Making telehealth delivery of cancer care at home effective and safe: A pragmatic cluster randomized trial.

Abstract

TPS1680 Background: Telehealth (TH) use for cancer care has rapidly expanded, both during and following the COVID-19 pandemic. However, evidence regarding safety, feasibility, effectiveness, equity, stakeholder satisfaction, and implementation of telehealth-enabled oncology care remains limited. We seek to assess the impact of TH on these outcomes in breast and prostate cancer patients. Methods: The MATCH-UP pragmatic cluster randomized trial is being conducted at Memorial Sloan Kettering Cancer Center to compare alternate models of TH use in oncology practice. Sixty-two physician practice clusters in breast and prostate medical oncology are randomized 1:1 to enhanced telehealth (ET) or usual practice (UP), stratified by disease type and clinic volume. ET emphasizes TH with expanded home services designed to deliver as many components of care as desired in patients’ homes. Usual care involves routine practice with TH visits at the discretion of the patient and MD or APP. Eligible patients have >=3 prior medical oncology visits and are not enrolled on a therapeutic trial. Automated enrollment is triggered by a routine oncology visit with waiver of informed consent. The ET intervention includes EHR-enabled telehealth scheduling defaults for routine follow-up visits, optional home phlebotomy, structured support for home administration of select injectable medications, and digital support for patients with TH access barriers. The primary endpoint is the proportion of routine medical oncology visits conducted in person among all routine medical oncology visits over 1 year. Secondary outcomes include healthcare utilization, no-show and late cancellation rates, and overall survival. Patient-reported outcomes include: quality of life, healthcare costs, experience of care, and preferences for use of TH at future visits. Clinician-reported outcomes include: experience of care and preferences for TH use at future visits. For patients in the ET arm only, telehealth accessibility, intervention uptake and efficiency, and implementation outcomes, including acceptability, appropriateness, and feasibility, are also being collected. The primary endpoint will be analyzed using generalized linear mixed models with a logistic link, accounting for repeated visits within patients and clustering within randomized practice units and adjusting for stratification factors. Enrollment will continue through March 2026 with follow-up for 12 months. To date, 7256 patients have been enrolled, with 3641 patients assigned to ET, (n=2437 [67%] breast cancer; n=1204 [33%] prostate cancer and 3,615 assigned to UP (n=2252 [62%] breast cancer; n=1363 [38%] prostate cancer). MATCH-UP will generate pragmatic evidence on the effectiveness, patient-centeredness, implementation, and equity-relevant barriers of a scalable, EHR-embedded enhanced telehealth model for breast and prostate oncology care. Clinical trial information: NCT06954337 .