COVID Builds a Case for Remote Patient Monitoring in Cancer Care

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At-home monitoring substantially reduced the number of cancer patients admitted for SARS-CoV-2 infection in the Mayo Clinic health system.

When the pandemic struck, Mayo customized its chronic diseases remote monitoring program (RPM) for people at risk for severe complications after a COVID diagnosis.

Among the first 71 cancer patients enrolled in the program from March to July 2020, all of whom were undergoing active cancer treatment or surveillance, the odds of hospitalization dropped almost fourfold compared with 116 patients who were not enrolled. Some patients were not enrolled because they declined to do so, but often it was because the program was not yet available in their area.

Balanced for baseline confounders, the hospitalization rate among participants was 2.8%, vs 13% among those who didn't enroll, according to a report presented at the American Society of Clinical Oncology (ASCO) 2021 annual meeting and published simultaneously in JCO Oncology Practice.

Since then, more than 10,000 patients, some with and some without cancer, have participated in Mayo's COVID-19 RPM, with similar success, said senior investigator Tufia Haddad, MD, an associate professor of oncology and the RPM medical director across Mayo's multistate health system.

"We are certainly very encouraged by these findings," she added. She said her team is now building off the momentum to establish new pilots for using RPM for cancer management, particularly among patients at high risk for treatment complications.

"We really foresee a future where [RPM] is a new standard way to take care of patients. It just makes sense" in oncology and other disciplines, she told Medscape Medical News.

Overall, the COVID "experience suggests that the design and implementation of innovative RPM programs harbors the potential to transform our current models of cancer care delivery," said lead investigator Joshua Pritchett, MD, a hematology and medical oncology fellow, after he presented the findings.

Elegance "in the Midst of Chaos"

The COVID program, like other RPMs, worked because it caught problems early, before they got out of hand, Haddad said.

The heart of the effort was a cellular enabled tablet coupled with monitoring devices such as pulse oximeters, thermometers, and blood pressure cuffs that were connected to it by Bluetooth.

The equipment was shipped to people who were in isolation at home after having been diagnosed with COVID. Several times a day for a few weeks after patients were diagnosed, the tablet would survey them about their symptoms and prompt them to take measurements. The data would download automatically to the tablet and be transmitted directly to Mayo's electronic health record system. Alerts would be triggered when values fell outside of preset parameters.

A team of nurses monitored the system at the other end and escalated care to COVID specialists at the first sign of trouble. Patients would be brought in for supportive care, often to receive supplemental oxygen or IV fluid, and were then usually sent home instead of being admitted for observation, because physicians knew they were already being closely watched.

It was an "elegant" approach "in the midst of chaos," said Alexi Wright, MD, an associate professor and health outcomes researcher at the Dana-Farber Cancer Institute, Boston, Massachusetts.

"The question is if it will translate" to less urgent situations, such as at-home palliative care. In such a setting, monitoring could go on for months, and patients might not be as motivated. Even so, Mayo's COVID efforts help point the way for future RPMs in cancer care, she said while commenting after Pritchett's presentation.

No ICU Admissions, No Deaths

Even when RPM patients were hospitalized, their stays were shorter than those of patients who did not participate in the program (median, 3 days vs 6 days). Among those in the RPM, there were no COVID intensive care unit (ICU) admissions or deaths; among patients who were not in the RPM, there were six ICU admissions and four deaths.

The benefits were seen in major cities served by Mayo, such as Phoenix, Arizona, and Jacksonville, Florida, as well as in small rural communities in the Midwest.

The patient experience went well. "We heard from both patients and family members that monitoring actually gave them an incredible sense of relief," Haddad said.

As for the technology, all that patients "had to do was open up the box, power up the tablet," and follow the instructions. "We loved it when our 80-some-year-old patients told us it was easy to use," she said.

Mayo has been ramping up its RPM offerings since the chronic disease program started in 2016. A postsurgical RPM was launched in 2019, and other programs for speciality services have been launched since then. Before the pandemic, however, its use in oncology had been limited to patients who had received CAR-T therapy.

The upfront cost of the equipment is more than offset by downstream savings on hospital costs. In addition, Mayo follows guidelines from the Centers for Medicare & Medicaid Services, so RPM is a billable service, Haddad said.

About three quarters of the study participants had solid tumors; the rest had hematologic cancers.

The study received no external funding. The investigators have disclosed no relevant financial relationships. Wright is an advisor for GSK and is a researcher for AstraZeneca.

American Society of Clinical Oncology (ASCO) 2021: Abstract 1503. Presented June 4, 2021.

M. Alexander Otto is a physician assistant with a master's degree in medical science, and an award-winning medical journalist who has worked forseveral major news outlets before joining Medscape. Email: aotto@mdedge.com.

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