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Mullangi S, Daly B. Honing in on the Hospital-at-Home Model. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2023; 1:435-437. [PMID: 38125385 PMCID: PMC10732412 DOI: 10.1016/j.mcpdig.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Samyukta Mullangi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bobby Daly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Cracchiolo JR, Arafat W, Atreja A, Bruckner L, Emamekhoo H, Heinrichs T, Raldow AC, Smerage J, Stetson P, Sugalski J, Tevaarwerk AJ. Getting ready for real-world use of electronic patient-reported outcomes (ePROs) for patients with cancer: A National Comprehensive Cancer Network ePRO Workgroup paper. Cancer 2023; 129:2441-2449. [PMID: 37224181 DOI: 10.1002/cncr.34844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Electronic patient‐reported outcome (ePRO) programs may offer advantages for patients with cancer, clinicians, health care systems, payors, and society in general; but developing and maintaining an ePRO program will require cancer centers to navigate defining meaningful problems, collecting ePROs, implementing action when those ePROs require intervention without over‐burdening clinicians, and monitoring the successes and failures of their ePRO programs. Physician informaticists from the National Comprehensive Cancer Network Electronic Health Record Advisory Group offer 10 guiding principles to consider when contemplating, building, or refining an ePRO program for patients with cancer.
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Affiliation(s)
| | - Waddah Arafat
- Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashish Atreja
- University of California-Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Lauren Bruckner
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Hamid Emamekhoo
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Tricia Heinrichs
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
| | - Ann C Raldow
- University of California-Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Jeffrey Smerage
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Peter Stetson
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
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3
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Offodile AC, Delgado D, Lin YL, Geyen D, Miller CJ, Jain S, Finder JP, Shete S, Fossella FV, Overman MJ, Peterson SK. Integration of Remote Symptom and Biometric Monitoring Into the Care of Adult Patients With Cancer Receiving Chemotherapy-A Decentralized Feasibility Pilot Study. JCO Oncol Pract 2023; 19:e811-e821. [PMID: 36821818 PMCID: PMC10332844 DOI: 10.1200/op.22.00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/05/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE Although electronic patient-reported outcomes (ePROs) are efficacious in symptom management, much is unknown about the utility of vital signs surveillance. We examined the feasibility of a remote patient monitoring platform that integrates ePROs and biometrics into the ambulatory management of symptom burden. METHODS Using a decentralized workflow, patients with gastrointestinal or thoracic cancer were approached for a 1-month study. Patients reported symptom burden via ePROs and biometrics (blood pressure, oxygen saturation, pulse, weight, and temperature) using bluetooth-enabled devices daily. Alerts on the basis of prespecified thresholds were managed via nurse-led triage. Adherence was defined as the completion of > 70% of daily symptom and biometric reporting requirements. Pilot acceptability, appropriateness, and feasibility were measured using validated instruments. Net promoter score, system usability scale, and emergency department (ED) admission rates were collected. RESULTS Over 8 months, 36 patients were enrolled and 25 (60% gastrointestinal) completed the study. Participants had a mean age of 58.0 years, mean Eastern Cooperative Oncology Group score of 0.88, were 52% female, and predominantly had stage IV or recurrent disease (72%). Program adherence was 73% and associated with high acceptability (4.63), feasibility (4.56), and appropriateness (4.46). System usability scale and net promoter score scores were 88 and 55, respectively. Seventy percent of alerts were generated by biometrics, 28% for symptoms, and 2% were patient-initiated communication. Finally, the ED visitation rate over the pilot period was 8%. CONCLUSION Our remote patient monitoring pilot program was highly acceptable, feasible, and appropriate. It had high rates of patient adherence and satisfaction and was associated with low ED visitation rates.
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Affiliation(s)
- Anaeze C. Offodile
- Institute for Cancer Care Innovation, University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Domenica Delgado
- Office of the Chief Data and Technology Officer, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu-Li Lin
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Danielle Geyen
- Institute for Cancer Care Innovation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher J. Miller
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanchita Jain
- Office of the Chief Data and Technology Officer, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Janice P. Finder
- Patient Experience Clinical Programs, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanjay Shete
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frank V. Fossella
- Department of Thoracic Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael J. Overman
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan K. Peterson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
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4
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Feng G, Parthipan M, Breunis H, Puts M, Emmenegger U, Timilshina N, Hansen AR, Finelli A, Krzyzanowska MK, Matthew A, Clarke H, Mina DS, Soto-Perez-de-Celis E, Tomlinson G, Alibhai SMH. Feasibility and acceptability of remote symptom monitoring (RSM) in older adults during treatment for metastatic prostate cancer. J Geriatr Oncol 2023; 14:101469. [PMID: 36917921 DOI: 10.1016/j.jgo.2023.101469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Emerging data support multiple benefits of remote symptom monitoring (RSM) during chemotherapy to improve outcomes. However, these studies have not focused on older adults and do not include treatments beyond chemotherapy. Although chemotherapy, androgen receptor axis-targeted therapies (ARATs), and radium-223 prolong survival, toxicities are substantial and increased in older adults with metastatic prostate cancer (mPC). We aimed to assess RSM feasibility among older adults receiving life-prolonging mPC treatments. MATERIALS AND METHODS Older adults aged 65+ starting chemotherapy, an ARAT, or radium-223 for mPC were enrolled in a multicentre prospective cohort study. As part of the RSM package, participants completed the Edmonton Symptom Assessment Scale (ESAS) daily and detailed questionnaires assessing mood, anxiety, fatigue, insomnia, and pain weekly online or by phone throughout one treatment cycle (3-4 weeks). Alerts were sent to the clinical oncology team for severe symptoms (ESAS ≥7). Participants also completed an end of study questionnaire that assessed study burden and satisfaction. Descriptive statistics were used to determine recruitment and retention rates, participant response rates to daily and weekly questionnaires, clinician responses to alerts, and participant satisfaction rates. An inductive descriptive approach was used to categorize open-ended responses about study benefits, challenges, and recommendations into relevant themes. RESULTS Ninety males were included (mean age 77 years, 48% ARAT, 38% chemotherapy, and 14% radium-223). Approximately 38% of patients preferred phone-based RSM. Patients provided RSM responses in 1216 out of 1311 daily questionnaires (93%). Over 93% of participants were satisfied (36%), very satisfied (43%), or extremely satisfied (16%) with RSM, although daily reporting was reported by several (8%) as burdensome. Nearly 45% of patients reported severe symptoms during RSM. Most symptom alerts sent to the oncology care team were acknowledged (97%) and 53% led to follow-ups with a nurse or physician for additional care. DISCUSSION RSM is feasible and acceptable to older adults with mPC, but accommodation needs to be made for phone-based RSM. The optimal frequency and duration of RSM also needs to be established.
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Affiliation(s)
- Gregory Feng
- Department of Medicine, University Health Network, Toronto, Canada.
| | | | | | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Toronto, Canada.
| | | | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Antonio Finelli
- Division of Urology, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Andrew Matthew
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Hance Clarke
- Department of Anesthesia, Toronto General Hospital, Toronto, Canada.
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Canada.
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.
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5
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Emery LP, Muralikrishnan S, Schrag D, Tosteson AN, Brooks GA. Comparison of Oncologist and Model Estimates of Risk for Hospitalization During Systemic Therapy for Advanced Cancer. JCO Oncol Pract 2023; 19:e336-e344. [PMID: 36475736 PMCID: PMC10022874 DOI: 10.1200/op.22.00422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/07/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE A validated risk model with inputs of pretreatment sodium and albumin can identify patients at risk for hospitalization during cancer treatment. We evaluated how the model compares with risk estimates from treating oncologists. METHODS We evaluated the 30-day risk of hospitalization or death in patients starting palliative-intent systemic therapy for solid tumor malignancy. For each patient, we prospectively recorded categorical estimates of 30-day hospitalization risk (bottom third, middle third, top third) generated by a treating oncologist and by the two-variable model; a third hybrid risk estimate represented a composite of the oncologist and model risk assessments. We analyzed the agreement of oncologist and model-based risk estimates and compared discrimination, sensitivity, and specificity of each risk assessment method. RESULTS We collected oncologist, model, and hybrid estimates of hospitalization risk for 120 patients. The 30-day rate of hospitalization or death was 20%. There was minimal agreement between oncologist and model risk estimates (weighted kappa = 0.27). The c-statistic (a measure of discrimination) was 0.69 (95% CI, 0.57 to 0.81) for the clinician assessment, 0.77 for the model assessment (CI, 0.67 to 0.86; P = .24 compared with the oncologist assessment), and 0.79 for the hybrid assessment (CI, 0.69 to 0.90; P = .007 compared with the oncologist assessment). Sensitivity and specificity of the high-risk categorization did not differ significantly between the oncologist and model assessments; the hybrid assessment was significantly more sensitive (P = .02) and less specific (P = .03) than the oncologist assessment. CONCLUSION A model with inputs of pretreatment sodium and albumin improves oncologists' predictions of hospitalization risk during cancer treatment.
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Affiliation(s)
| | | | - Deb Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna N.A. Tosteson
- Dartmouth Cancer Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH
| | - Gabriel A. Brooks
- Dartmouth Cancer Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH
- Dartmouth Hitchcock Medical Center, Lebanon, NH
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6
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Daly B, Nicholas KJ, Flynn J, Panageas KS, Silva N, Duck E, Zervoudakis A, Holland J, Salvaggio R, Begue A, Wagner I, Sokolowski S, Zablocki M, Chiu YO, Kuperman GJ, Simon BA, Perchick W, Reidy‐Lagunes DL. Association Between Remote Monitoring and Acute Care Visits in High-Risk Patients Initiating Intravenous Antineoplastic Therapy. JCO Oncol Pract 2022; 18:e1935-e1942. [PMID: 36265089 PMCID: PMC9750548 DOI: 10.1200/op.22.00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/26/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Traditional oncology care models have not effectively identified and managed at-risk patients to prevent acute care. A next step is to harness advances in technology to enable patients to report symptoms any time, enabling digital hovering-intensive symptom monitoring and management. Our objective was to evaluate a digital platform that identifies and remotely monitors high-risk patients initiating antineoplastic therapy with the goal of preventing acute care visits. METHODS This was a single-institution matched cohort quality improvement study conducted at a National Cancer Institute-designated cancer center between January 1, 2019, and March 31, 2020. Eligible patients were those initiating intravenous antineoplastic therapy who were identified as high risk for seeking acute care. Enrolled patients' symptoms were monitored using a digital platform. A dedicated team of clinicians managed reported symptoms. The primary outcomes of emergency department visits and hospitalizations within 6 months of treatment initiation were analyzed using cumulative incidence analyses with a competing risk of death. RESULTS Eighty-one patients from the intervention arm were matched by stage and disease with contemporaneous high-risk control patients. The matched cohort had similar baseline characteristics. The cumulative incidence of an emergency department visit for the intervention cohort was 0.27 (95% CI, 0.17 to 0.37) at six months compared with 0.47 (95% CI, 0.36 to 0.58) in the control (P = .01) and of an inpatient admission was 0.23 (95% CI, 0.14 to 0.33) in the intervention cohort versus 0.41 (95% CI, 0.30 to 0.51) in the control (P = .02). CONCLUSION The narrow employment of technology solutions to complex care delivery challenges in oncology can improve outcomes and innovate care. This program was a first step in using a digital platform and a remote team to improve symptom care for high-risk patients.
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Affiliation(s)
- Bobby Daly
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Elaine Duck
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Aaron Begue
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Isaac Wagner
- Memorial Sloan Kettering Cancer Center, New York, NY
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Li BT, Daly B, Gospodarowicz M, Bertagnolli MM, Brawley OW, Chabner BA, Fashoyin-Aje L, de Claro RA, Franklin E, Mills J, Legos J, Kaucic K, Li M, The L, Hou T, Wu TH, Albrecht B, Shao Y, Finnegan J, Qian J, Shahidi J, Gasal E, Tendler C, Kim G, Yan J, Morrow PK, Fuchs CS, Zhang L, LaCaze R, Oelrich S, Murphy MJ, Pazdur R, Rudd K, Wu YL. Reimagining patient-centric cancer clinical trials: a multi-stakeholder international coalition. Nat Med 2022; 28:620-626. [PMID: 35440725 DOI: 10.1038/s41591-022-01775-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Bob T Li
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, NY, USA.
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Center, , University of Toronto, Toronto, Ontario, Canada
| | | | - Otis W Brawley
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce A Chabner
- Massachusetts General Hospital Cancer Center, Boston, MA, USA.,Society for Translational Oncology, Durham, NC, USA
| | - Lola Fashoyin-Aje
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - R Angelo de Claro
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | - Mark Li
- Resolution Bioscience, Agilent Technologies, Kirkland, WA, USA
| | - Lydia The
- McKinsey Cancer Center, McKinsey & Company
| | - Tina Hou
- McKinsey Cancer Center, McKinsey & Company
| | | | | | - Yi Shao
- McKinsey Cancer Center, McKinsey & Company
| | | | - Jing Qian
- Asia Society Policy Institute, Asia Society, New York, NY, USA
| | | | | | - Craig Tendler
- Janssen, Johnson and Johnson, New Brunswick, NJ, USA
| | | | | | | | - Charles S Fuchs
- Genentech, South San Francisco, CA, USA.,Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | | | | | | | - Martin J Murphy
- Society for Translational Oncology, Durham, NC, USA.,Shanghai TuoXin Health Promotion Center, Shanghai, China.,CEO Roundtable on Cancer, Morrisville, NC, USA
| | - Richard Pazdur
- Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - Kevin Rudd
- Asia Society Policy Institute, Asia Society, New York, NY, USA
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Chinese Thoracic Oncology Group, Guangzhou, China
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8
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Offodile AC, DiBrito SR, Finder JP, Shete S, Jain S, Delgado DA, Miller CJ, Davidson E, Overman MJ, Peterson SK. Active surveillance of chemotherapy-related symptom burden in ambulatory cancer patients via the implementation of electronic patient-reported outcomes and sensor-enabled vital signs capture: protocol for a decentralised feasibility pilot study. BMJ Open 2022; 12:e057693. [PMID: 35383081 PMCID: PMC8984061 DOI: 10.1136/bmjopen-2021-057693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Remote patient monitoring (RPM) has emerged as a potential avenue for optimising the management of symptoms in patients undergoing chemotherapy. However, RPM is a complex, multilevel intervention with technology, workflow, contextual and patient experience components. The purpose of this pilot study is to determine the feasibility of RPM protocol implementation with respect to decentralised recruitment, patient retention, adherence to reporting recommendations, RPM platform usability and patient experience in ambulatory cancer patients at high risk for chemotherapy-related symptoms. METHODS AND ANALYSIS This protocol describes a single-arm decentralised feasibility pilot study of technology-enhanced outpatient symptom management system in patients with gastrointestinal and thoracic cancer receiving chemotherapy and cancer care at a single site (MD Anderson Cancer Center, Houston Texas). An anticipated total of 25 patients will be recruited prior to the initiation of chemotherapy and provided with a set of validated questionnaires at enrollment and after our 1-month feasibility pilot trial period. Our intervention entails the self-reporting of symptoms and vital signs via a HIPAA-compliant, secure tablet interface that also enables (1) the provision of self-care materials to patients, (2) generation of threshold alerts to a dedicated call-centre and (3) videoconferencing. Vital sign information (heart rate, blood pressure, pulse, oxygen saturation, weight and temperature) will be captured via Bluetooth-enabled biometric monitoring devices which are integrated with the tablet interface. Protocolised triage and management of symptoms will occur in response to the alerts. Feasibility and acceptability metrics will characterise our recruitment process, protocol adherence, patient retention and usability of the RPM platform. We will also document the perceived effectiveness of our intervention by patients. ETHICS AND DISSEMINATION This study has been granted approval by the institutional review board of MD Anderson Cancer Center. We anticipate dissemination of our pilot and subsequent effectiveness trial results via presentations at national conferences and peer-reviewed publications in the relevant medical journals. Our results will also be made available to cancer survivors, their caregivers and hospital administration. TRIAL REGISTRATION NUMBER NCI202107464.
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Affiliation(s)
- Anaeze C Offodile
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sandra R DiBrito
- Division of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janice P Finder
- Patient Experience Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanchita Jain
- Office of the Chief, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Domenica A Delgado
- Office of the Chief, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher J Miller
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elenita Davidson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Daly B, Nicholas K, Flynn J, Silva N, Panageas K, Mao JJ, Gazit L, Gorenshteyn D, Sokolowski S, Newman T, Perry C, Wagner I, Zervoudakis A, Salvaggio R, Holland J, Chiu YO, Kuperman GJ, Simon BA, Reidy-Lagunes DL, Perchick W. Analysis of a Remote Monitoring Program for Symptoms Among Adults With Cancer Receiving Antineoplastic Therapy. JAMA Netw Open 2022; 5:e221078. [PMID: 35244701 PMCID: PMC8897754 DOI: 10.1001/jamanetworkopen.2022.1078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Electronic patient-reported outcomes (ePROs) may have the potential to improve cancer care delivery by enhancing patient quality of life, reducing acute care visits, and extending overall survival. However, the optimal cadence of ePRO assessments is unknown. OBJECTIVE To determine patient response preferences and the clinical value associated with a daily cadence for ePROs for patients receiving antineoplastic treatment. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study of adult patients undergoing antineoplastic treatment assessed a remote monitoring program using ePROs that was developed to manage cancer therapy-related symptoms. ePRO data submitted between October 16, 2018 to February 29, 2020, from a single regional site within the Memorial Sloan Kettering Cancer Center network were included. Data were analyzed from April 2020 to January 2022. EXPOSURE While undergoing active treatment, patients received a daily ePRO assessment that, based on patient responses, generated yellow (moderate) or red (severe) symptom alerts that were sent to clinicians. MAIN OUTCOMES AND MEASURES The main outcomes assessed included patient response rate, symptom alert frequency, and an analysis of the clinical value of daily ePROs. RESULTS A total of 217 patients (median [range] age, 66 [31-92] years; 103 [47.5%] women and 114 [52.5%] men) initiating antineoplastic therapy at high risk for symptoms were monitored for a median (range) of 91 (2-369) days. Most patients had thoracic (59 patients [27.2%]), head and neck (48 patients [22.1%]), or gastrointestinal (43 patients [19.8%]) malignant neoplasms. Of 14 603 unique symptom assessments completed, 7349 (50.3%) generated red or yellow symptom alerts. Symptoms commonly generating alerts included pain (665 assessments [23.0%]) and functional status (465 assessments [16.1%]). Most assessments (8438 assessments [57.8%]) were completed at home during regular clinic hours (ie, 9 am-5 pm), with higher response rates on weekdays (58.4%; 95% CI, 57.5%-59.5%) than on weekend days (51.3%; 95% CI, 49.5%-53.1%). Importantly, 284 of 630 unique red alerts (45.1%) surfaced without a prior yellow alert for the same symptom within the prior 7 days; symptom severity fluctuated over the course of a week, and symptom assessments generating a red alert were followed by an acute care visit within 7 days 8.7% of the time compared with 2.9% for assessments without a red alert. CONCLUSIONS AND RELEVANCE These findings suggest that daily ePRO assessments were associated with increased insight into symptom management in patients undergoing antineoplastic treatment and symptom alerts were associated with risk of acute care.
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Affiliation(s)
- Bobby Daly
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin Nicholas
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicholas Silva
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lior Gazit
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Claire Perry
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Isaac Wagner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Rori Salvaggio
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessie Holland
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yeneat O. Chiu
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brett A. Simon
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Wendy Perchick
- Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Osterman CK, Sanoff HK, Wood WA, Fasold M, Lafata JE. Predictive Modeling for Adverse Events and Risk Stratification Programs for People Receiving Cancer Treatment. JCO Oncol Pract 2022; 18:127-136. [PMID: 34469180 PMCID: PMC9213197 DOI: 10.1200/op.21.00198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Emergency department visits and hospitalizations are common among people receiving cancer treatment, accounting for a large proportion of spending in oncology care and negatively affecting quality of life. As oncology care shifts toward value- and quality-based payment models, there is a need to develop interventions that can prevent these costly and low-value events among people receiving cancer treatment. Risk stratification programs have the potential to address this need and optimally would consist of three components: (1) a risk stratification algorithm that accurately identifies patients with modifiable risk(s), (2) intervention(s) that successfully reduce this risk, and (3) the ability to implement the risk algorithm and intervention(s) in an adaptable and sustainable way. Predictive modeling is a common method of risk stratification, and although a number of predictive models have been developed for use in oncology care, they have rarely been tested alongside corresponding interventions or developed with implementation in clinical practice as an explicit consideration. In this article, we review the available published predictive models for treatment-related toxicity or acute care events among people receiving cancer treatment and highlight challenges faced when attempting to use these models in practice. To move the field of risk-stratified oncology care forward, we argue that it is critical to evaluate predictive models alongside targeted interventions that address modifiable risks and to demonstrate that these two key components can be implemented within clinical practice to avoid unplanned acute care events among people receiving cancer treatment.
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Affiliation(s)
- Chelsea K. Osterman
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Hanna K. Sanoff
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - William A. Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC,Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Megan Fasold
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC,Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC,Jennifer Elston Lafata, PhD, University of North Carolina, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC 27599; e-mail:
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11
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Collomb B, Dubromel A, Caffin AG, Herledan C, Larbre V, Baudouin A, Cerutti A, Couturier L, Maire M, Karlin L, Maucort-Boulch D, Huot L, Dalle S, Bachy E, Ghesquieres H, Salles G, Couraud S, You B, Freyer G, Trillet-Lenoir V, Ranchon F, Rioufol C. Assessment of Patient Reported Outcomes (PROs) in Outpatients Taking Oral Anticancer Drugs Included in the Real-Life Oncoral Program. Cancers (Basel) 2022; 14:cancers14030660. [PMID: 35158928 PMCID: PMC8833408 DOI: 10.3390/cancers14030660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Patients receiving oral anticancer agents (OAAs) have a substantial symptom burden. Given the trend toward patient-centered care, the use of patient-reported outcomes (PROs) seems appropriate to secure medication management, and to improve clinical decision-making. The aim of this study was to assess symptoms potentially related to adverse events experienced by cancer outpatients treated by OAAs using PROs. In total, 407 questionnaires were completed by 63 patients, in which 2333 symptoms were reported. Almost three-quarters (74.6%) reported at least one high-level symptom. The symptoms most commonly experienced were fatigue, various psychological disorders and general pain. This initiative is the first step in the implementation of symptom assessment by PROs in patients treated by OAAs. The results highlight the need for close coordination between community and hospital health professionals, and the integration of patient self-reporting systems in oncologic clinical practice. Abstract Background In previous studies, patient-reported outcomes (PROs) have been shown to improve survival in cancer patients. The aim of the present study was to assess symptoms potentially related to adverse events experienced by cancer outpatients treated by oral anticancer agents (OAAs) using PROs. Methods Between September 2018 and May 2019, outpatients starting OAAs were included in a 12-week follow-up to assess 15 symptoms listed in the National Cancer Institute PRO Common Terminology Criteria for Adverse Events, using a 5-point scale of severity or frequency. Patients were requested to alert a referral nurse or pharmacist when they self-assessed high-level (level 3 or 4) symptoms. Results 407 questionnaires were completed by 63 patients in which 2333 symptoms were reported. Almost three-quarters (74.6%) reported at least one high-level symptom. The symptoms that were most commonly experienced were fatigue (>9 in 10 patients; 13.2% of symptoms declared), various psychological disorders (>9 in 10 patients; 28.6% of symptoms declared) and general pain (>8 in 10 patients; 9.4% of symptoms declared). Conclusion PROs are appropriate to detect potential adverse events in cancer outpatients treated by OAAs. This study is the first step for integrating the patient’s perspective in a digital e-health device in routine oncology care.
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Affiliation(s)
- Bastien Collomb
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Amélie Dubromel
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Anne Gaëlle Caffin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Ariane Cerutti
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Laurence Couturier
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Magali Maire
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Lionel Karlin
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Delphine Maucort-Boulch
- Department of Statistics and Bioinformatics, Hospices Civils de Lyon, 69002 Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, 69622 Lyon, France
| | - Laure Huot
- Cellule Innovation, Département de la Recherche Clinique et de L'innovation, Hospices Civils de Lyon, 69002 Lyon, France
| | - Stéphane Dalle
- Dermatology Department, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Emmanuel Bachy
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Hervé Ghesquieres
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Gilles Salles
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Sébastien Couraud
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Pneumology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Benoit You
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Gilles Freyer
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Véronique Trillet-Lenoir
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
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12
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Lapen K, Sabol C, Tin AL, Lynch K, Kassa A, Mabli X, Ford J, Cha E, Bernstein MB, Braunstein LZ, Cahlon O, Daly BM, Sandler K, McCloskey SA, Vickers AJ, Khan AJ, Gillespie EF. Development and Pilot Implementation of a Remote Monitoring System for Acute Toxicity Using Electronic Patient-Reported Outcomes for Patients Undergoing Radiation Therapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2021; 111:979-991. [PMID: 34314814 DOI: 10.1016/j.ijrobp.2021.07.1692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to develop and study the implementation of a remote system for toxicity assessment and management of acute side effects of breast radiation using electronic patient-reported outcomes (ePROs). METHODS AND MATERIALS A response-adapted Patient-Reported Outcomes Common Terminology Criteria for Adverse Events-based assessment for breast radiation toxicity was administered weekly during and for 8 weeks after radiation from June 2019 to July 2020. The care team received alerts when "severe" symptoms were reported by patients, who were then contacted. Treatment, clinic, and sociodemographic characteristics were abstracted from patient records. A subsample of patients and care team members was qualitatively interviewed at follow-up. RESULTS Overall, 5787 assessments were sent to 678 patients, of whom 489 (72%) completed 2607 assessments (45%). Moderate or greater toxicity was reported by 419 responders (86%; 95% CI, 82%-89%). Clinician alerts for severe toxicity were generated for 264 assessments among 139 unique patients, of which 83% occurred posttreatment. The proportion of surveys that prompted an alert was significantly higher after treatment (219 [13%]) than during treatment (45 [5%]) (P < .001). Survey completion rates in the posttreatment period were higher among patients undergoing partial breast irradiation than postmastectomy radiation (incidence rate ratio, 0.70; 95% CI, 0.60-0.81) (P < .001) despite these patients experiencing less severe toxicity. Interviews (15) found that patients had a positive experience with ePROs, although many thought the primary purpose was for research rather than symptom management. CONCLUSIONS With the majority of toxicity occurring after breast radiation has ended, remote symptom monitoring with ePROs appears to fill a gap in clinical practice, particularly for patients undergoing shorter courses of radiation. It is important to properly onboard patients and explain that the purpose of ePROs is to aid clinical care. Further research is needed to determine whether the costs associated with ePROs can be offset by reducing routine clinic visits and whether this approach is acceptable and appropriate.
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Affiliation(s)
- Kaitlyn Lapen
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher Sabol
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy L Tin
- Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathleen Lynch
- Departments of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alyse Kassa
- Departments of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xiaolin Mabli
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John Ford
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elaine Cha
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael B Bernstein
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lior Z Braunstein
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oren Cahlon
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bobby M Daly
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kiri Sandler
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Susan A McCloskey
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Andrew J Vickers
- Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Atif J Khan
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York.
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13
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Daly B, Lauria TS, Holland JC, Garcia J, Majeed J, Walters CB, Zablocki M, Chow K, Strachna O, Giles CE, Kelly MF, Housen A, Canavan M, Maresca NM, Baser R, Salvaggio R, Robson ME, Reidy-Lagunes DL. Oncology Patients' Perspectives on Remote Patient Monitoring for COVID-19. JCO Oncol Pract 2021; 17:e1278-e1285. [PMID: 34085536 DOI: 10.1200/op.21.00269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Oncology patients are vulnerable to adverse outcomes associated with COVID-19, and clinical deterioration must be identified early. Several institutions launched remote patient monitoring programs (RPMPs) to care for patients with COVID-19. We describe patients' perspectives on a COVID-19 RPMP at a National Comprehensive Cancer Center. METHODS Patients who tested positive for COVID-19 were eligible. Enrolled patients received a daily electronic COVID-19 symptom assessment, and a subset of high-risk patients also received a pulse oximeter. Monitoring was provided by a centralized team and was discontinued 14 days after a patient's positive test result and following 3 days without worsening symptoms. Patients who completed at least one assessment and exited the program were sent a patient engagement survey to evaluate the patient's experience with digital monitoring for COVID-19. RESULTS The survey was distributed to 491 patients, and 257 responded (52% completion rate). The net promoter score was 85%. Most patients agreed that the RPMP was worthwhile, enabled better management of their COVID-19 symptoms, made them feel more connected to their healthcare team, and helped prevent emergency room visits. Identified themes regarding patient-perceived value of a RPMP included (1) security: a clinical safety net; (2) connection: a link to their clinical team during a period of isolation; and (3) empowerment: an education on the virus and symptom management. CONCLUSION RPMPs are perceived to be of value to oncology patients with COVID-19. Policymakers should consider how these programs can be reimbursed to keep vulnerable patients at home and out of the acute care setting.
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Affiliation(s)
- Bobby Daly
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tara S Lauria
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Jibran Majeed
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Kimberly Chow
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Olga Strachna
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ashley Housen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ray Baser
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
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