ASCO Perspective Quote

“Both patients and physicians experience considerable time demands of cancer care, often referred to as time toxicity. Patients feel it in the waiting rooms and physicians feel it as they try and make room to attend to patients who need them. Interventions, like this one, are one way so that patients can reduce the time burdens of cancer care, such as unnecessary office visits, thus allowing physicians to see someone who may be more in need. Something like this could be a win-win for patients and clinics,” said Toby Campbell, MD, MS, ASCO Expert.

Study at-a-Glance

ALEXANDRIA, Va. — A new study showed that a text-based e-triage program in combination with routine laboratory testing could safely “fast track” patients to treatment with immune checkpoint inhibitors, eliminating the need for an in-person assessment with their doctor, and save patients 66 minutes in total care time and 30 minutes in total wait time per visit to the healthcare center. The research will be presented at the 2023 American Society of Clinical Oncology (ASCO) Quality Care Symposium, taking place October 27-28 in Boston. 

About the Study

“The current standard of care for patients treated with immunotherapy is screening with laboratory testing and a visit with their clinician prior to each treatment dose. This can result in excessively long days in the clinic with wait times in between each step. Our hypothesis was that some patients could safely proceed to their infusion without having to wait to see their clinician, giving them the option for a shorter day,” said lead study author Dr. Erin Mary Bange.

The researchers conducted a randomized controlled trial to assess whether a text message-based questionnaire combined with laboratory testing (e-triage) could identify patients who could safely bypass their clinician visit and proceed directly to immunotherapy treatment. To participate in the study, patients had to speak English, have access to a mobile device with text messaging, and be receiving treatment for a solid tumor with a single agent immune checkpoint inhibitor. Patients in the study were a median age of 67.5 years; 84.6% were White, 7.7% were Black, 5.1% were Asian, and 2.6% identified as other; and lived within 33 miles of the cancer center.  

The e-triage arm of the study assessed patients for symptoms of immune checkpoint inhibitor toxicity via two-way text messaging and routine laboratory testing 96 hours prior to scheduled treatment. Patients on the e-triage arm with normal bloodwork and no symptoms identified were eligible bypass the pre-treatment office visit. Usual care included the standard office visit.

Key Findings

The primary endpoint of the study was total care time—the total time per encounter (visit to the healthcare center) including commute, wait, infusion, and lab times. Secondary endpoints were patient wait time per encounter, incident emergency department or hospital visits during follow-up, health-related quality of life, and patient satisfaction. Implementation outcomes were adoption (number of patients who participated in the trial out of number approached) and fidelity (number of patients on the intervention arm who followed their triage assignment).

• Among 152 eligible patients, 51 consented onto the study (adoption rate 33.6%).
• Nineteen patients were randomized to e-triage and 21 patients to usual care. Eleven of the patients who consented to the study chose not to participate.
• Of 52 encounters on the e-triage arm, 23 adhered to their e-triage assessment (fidelity rate 44.2%). 
• Compared to the usual care arm, patients on the e-triage arm had 66 minutes less care time per encounter and 30.1 minutes less wait time. 
• The incidence of emergency department or hospital visits did not differ by treatment arm (usual care, n=2, 12.5% vs. intervention, n=3, 20%). Health-related quality of life and patient satisfaction scores were similar by treatment arm.

“Based on feedback we got from clinicians and patients, incorporating a human touch—even if just a post-triage phone call—would increase confidence in the program and make both parties feel the intervention is more acceptable,” said study co-author Kerry Q. Coughlin, MSW, Innovation and Engagement Manager at the Penn Center for Cancer Care Innovation.

Next Steps

The researchers plan to further explore how to integrate oncology nursing into the text-based symptom reporting workflow and expand the program to include home monitoring services.

The study was funded by the Conquer Cancer Foundation of the American Society of Clinical Oncology.

View the full abstract

View author disclosures

View the News Planning Team disclosures: https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2023-qcs-news-planning-team-disclosures.pdf

For your readers:

• What Is Immunotherapy?

ATTRIBUTION TO THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY QUALITY CARE SYMPOSIUM IS REQUESTED IN ALL COVERAGE.

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