Cancer is a leading cause of morbidity and mortality in the United States with 1,806,590 new cancer diagnoses and 606,520 cancer deaths annually. Cancer care significantly impacts the healthcare industry due to high rates of emergency department utilization and unplanned hospital admission which account for 48% of total expenditures for the care of a cancer patient. Cancer treatment costs are more than four times higher than treatment for other common health conditions, and by 2030, it’s estimated that the cost of cancer care in the United States will exceed $245 billion.
To reduce the total cost of care, improve patient satisfaction, and manage symptom exacerbations, health systems are getting more and more innovative with how they manage cancer patients. Many are using remote patient monitoring and telehealth to bring care management into the patient's home.
Among patients with cancer, patient-reported outcomes (PROs) have been proven effective in early identification and addressing of cancer symptoms, resulting in reduced hospitalizations, decreased follow-up costs, and improved overall survival rates.
Memorial Sloan Kettering Leverages Telehealth for Cancer Care
In a landmark study out of Memorial Sloan Kettering, 766 patients with advanced solid tumors undergoing chemotherapy were randomized to either an online symptom reporting platform (PROs) or standard care. The patients in the PRO group received weekly email requests to report on 12 common symptoms through a web-based portal with any severe change prompting an email alert to an oncology nurse.
Over the course of the study, PROs were associated with an improvement in quality-of-life scores, fewer visits to the emergency department, longer durations of chemotherapy treatment, and median overall survival was 20% longer. This was due, in large part, to early interventions including remote symptom management, prescribing supportive medications, active chemotherapy dose modifications, and specialty referrals.
Incorporating RPM into Cancer Care
Due to improvements in technology, common symptoms such as pain, fatigue, loss of appetite, dehydration, nausea, vomiting, constipation, diarrhea, anxiety and depression (among others) can now be easily captured through RPM. Through a managed tablet, Bluetooth integrated peripheral devices, and custom survey capabilities, symptoms can be monitored in real-time.
Additionally, educational material can be effectively delivered to the patient informing them of their clinical condition and care plan helping to reduce anxiety and improve self-management. RPM can be a safety net to catch the patient that is struggling at home but doesn’t want to bother their care team or schedule an in-person appointment.
In today’s age of COVID-19, immunosuppression caused by chemotherapy treatment leaves cancer patients more vulnerable. Home monitoring can limit visits to outpatient cancer centers for clinical evaluations and unnecessary visits to an overcrowded emergency department.
3 essential components to consider when implementing an RPM program for cancer care:
- Patient selection: This should include criteria such as the nature of malignancy and treatment plan, medications, social determinants of health (SDoH), and prior ED visits and hospitalizations. Lung cancer and lymphoma patients may be a good starting point as they frequently readmit.
- Staffing model: Create a sustainable and scalable structure to provide the necessary monitoring services for your patients understanding that 77% of the symptoms flagged in the Memorial Sloan Kettering study required clinical interventions. This could consist of a dedicated, centralized team of oncology registered nurses and nurse practitioners.
- Technology: Choose a platform that includes the necessary hardware, software, and data connectivity to service patients that struggle with technology or live-in remote locations. Functionality such as language translation, text-to-speech, and reminders that make it simple enough to be universally used by all your patients.
Through RPM, cancer patients can monitor their symptoms, record their vitals, and communicate with their clinician(s) in real time. More proactive, connected cancer care will ultimately benefit patients, providers, and society at large as quality of patient experience improves and cost of care falls.