Remote symptom monitoring can ‘close care gaps’ for people with cancer
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Technology-enabled symptom monitoring in conjunction with nurse practitioner follow-up provided responsive care to patients with cancer during the COVID-19 pandemic, according to study results.
The findings — presented at the virtual Oncology Nursing Society Congress — showed this approach offered patients easy access to oncology nurse practitioners from the safety of their homes, according to researchers.
“This minimizes exposure to potential infections, including COVID-19, and offers high-quality cancer care between scheduled clinic visits,” Jennifer Lloyd, MSN, FNP-C, OCN, advanced practice registered nurse at Huntsman Cancer Institute at University of Utah, said during a presentation.
Patients with cancer often struggle to adjust to their diagnosis, treatment demands, and adverse events caused by their disease or treatment.
The COVID-19 pandemic compounded these challenges, as patients faced increased risk for infection and often lacked access to necessary treatment or adequate symptom control. Many also faced social isolation and experienced pandemic-related anxiety, according to study background.
Consequently, innovative solutions are needed to ensure patients’ needs are met while ensuring their safety, Lloyd said.
“Utilization of patient-reported automated symptom technology in oncology care is showing improvement of symptoms in patients [who] use home-based automated systems,” Lloyd said. “Cancer mortality rates are higher for patients in rural settings than their urban counterparts. Improving access to high-quality care has the potential to close this gap.”
Lloyd and colleagues aimed to describe symptoms that people with cancer experienced during treatment and assess the value of Symptom Care at Home, a remote, automated home monitoring system that provided alerts to oncology nurse practitioners. The nurse practitioners then could address patients’ concerns, whether related to cancer or COVID-19.
Researchers used a prospective interventional design and enrolled 129 patients (median age, 62 years; range, 22-88; 93% white, 61.7% women) who received cancer treatment between May and December 2020. Most patients had stage III (25.6%) or stage IV (39.5%) disease, and most cancers were metastatic (60.5%). The most common diagnoses in the cohort were colorectal cancer (20.9%), breast cancer (16.3%), ovarian cancer (10.1%) and pancreatic cancer (9.3%).
Patients received instructions to call the Symptom Care at Home system each day and — using a 10-point scale — report the presence and severity of 11 symptoms related to cancer or COVID-19.
Nurse practitioners received alerts when patients reported moderate or high symptom levels so they could call them for further evaluation and treatment.
Nurse practitioners received 1,832 symptom alerts during the study period. The most common reasons included pain (16.8%), anxiety (11.5%), depressed mood (9%), dry cough (8.9%), feeling achy or having flu-like symptoms (8.5%), problems with taste or smell (8.3%), feeling too sick to continue (7.8%), nausea (6.6%) or fatigue (6.6%). Forty-six alerts (2.5%) indicated patients had come in contact with a person who had tested positive for COVID-19.
Per protocol, nurse practitioners responded to patients within 2 days in nearly all cases (90.3%).
Researchers reported higher rates of psychosocial distress among women, patients with early-stage cancers and those who did not self-identify as actively religious.
“Future studies should further examine what other factors related to gender may account for these differences,” Lloyd said.
A mixed-effects longitudinal model that controlled for gender, actively religious status, cancer stage and baseline distress scores showed a significant increase in distress over time in the overall cohort (P < .01). Distress increased faster among women than men (P < .001), patients with stage I disease than those with stage II to stage IV disease (P < .001), and those who self-reported they were not active in religion compared with those who described themselves as active (P < .001).
“Using this model to monitor symptoms over time, we can see that symptom patterns change,” Lloyd said. “There was escalated psychosocial distress as patients navigated their cancer care through the COVID-19 pandemic. Daily monitoring and early intervention by oncology nurse practitioners helped patients manage symptoms.”
When nurse practitioners contacted patients, they utilized pharmacologic and nonpharmacologic interventions.
“Pharmacologic interventions included writing prescriptions, recommending over-the-counter medications, and ensuring the proper use of medications that the patient already had prescriptions for,” Lloyd said. “Nonpharmacologic interventions could include alternative pain management therapy such as hot or cold packs, active listening, and medical or emotional counseling when appropriate. Nurse practitioners also were able to assess for the presence of any urgent medical conditions, which helped them triage and recommend and coordinate higher levels of care for additional diagnostic workup if needed.”
The results showed the incorporation of daily follow-up calls into nurse practitioners’ schedules was efficient and cost-effective, Lloyd said.
“Utilizing oncology nurse practitioners draws on their clinical experience and triage ability to follow up and manage patient medical needs,” Lloyd said. “This type of system could be incorporated into the nurse practitioners’ existing clinical practice to close care gaps.”
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Lloyd J, et al. Oncology nurse practitioner symptom management through technology-enabled monitoring during the COVID-19 pandemic. Presented at: Oncology Nursing Society Congress (virtual meeting); April 20-29, 2021.
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