Oncology Rounds

Improve cancer patient survival and cut costs? There's a remote symptom monitoring platform for that.

by Deirdre Saulet and Ashley Riley

According to our 2019 Cancer Patient Experience Survey, cancer patients value specialized symptom management above all other cancer program services. In addition, improved symptom management can help reduce costs and improve quality.

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However, it can be tough to proactively identify and support patients experiencing symptoms—especially once they leave the cancer center. A possible solution? Remote symptom monitoring. Read on to learn how innovative programs are using technology to drive significant benefits for their patients.

Web-based symptom monitoring increases survival for lung cancer patients, clinical trial shows

In a multi-center randomized clinical trial in France, researchers compared overall survival for lung cancer patients who received standard follow-up care to detect symptomatic recurrence (at least 75% of lung cancer recurrences are symptomatic) after initial treatment (n=61) with the survival rate of patients who used a web-based symptom monitoring program, called the Sentinel PRO system (Hyperion) (n=60). Both groups met with their oncologist every three months and received imaging scans every three to six months, depending on the stage of tumor and their type of treatment.

Between visits, patients in the intervention group reported weekly on 13 common symptoms using an electronic form, which they accessed via their computer or smartphone. If their symptoms met predefined criteria for severe or worsening symptoms, the online platform would automatically issue email alerts to the care team. Then, after a nurse verified the patient's symptoms, the oncologist would call the patient to determine if a clinical visit or imaging was necessary.

Interim analyses showed that patients in the intervention group consistently reported their symptoms via the online platform (75% average weekly compliance, 92% average monthly compliance). Overall, according to additional interim analyses, 86% of patients who reported their symptoms online had at least one alert that triggered a call from their oncologist that led to additional supportive care. On average, oncologists spent 15 minutes per week managing symptom-related alerts they received through the web-based platform. 

By the end of the two-year follow-up period, 47.5% of the patients who participated in web-based symptom monitoring had died, compared with 66.7% of those in the control group. Among patients who died, the web-based symptom monitoring group had a 51% increased median overall survival compared with the control group (22.5 months vs. 14.9 months), which the researchers attributed to earlier detection of adverse events or relapses. In fact, interim analyses showed that relapse was detected five weeks earlier on average in the intervention group. Intervention patients also had earlier and more frequent access to supportive and palliative care, which aligns with findings that more patients in the intervention arm (80.6%) had stable or improved quality of life scores compared with patients in the control arm (58.6%).

Use telehealth to improve patient self-management

Memorial Sloan Kettering first to find remote symptom monitoring can improve survival, decrease utilization

The findings from this study corroborate the results from the landmark study out of Memorial Sloan Kettering a couple years ago. In this randomized controlled trial, patients getting chemotherapy for metastatic solid tumors (n=441) received weekly email prompts to report on 12 common symptoms at and between visits using a web-based platform called Symptom Tracking and Reporting (STAR). Among patients who died during the study, patients who used the STAR platform had a 20% increased overall survival (31.2 months vs. 26.0 months) compared with a control group (n=325). Across all patients, the STAR cohort also had 17% fewer ED visits (34% of patients vs. 41% of patients) and 8% fewer hospitalizations (45% of patients vs. 49% of patients) over one year.

Patients feel their symptoms first—here's how they can tell their providers

Why your cancer program should invest in remote symptom monitoring

The results from both of these studies suggest that remote symptom monitoring is worth the upfront technology investment and ongoing maintenance for cancer programs. Remote symptom monitoring can not only help you to meet patient demand for specialized symptom management services, but also help you keep your cancer patients out of the ED and hospital—metrics that  CMS is starting to track through the Outpatient Quality Reporting Program.

In addition, for organizations taking on risk, this technology provides a tremendous opportunity to reduce avoidable costs. For instance, using some back-of-the-envelope math, remote symptom monitoring for just those 441 clinical trial patients potentially saved Memorial Sloan Kettering almost $25,000 in a single year from reducing ED visits alone (not to mention all the subsequent, much more expensive inpatient admissions).

Our rough estimates

Of the 441 patients in the trial, 34%—or 150 patients—went to the ED. If they hadn’t had remote symptom monitoring, 41%—181 patients—would've gone to the ED. From a Milliman study, we know the average cost of chemo-related ED visit to be $800. So they avoided at least $24,800 for this group.

How to keep your cancer patients out of the ED

Your 3-step guide to implement remote system monitoring

Once you've made the business case, there are three key steps to implement remote symptom monitoring successfully:

  1. Evaluate technology options carefully and help doctors, nurses, and patients feel comfortable with the selected technology. While the examples outlined above use web-based platforms, there are also various smartphone apps that can be used for symptom reporting. These apps may drive even greater patient compliance in our smartphone-driven society.

  2. Build out the infrastructure for ongoing system maintenance. This infrastructure includes hiring staff to provide tech support, and creating a plan for managing, integrating, and ensuring the security of the patient data collected.

  3. Ensure you have standardized pathways for promptly and effectively triaging and addressing identified symptoms. For example, 77% of the severe or worsening symptoms flagged for review by the STAR platform for nurses at Memorial Sloan Kettering required discrete clinical interventions, such as calls to provide symptom management counseling, supportive medications, chemo dose modification, and referrals for various services.
 

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