Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium.

Background

Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) has been shown to reduce symptom burden and hospitalizations, increase dose intensity and improve quality of life of patients during systemic therapy being recommended by international guidelines in routine oncology practice. However, implementation in routine care has been slow and faces several challenges. In this study we report on the real-world multi-center implementation of a RPM pathway encompassing weekly patient symptom ePRO reporting with electronic alert notifications triggered to providers for severe or worsening symptoms.

Methods

An RPM pathway was implemented in 33 European cancer centers in France and Belgium between November 2021 and August 2023. The implementation process followed a standardized phasic process of Exploration, Preparation, Implementation and Sustainment. Patient-level and system-level implementation metrics were collected and evaluated according to the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.

Findings

Across the 33 cancer centers, the RPM pathway was implemented for 3015 patients cared for by 168 providers. The RPM pathway enabled effective and timely symptom management with 94.6% of all alerts (10,132/10,711) evolving to an improvement two weeks later, among which 88.4% (9468/10,711) showed ≥2 grades of improvement on the 5-point scale of the Patient-Reported Outcomes Common Terminology (PRO-CTCAE). The median time to alert management by the care team was 13 h 41 min (25th percentile: 1 h 42 min, 75th percentile: 1 day + 19 h 54 min), with 80% (36,269/45,334) of alerts managed by a nurse navigator telephone call. Patient adherence with weekly ePRO reporting was 82% (2472/3015). In an experience survey, 87% (32/38) of providers were satisfied with integrating the solution into their organization and 90% (276/307) of the patients felt that ePRO reporting positively impacted their care. As of March 2024, the pathway has been maintained in all participating centers, with activation of an additional 18 centers following data lock, and reimbursement for this RPM pathway approved in France in October 2023.

Interpretation

These findings demonstrate the feasibility of implementing and maintaining an RPM pathway during routine care across a diverse group of cancer centers in the European setting, with high levels of patient and provider engagement, and positive clinical impact.

Funding

Part of this work was funded Breast Cancer Research Foundation (Career Development Award to Maria Alice Franzoi) and Resilience (nurse navigation and technology support).

Informations de copyright

© 2024 The Authors.

Déclaration de conflit d'intérêts

Maria Alice Franzoi: Research Funding: Resilience Care (Institution). Speaker honoraria: Novartis (Institution). Arlindo Ferreira: Resilience (Employment). Antoine Lemaire: Consultancy or speaker honoraria: Ethypharm, Kyowa Kirin, Baxter, Alfasigma, Mundi Pharma, Accord Healthcare. Joseph Rodriguez: None. Jessica Grosjean: None. Joana M Ribeiro: Travel, Accommodations, Expenses: Gilead, Astra Zeneca, eESO, Exact Sciences, Novartis, Pfizer, Roche and Sanofi, MSD. Laura Polastro: Speaker fees: Resilience; Research Funding: Resilience (institution). Thomas Grellety: Speaker fees: Resilience. Xavier Artignan: None. Katell Le Du: None. Martina Pagliuca: Travel expenses: Gilead. Élodie Nouhaud: Resilience (Employment). Maximilien Autheman: Resilience (Employment). Fabrice André: Research Funding: AstraZeneca (Inst), Novartis (Inst), Pfizer (Inst), Eli Lilly (Inst), Roche (Inst), Daiichi (Inst). Travel, Accommodations, Expenses: Novartis, Roche, GlaxoSmithKline, AstraZeneca. Ad boards or symposium compensated to the hospital: AstraZeneca, Lilly, Novartis, Pfizer, Daiichi-Sankyo, Relay Tx and Roche. Ad board compensated to the author: Lilly. Ethan Basch: Stock and Other Ownership Interests: Vector Science. Consulting or Advisory Role: SIVAN Innovation, Navigating Cancer, AstraZeneca, Resilience Care. Other Relationship: Centers for Medicare and Medicaid Services, National Cancer Institute, American Society of Clinical Oncology, JAMA-Journal of the American Medical Association, Patient-Centered OUtcomes Research Institute (PCORI). Otto Metzger: Dr Metzger reported receiving grant funding from Pfizer Inc and personal fees from Merck & Co and Oncoclinicas outside the submitted work. Charles Ferté: Resilience (Employment). Mario Di Palma: Honoraria: AstraZeneca, Novartis. Consulting or Advisory Role: Sandoz. Speakers' Bureau: Amgen, Kyowa Kirin International, MSD Oncology, Mundipharma, Sandoz, Roche. Research Funding: Bayer, Sandoz (Inst), Pierre Fabre (Inst), Fresenius Kabi, Astellas Pharma (Inst), Janssen Oncology (Inst), Roche (Inst), Sanofi (Inst). Travel, Accommodations, Expenses: Pfizer, Novartis. Florian Scotté: Honoraria: Leo Phar, Viatris, Pharmanovia, Amgen, Gilead Sciences, B. MS GmbH & Co. KG, GlaxoSmithKline. Ines Vaz-Luis: Speaker honoraria from Amgen, AstraZeneca, Pfizer/Edimark, Novartis, Sandoz (Institutional); Writing engagement from Pfizer/Edimark (Institutional); Research funding from Resilience Care (Institutional), Travelling Novartis.