Randomized trial of remote cancer symptom monitoring during COVID-19: Impact on symptoms, QoL, and unplanned health care utilization.
Authors: Mooney Kathi , Iacob Eli , Wilson Christina M. , Lloyd Jennifer , Nielson Heidi , Ward John Harris 
Published: June 2021

12000

Background: Unplanned health care utilization due to poorly controlled cancer symptoms is common and important to avoid during the Covid-19 pandemic. In a randomized trial we evaluated whether remote symptom monitoring and management utilizing Symptom Care at Home (SCH), would reduce symptom burden, improve quality of life, and decrease unplanned health care use in cancer patients receiving active treatment. Methods: Patients (n = 252) receiving chemotherapy and/or radiation therapy were randomized to the SCH intervention (n = 128) or usual care (UC) (n = 124). Daily, those in the intervention group, utilized the SCH system to report the presence and severity of 9 common symptoms during treatment. For symptoms endorsed, SCH participants received immediate, tailored automated self-management coaching. Symptoms at moderate to severe levels were automatically reported to oncology nurse practitioners who called the SCH patients to improve symptom management based on a decision support dashboard. Participants from both groups were assessed at baseline and monthly for up to 5 months on symptom burden (MDASI), mental health well-being and social isolation (PROMIS; HADS) and Health-related Quality of Life (HRQoL) (Penedo Covid-19 HRQoL subscale). Unplanned health care use was extracted from the EHR. Descriptive statistics examined equivalency between groups. Mixed effects models with random intercepts were utilized to examine group differences over time with post-hoc analyses to determine specific timepoint differences. Results: Participants did not differ on demographic or baseline measures. On average participants were 61 years of age, predominantly female (61%) and white (93%). A variety of cancers were represented with colon, breast and ovarian most common and 60% had stage 3 or 4 disease. Longitudinal mixed effects models found significant effects for lower symptom burden (p =.018) and better HRQoL (p =.007) for SCH participants versus UC at months 1 and 2 with improvements subsiding over the remaining months. Mental health wellbeing and social isolation were not significantly different. There were a total of 71 unplanned health care episodes with 28 for SCH and 43 for UC. Unplanned episode types included: unplanned clinic visit- 3 SCH vs 2 UC; ED visit- 10 SCH vs 16 UC and unplanned hospitalizations-15 SCH vs 25 UC. More SCH participants had no unplanned health care episodes than UC participants (χ2 4.08; p =.04). Conclusions: Remote monitoring and management of patients’ cancer and treatment-related symptoms during the Covid-19 pandemic reduced symptom burden and improved quality of life during the first two months of monitoring. Unplanned health care utilization trended lower for those remotely monitored. Extending care to the home during the pandemic can decrease demand on the health care system and improve cancer patients’ symptom experience. Clinical trial information: NCT04464486.