Randomized trial of a supportive oncology care at home intervention for patients with cancer receiving curative treatment.

Abstract

11003 Background: Patients with cancer receiving curative treatment often endure substantial symptoms and utilize significant healthcare resources. Symptom monitoring interventions and hospital at home care models represent a promising approach for improving these patients’ outcomes. Methods: We conducted a randomized trial of a Supportive Oncology Care at Home intervention versus usual care in adult patients receiving treatment with curative intent (chemotherapy and/or chemoradiation) for pancreatic, rectal, gastroesophageal, and head and neck (H&N) cancer, as well as non-Hodgkin lymphoma, who resided in-state, within 50 miles of our hospital. Patients were randomized to receive the Supportive Oncology Care at Home intervention or usual care within two weeks of initiating therapy and remained on trial for up to 6 months. The intervention entailed: 1) remote monitoring of daily patient-reported symptoms, vital signs, and body weight; 2) a hospital at home care model for symptom assessment and management; and 3) structured communication with the oncology team. The primary outcome was the proportion of patients requiring inpatient hospital admission or emergency department (ED) visits during the study period. Secondary outcomes included urgent visits to the clinic, treatment delays, and longitudinal changes in monthly assessments of quality of life (QOL; Functional Assessment of Cancer Therapy-General), symptoms (Edmonton Symptom Assessment System [ESAS] and Hospital Anxiety and Depression Scale [HADS]), and activities of daily living (ADLs). Results: We enrolled 50.8% (199/392) of potentially eligible patients. One patient withdrew consent and 2 became ineligible following consent, resulting in 196 participants (median age=65.8 [range: 21.1-92.0], 39.8% female, cancer types: 34.2% pancreatic, 27.0% H&N, 16.3% lymphoma, 12.8% rectal, 9.7% gastroesophageal). The proportion of patients requiring hospital admission or ED visit did not differ significantly between the intervention and usual care groups (37.1% v 35.7%, p=.87). Intervention participants were less likely to require an urgent visit (7.2% v 24.5%, p<.01), but there were no differences in rates of treatment delays >7 days (29.9% v 33.0%, p=.62). Compared to baseline assessments, intervention participants had greater improvement in ESAS symptoms (p<.01) and ADLs (p=.04) over time. QOL and HADS depression/anxiety symptoms did not differ longitudinally between groups. Conclusions: Although this Supportive Oncology Care at Home intervention did not have a significant impact on rates of hospital admissions or ED visits, we found encouraging results for reducing urgent visits to the clinic and substantial improvement in symptom burden and ADLs, underscoring the potential utility of this novel care model for enhancing care delivery and outcomes for patients with cancer receiving curative treatment. Clinical trial information: NCT04544046 .