|The following article features coverage from the American Society of Clinical Oncology 2020 virtual meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
Implementation of a chemotherapy remote care monitoring program (CRCMP) allowed for rapid assessment of patient-reported outcomes (PROs) and reduced use of healthcare visits for chemotherapy-related nausea. These findings were presented during the ASCO20 Virtual Scientific Program.
Chemotherapy-induced nausea and vomiting (CINV) is a common and dreaded side effect of cancer therapy. It is also a frequent reason for emergency department (ED) and other unplanned healthcare visits. A team at the University of Michigan Rogel Cancer Center in Ann Arbor, sought to proactively identify patients experiencing CINV and provide early intervention.
The researchers initiated a CRCMP that integrates the patient’s responses to a survey conducted via text messages into a flowsheet in their electronic health record (EHR). The survey is based on the validated Multinational Association of Supportive Care in Cancer (MASCC) antiemesis tool (MAT).
Once enrolled in the CRCMP, patients receiving highly emetogenic chemotherapy, identified as those who received a NK1 antagonist for CINV prophylaxis, receive a daily text message survey for 7 days after treatment. Responses higher than a set threshold triggered a message to the team pharmacist for intervention.
Six hundred and fifty-two patients received a NK1 antagonist in 2244 total cycles administered over 8 months. Of those, 387 patients (59%) enrolled in the CRCMP. Each patient enrolled for an average of 1.8 cycles of chemotherapy (range 1 to 8). Of the patients enrolled, 61.4% were female and 86.2% were white. Treatment regimens included cisplatin-based (29.7%), carboplatin-based (22.5%), and 5-fluorouracil-based (20.9%) therapy. Intent of treatment was curative for 51.7% of patients and palliative for 48.3% of patients.
A total of 19,256 text messages were sent. Of the 18,143 responses received, 7% noted vomiting and 33% noted nausea during 861 cycles of therapy.
Since implementation of CRCMP for CINV, total visits (118), admissions (ED/inpatient/observation; 80), and urgent care use (38) has decreased compared with historical data (234, 124, 110, respectively; P =.029). When healthcare use for nausea-related diagnoses was considered, the reductions were more notable (total visits 45 vs 14, admissions 22 vs 7, and urgent care 110 vs 38, respectively, before and after CRCMP).
“While these changes were numerically small, reduction in unnecessary care utilizing PROs can contribute to high value care for cancer patients,” the authors concluded.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Hough S, McDevitt R, Nachar V, et al. Chemotherapy remote care monitoring program (CRCMP): integration of an SMS text patient-reported outcome (PRO) in the electronic health record (EHR) to identify patients needing pharmacist intervention for chemotherapy-induced nausea and vomiting (CINV). Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 2001.