Cancer COVID Watch: A feasibility study of intensive remote symptom monitoring via automated text messages with integrated nurse practitioner triage for patients with cancer and suspected or confirmed COVID-19.
Authors: Cotner Cody , Manz Christopher , Balachandran Mohan , Ferrell Will , Khan Neda , Kopinsky Michael , McGettigan Suzanne , Morgan Anna , Zinck Lindsey , Schuchter Lynn Mara , Shulman Lawrence N. , Asch David , Parikh Ravi Bharat 
Published: June 2021

e13580 Background: Patients with cancer are at greater risk of developing severe symptoms and dying from COVID-19 than the general population. Early detection of worsening symptoms and rapid nurse practitioner assessment may identify patients with cancer and suspected COVID-19 who require escalation of care while limiting strain on healthcare resources. Methods: We conducted a feasibility study of Cancer COVID Watch, an automated COVID-19 symptom monitoring program with oncology nurse practitioner-led triage among patients with cancer between April 23 and June 30, 2020. Oncology clinicians enrolled 34 patients who tested positive for COVID-19 or were experiencing symptoms concerning for COVID-19. Enrolled patients received twice daily automated text messages over 14 days that asked “How are you feeling compared to 12 hours ago? Better, worse, or the same?” and, if worse, “Is it harder than usual for you to breathe?” Patients who responded “worse” and “yes” were contacted within 1 hour by an oncology nurse practitioner to determine next steps in management. Chi-square and student t-tests are used to compare adherence, demographics, and outcomes between intervention responders and non-responders. Results: Mean age of patients was 62 years, 20 (59%) were female, 13 (38%) Black, 19 (56%) White, and mean ECOG was 1.2. 15 (44%) tested positive for COVID at the time of enrollment, 16 (47%) had a pending or scheduled test, and 2 (6%) tested negative but were enrolled due to concern of a false-negative test. 25 (74%) patients responded to ≥1 text message, and 24 (71%) responded to multiple messages. Patients were more likely to respond if they did not have an outpatient healthcare appointment within 14 days after enrollment (100% vs. 46%, p = 0.001) and if they had a pending or scheduled test versus a positive test at enrollment (88% vs. 53%, p = 0.04). 4 (12%) patients were escalated to the triage line: 1 was advised to present to the ED, and 3 were managed in the outpatient setting. 7 (21%) patients presented to the ED for infectious symptoms within 14 days of enrollment, and 2 (6%) were admitted for worsening COVID-19 symptoms. There was no difference in the ED presentation rate between patients who responded to ≥1 text message and those who did not (20% vs. 22%, p = 0.88). 3 (9%) patients died within 30 days of enrollment; no deaths were attributed to COVID. Participant satisfaction was high (Net Promoter Score 100, n = 4). Conclusions: Intensive remote symptom monitoring and rapid nurse practitioner triage for worsening symptoms is feasible for outpatients with cancer and suspected/confirmed COVID-19 infection. Patients with concerning symptoms were adherent with Cancer COVID Watch and mostly managed in the outpatient setting. Efforts to manage symptomatic patients with cancer during future pandemics could use a similar approach.