Text-based prescreening can reduce clinic time for immunotherapy recipients
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Key takeaways:
- Prescreened individuals had an average of 30 minutes less wait time.
- Researchers noted no decrease in quality of life or patient satisfaction when compared with usual care.
Text-based e-triage can select individuals for a fast-track process that allows them to proceed directly to infusion, saving as much as 66 minutes total care time, according to a study presented at ASCO Quality Care Symposium.
The findings — presented by Erin Mary Bange, MD, MSCE, genitourinary oncologist at Memorial Sloan Kettering Cancer Center — provide a time-savings solution for patients undergoing treatment with immune checkpoint inhibitors for solid tumors without increasing need for subsequent emergency care or decreasing quality of life or patient satisfaction.
“We were very excited to find that a simple text-based intervention could save patients over an hour of their time at each treatment appointment,” Bange told Healio. “This [became] even more important after learning from patients that a greater than 45-minute reduction in their visit time would significantly improve their quality of life.”
Background and methodology
New strategies to mitigate time needed to complete cancer therapy are needed, according to Bange. Prior research has shown that text-based e-triage can utilize patient-reported outcomes to identify patients without previous immune checkpoint inhibitor toxicity that could safely fast-track to treatment without a pre-infusion office visit.
Researchers conducted a randomized controlled trial to assess if a text message-based questionnaire combined with lab testing could identify patients receiving immune checkpoint inhibitors who are able to bypass their clinician visit and proceed directly to immunotherapy treatment.
The analysis included 40 patients (mean age, 67.5 years; 84.6% white) undergoing treatment with single-agent immune checkpoint inhibitors for solid tumors who spoke English and had access to a mobile device with text messaging. Researchers randomly assigned study participants to receive either e-triage (n = 19) intervention or standard care (n = 21).
Care time (total time per ambulatory encounter) served as the study’s primary endpoint, whereas patient wait time per encounter, incident ED visits during follow-up, health-related quality of life and patient satisfaction served as secondary endpoints.
Results
Among the 52 e-triage surveys delivered, 42 received responses, for a completion rate of 80%. Twenty-three respondents adhered to their e-triage assignment, for a fidelity rate of 54.7%.
When compared with the usual care arm, patients in the e-triage group had an average of 66 minutes less care time per encounter (95% CI, 123.7 to 8.1 minutes) and 30.1 minutes less wait time (95% CI, 60.9 to 1.1 minutes).
Incidence of ED or hospital visits did not differ by treatment arm (usual care, 12.5% vs. intervention, 20%).
Next steps
The study findings demonstrate that text-based e-triage can select patients for a potential fast-track process that allows them to proceed to infusion without first visiting with their respective clinician, according to researchers.
However, further studies are needed in a larger cohort with longer follow-up before such implementation can become routine care.
“The biggest take-home message is that a text-based e-triage system can safely give patients the option to streamline their immunotherapy treatment without negatively impacting quality of life or patient satisfaction,” Bange told Healio.
“Further work needs to improve the e-triage system by incorporating nursing to address patient and clinician barriers to participation and to test the cost and real-world effectiveness in a larger scale, pragmatic trial,” she added. “Also, we only evaluated patients receiving single-agent checkpoint inhibitor-based treatment, so this approach would need to be adapted prior to expanding it to other types of cancer treatment.”
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Bange EM, et al. Abstract 301. Presented at: ASCO Quality Care Symposium. Oct. 27-28, 2023; Boston.
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