Patient-reported experience with an immunotherapy telehealth platform.
Authors: Daly Robert Michael , Bange Erin Mary , Doshi Sahil D , Li Bob T. , Shah Neil J. , Aggen David H , Kotecha Ritesh R , Eng Juliana , Ng Kenneth K. , Polubriaginof Fernanda C. G. , Kuperman Gilad , Lipitz-Snyderman Allison , Stetson Peter D. , Schrag Deb , Panageas Katherine , Morris Michael J. 
Published: May 2024

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Background: The Making Telehealth Delivery of Cancer Care at Home Effective and Safe for Immunotherapy (MATCHES-IO) intervention seeks to improve the efficiency and patient experience for those treated with single agent pembrolizumab. Because pembrolizumab is administered as an outpatient infusion every 3-weeks, patients require up to 18 clinic visits per year to receive treatment, which is arduous. During the COVID-19 pandemic, the FDA granted accelerated approval for an extended interval dosing administered every 6 weeks, but despite this approval every 3-week dosing remains the standard (65% of prescriptions) as clinicians perceive this schedule enables them to identify and manage toxicity early. Telehealth may be the impetus to change the standard to the more convenient 6-week in person schedule, but evidence is needed. Methods: We conducted a single arm pragmatic trial to evaluate the efficiency and patient experience of a telehealth immunotherapy platform (MATCHES-IO) in patients with non-small cell lung, genitourinary, or melanoma cancers receiving single agent pembrolizumab. MATCHES-IO evaluates whether in-person visits for pembrolizumab therapy q6wk (rather than q3wk), with interim telehealth toxicity checks between in-person treatments, is more efficient and enhances patient experience relative to the standard q3wk infusion visits. The components of the platform include clinician-patient virtual visits, labs at home, biometric devices at home for vital sign monitoring, and electronic patient-reported outcomes to monitor for common IO-related toxicities. Patient experience was assessed after each MATCHES-IO televisit for up to two televisits. We measured experience with a patient experience survey that included the net promoter score, of how likely are they to recommend this intervention to similar patients (scale 0-10, higher score is desirable). A score of 9 or greater is considered excellent. Results: Between July 2023 and February 2024, 27 patients were enrolled, median age 68 (range 45–85), 74% white, 11% black, 11% Asian, and 41% female. Cancer types included thoracic (59% of patients), genitourinary (33%), and melanoma (7%). 19 patients (70.4%) have completed a MATCHES-IO televisit and completed the patient experience survey. The median net promoter score was 9 (range 2-10). 94% patients perceived a benefit to the MATCH-IO televisit including saved time (83% of respondents), patient convenience (83%), convenience for caregiver/family (44%), saved money (44%), and better monitoring of cancer and treatment (39%). 78% of patients found the at home visit less stressful than the in-person visit. Conclusions: Patients endorsed an enhanced experience with an immunotherapy telehealth platform for extended dosing of pembrolizumab. Further follow-up is needed to confirm these experience findings and determine whether this platform improved efficiency through fewer in-person visits.