HRQoL subscale during the first 2 months, “with improvements then subsiding over the remaining 3 months,” said Mooney.
But there was no significant difference between the study arms with regard to measures of mental health and social isolation.
There was, however, a significant reduction in the frequency of unplanned healthcare visits over the 5-month study period in the SCH intervention versus the usual care group, at rates of 11.7% and 22.6%, respectively.
Mooney said in conclusion that “[a]utomated systems that have stepped approaches and efficient use of oncology care providers' time make these approaches sustainable, generalizable, and overcome barriers, such as the patient's distance from an academic or community cancer treatment center.”
She continued: “Remote simply monitoring and management adds value to cancer care, and in particular adds value during a pandemic.”
RPM associated with reduced acute healthcare use in cancer patients with COVID-19
Joshua Pritchett (Mayo Clinic in Rochester, Minnesota, USA) reported on acute care resource utilization and clinical outcomes of cancer patients diagnosed with COVID-19 and managed in an outpatient setting via the institute’s COVID-19 RPM service, which included centralized virtual monitoring and nursing support.
The study included 224 individuals with active cancer – that is, either receiving anticancer treatment or in recent remission and undergoing active surveillance – who received a PCR-confirmed diagnosis of SARS-CoV-2 infection between March and July 2020. Just under half (49%) of these patients enrolled in the RPM service at any point during the study.
There were no significant differences between patients who did and did not undergo RPM in terms of age, sex, race, or ethnicity. But RPM patients had more comorbidities, including higher rates of pulmonary disease, hypertension, diabetes, and chronic kidney disease, and more severe COVID-19 at onset, said Pritchett.
In addition, RPM patients were more likely to have active cancer, whereas the non-RPM patients tended to be in remission, he observed.
For the comparative analysis, the researchers excluded the 37 patients who needed hospitalization within 48 hours of diagnosis and focused on the 187 who were initially managed in the outpatient setting (38% with RPM).
A greater proportion of patients in the RPM than non-RPM group had a complete home recovery, at 90% versus 84%, while the converse was true for emergency department visits, at 10% versus 16%, and hospitalization, at 4% versus 13%.
After balancing the groups by inverse propensity weighting, the hospitalization rate in the RPM group was significantly lower than that in the non-RPM group, at 2.8% and 13.0%, respectively, and equated to a 78% reduction in the risk for hospitalization with RPM.
Pritchett also highlighted that when hospitalized, patients managed with RPM had a shorter length of stay (median, 3 vs 6 days), fewer hospitalizations of 7 days or more (n=0 vs 6), fewer admissions to the intensive care unit (n=0 vs 6), and fewer deaths at discharge (n=0 vs 4) than their counterparts who did not undergo RPM.
He concluded that these results “support an expanded role for RPM programs beyond chronic disease management, including acute and subacute care settings such as COVID-19 illness,” adding that “[b]eyond COVID-19, RPM has the potential to transform models of cancer care delivery.”
Patients with cancer and COVID-19 view RPM programs favorably
Bobby Daly and colleagues from Memorial Sloan Kettering Cancer Center in New York, USA, sought to evaluate cancer patients’ experience with the COVID-19 RPM program at their institution.
Daly explained that the program required patients to respond daily to seven questions about symptoms, with an automatic alert to a centralized monitoring team in case of new or worsening symptoms; high-risk patients were given a pulse oximeter. Patients discontinued RPM 14 days after diagnosis and after 3 days without worsening symptoms or fever.
Of the 491 patients who provided at least one daily assessment before exiting the program between May and October 2020, 52% provided a response to the 22-question patient engagement survey developed by the team. The respondents were aged a median of 59 years, the majority (63%) were White, and just over half (53%) were men. The most common malignancies were hematologic (22%), breast (18%), genitourinary (16%), and gastrointestinal (16%) cancer.
The COVID-19 RPM program was generally perceived favorably by respondents, reported Daly. For instance, 91% of the respondents agreed or strongly agreed that the time and effort required to report symptoms was worth it, while 87% felt the program to be an important part of their COVID-19 care. Seventy-three percent of respondents agreed or strongly agreed that the program helped them to cope with the COVID-19 diagnosis, and 59% believed that the program helped to prevent emergency department visits.
Daly also highlighted that 92% of respondents agreed or strongly agreed that they would recommend the program to other patients, while 7% disagreed or strongly disagreed with the statement, which gave a “high” net promoter score of 85%.
A qualitative analysis of responses to an open-ended question about the best and worst features about the RPM program revealed three key themes, namely security, connection, and empowerment. These themes “likely apply in other clinical contexts outside of COVID-19 symptom monitoring and could serve as the foundation for building remote patient monitoring programs for other clinical indications,” said the presenter.
And he concluded: “The lessons learned from the crisis and care delivery caused by the COVID-19 pandemic should serve as fertile ground to grow and harvest the next generation of technology-enabled care delivery.”
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22 June 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.
2021 ASCO Annual Meeting; 4–8 June (Abstract 12000)
2021 ASCO Annual Meeting; 4–8 June (Abstract 1503)
JCO Oncol Pract 2021; doi:10.1200/OP.21.00307
2021 ASCO Annual Meeting; 4–8 June (Abstract 1504)
JCO Oncol Pract 2021; doi:10.1200/OP.21.00269