At-home intervention has potential to enhance cancer care delivery, outcomes
At-home Cancer Care Improves Symptoms, Reduces Clinic Visits
CHICAGO — A new study presented at the ASCO Annual Meeting suggests that providing supportive oncology care at home may improve the care and outcomes for cancer patients undergoing curative treatment. While the at-home intervention did not reduce inpatient hospital admissions or emergency department (ED) visits, it did lead to fewer urgent clinic visits and improved symptom burden.
The research, led by Ryan Nipp, MD, MPH, a gastrointestinal oncologist and cancer outcomes researcher at OU Health Stephenson Cancer Center, indicates that this type of intervention could enhance care delivery for those undergoing curative cancer treatment. The primary outcome measured was the rate of inpatient hospital admissions and ED visits, which showed no significant difference between the intervention group and the usual care group.
Cancer patients undergoing curative treatment often grapple with significant symptom burdens, including fatigue, nausea, pain, anxiety, and depression. Nipp noted that thes symptoms and treatment side effects contribute to high health care utilization,impaired functional status,and a diminished quality of life. He suggested that symptom monitoring interventions and hospital-at-home care models offer promising avenues for enhancing patient outcomes and improving cancer care.
The randomized controlled trial involved 196 patients within 50 miles of Massachusetts General Hospital, all undergoing chemotherapy or chemoradiation for pancreatic cancer, head and neck cancer, non-Hodgkin lymphoma, rectal cancer, or gastroesophageal cancer. Patients were randomly assigned to either the at-home intervention (n = 98) or usual care (n = 98) for up to six months.
The at-home intervention featured daily remote monitoring of patient-reported symptoms,body weight,and vital signs. It also incorporated a hospital-at-home care model for symptom assessment and management, along with structured communication with the oncology team. Algorithms determined when patients required phone contact or home visits. The oncology team received summary emails before each chemotherapy cycle and within 24 hours of phone calls or home visits.
while hospital admission and ED visit rates remained similar between the two groups (37.1% vs.35.7%), a substantially smaller percentage of patients in the intervention group required urgent clinic visits (7.2% vs. 24.5%). Furthermore, those in the intervention group demonstrated greater betterment in symptom scores and activities of daily living.
“A patient’s symptom burden and treatment side effects contribute to high health care utilization, impaired functional status and worse quality of life,” Nipp said during a presentation. “Symptom monitoring interventions and hospital-at-home care models represent promising approaches for improving patient outcomes.”
The study did not reveal any differences in quality of life or depression/anxiety symptoms.Researchers acknowledged limitations such as the single-center design and limited diversity.
What’s next
Nipp emphasized the need for further research to understand potential moderators and mediators, such as differences based on cancer type or age. he also suggested exploring whether improved functional status stems from better symptom management and assessing the cost-effectiveness of such models for supportive oncology care.