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Remote Monitoring, Management of Cancer Symptoms During Pandemic Significantly Lowered Symptom Burden

December 30, 2021

The increased use of telemedicine during the COVID-19 pandemic had several effects on cancer care, and only now are long-term data highlighting those effects in greater detail starting to emerge. According to a study presented at the 2021 American Society of Clinical Oncology Annual Meeting, remote monitoring and treatment of cancer and treatment-related symptoms during the global health crisis was associated with significant reductions in symptom burden and improvements in quality of life (QoL), at least during the first two months of remote monitoring.

In the randomized study, which was presented by Kathi Mooney, PhD, RN, of the Huntsman Cancer Institute at the University of Utah, a research team funded by the National Institutes of Health examined the effects of remote symptom monitoring and management on symptom burden, QoL, and unplanned healthcare use in 252 patients with cancer receiving chemotherapy and/or radiation therapy. Remote monitoring to avoid viral exposure is particularly important for patients with cancer, Dr. Mooney noted.

Participants were enrolled between April 21 and December 31, 2020, and were randomly assigned to receive remote monitoring and management (n=128) or usual care (UC; n=124). Patients in the remote Symptom Care at Home (SCH) intervention group used the monitoring system to report daily the presence and severity of nine frequent symptoms during treatment. The SCH group received algorithm-based self-care coaching determined by the specific symptoms and severity levels reported.

Symptoms reported as moderate or severe were automatically delegated to the oncology nurse practitioners. These clinicians called the patients from the SCH group in an effort to improve symptom management using the system's decision support dashboard.

Both groups completed baseline and monthly questionnaires for five months. Assessments included symptom burden (MD Anderson Symptom Inventory), mental health well-being and social isolation (PROMIS; HADS), and health-related QoL (HRQoL; Penedo COVID-19 HRQoL subscale). In addition, the investigators assessed unplanned healthcare use per data from the electronic health record.

There were no significant differences between the two groups in terms of demographic or baseline variables. The mean age of the population was 61 years, and most patients were female (61%) and white (93%). Overall, the most common cancers were colon, breast, and ovarian. Approximately 60% of patients had stage 3 or 4 disease.

At months 1 and 2, patients in the SCH groups had significantly lower symptom burden (p=0.018) and better HRQoL (p=0.007) compared with those who received UC. These improvements tended to subside during the remaining study period. The most commonly reported moderate or severe symptoms were fatigue (57.3%), nervousness/anxious (51.3%), and pain (44.4%).

Seventy-one unplanned healthcare use episodes were reported over the study period, including 28 in the SCH group and 43 in the UC group. A greater proportion of patients in the SCH group had no unplanned health care episodes (p=0.04).

The types of unplanned healthcare use included unplanned clinic visit (3 for SCH vs. 2 for UC), visit to the emergency department (10 SCH vs. 16 UC), and unplanned hospitalizations (15 SCH vs. 25 UC).

During the study, no differences were observed between the groups regarding mental health well-being and social isolation, Dr. Mooney added. For HRQoL, the researchers observed early improvements in the SCH intervention group, but these effects eventually subsided.

Dr. Mooney expects telemedicine to continue to play a larger role in patient care after the COVID-19 pandemic subsides, but noted that it will need to be supported in the payment model to fully take hold.

The authors report no relevant conflicts of interest.

Reference

Mooney K, Iacob E, Wilson CM, et al. Randomized trial of remote cancer symptom monitoring during COVID-19: Impact on symptoms, QoL, and unplanned health care utilization. Abstract #12000. Presented at the 2021 American Society of Clinical Oncology Annual Meeting, June 4-8, 2021.

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