Remote monitoring of symptoms can ‘close gaps in care’ for people with cancer

April 22, 2021

3 min reading

Source / Discoveries

Source:

Lloyd J, et al. Managing the symptoms of an oncology nurse through technology-enabled monitoring during the COVID-19 pandemic. Presented at: Congress of the Oncology Nursing Society (virtual meeting); 20.-29. April 2021

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The NCI and the NIH National Center for the Advancement of Translational Sciences supported this research.


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According to the results of the study, the technologically enabled monitoring of symptoms, together with the monitoring of the nurse, provided quick help to cancer patients during the COVID-19 pandemic.

The findings – presented at the Virtual Congress of the Oncology Society for Nursing – showed that this approach allowed patients easy access to oncology nurses from the safety of their homes, the researchers say.

The technologically enabled monitoring of symptoms, together with the monitoring of the nurse, provided quick help to cancer patients during the COVID-19 pandemic.

“This reduces exposure to potential infections, including COVID-19, and offers high-quality cancer care between scheduled clinic visits,” Jennifer Lloyd, MSN, FNP-C, OCN, a nurse registered for advanced practice at the Huntsman Cancer Institute at the University of Utah, said during the presentation.

Cancer patients often struggle to adapt to diagnosis, treatment requirements, and adverse events caused by their illness or treatment.

The COVID-19 pandemic posed these challenges because patients faced an increased risk of infection and often lacked access to necessary treatment or adequate symptom control. According to research, many have faced social isolation and experienced pandemic-related anxiety.

Consequently, innovative solutions are needed to ensure that patient needs are met while ensuring their safety, Lloyd said.

“The use of automated symptom technology reported by patients in oncology care shows improvement in symptoms in patients [who] use automated systems from home, ”Lloyd said. “Cancer mortality rates are higher for patients in rural areas than their urban counterparts. Improving access to high-quality care can potentially close that gap. “

Lloyd and colleagues aimed to describe the symptoms people with cancer experienced during treatment and to assess the value of Symptom Care at Home, a remote, automated home monitoring system that provided alerts to oncology nurses. Then nurses could address patients ’concerns, whether it is related to cancer or COVID-19.

The researchers used a prospective interventional design and enrolled 129 patients (mean age 62 years; range 22-88; 93% white, 61.7% women) who were treated for cancer between May and December 2020. Most patients had stage III , 6%) or stage IV (39.5%) disease, and most cancers were metastatic (60.5%). The most common diagnoses in the cohort were colon cancer (20.9%), breast cancer (16.3%), ovarian cancer (10.1%), and pancreatic cancer (9.3%).

Patients were instructed daily to call the Symptom Care at Home system and – using a 10-point scale – report the presence and severity of 11 cancer-related symptoms or COVID-19.

Nurses received warnings when patients reported moderate or high levels of symptoms so that they could be called for further assessment and treatment.

Nurses received 1,832 symptom warnings during the study period. The most common reasons are pain (16.8%), anxiety (11.5%), depressed mood (9%), dry cough (8.9%), feeling of pain or flu-like symptoms (8.5%), problems with taste or smell (8.3%), too sick to continue (7.8%), nausea (6.6%) or fatigue (6.6%). Forty-six warnings (2.5%) indicated that patients had come into contact with a person who had tested positive for COVID-19.

According to the protocol, nurses in almost all cases responded to patients within 2 days (90.3%).

The researchers reported a higher rate of psychosocial stress among women, patients with early-stage cancer, and those who did not identify as actively religious.

“Future studies should further examine what other gender-related factors may explain these differences,” Lloyd said.

A longitudinal model with mixed effects that controlled gender, active religious status, cancer stage, and initial stress scores showed a significant increase in stress over time in the overall cohort (Str <.01). Troubles increased faster among women than men (Str <.001), patients with stage I of those with stage II to IV stage (Str <.001), and those who declared themselves not to be active in religion in relation to those who described themselves as active (Str <.001).

“Using this model to monitor symptoms over time, we can notice that symptom patterns change,” Lloyd said. “There was an escalation of psychosocial suffering as patients navigated through cancer care through the COVID-19 pandemic. Daily monitoring and early intervention by an oncology nurse helped patients manage symptoms. “

When nurses contacted patients, they used pharmacological and nonpharmacological interventions.

“Pharmacological interventions included writing prescriptions, recommending over-the-counter medications, and ensuring proper use of medications for which the patient already had prescriptions,” Lloyd said. “Non-pharmacological interventions may include alternative pain management therapies, such as hot or cold compresses, active listening, and medical or emotional counseling when appropriate. Nurses were also able to assess the presence of any medical emergencies, which helped them triage and recommend and coordinate higher levels of care for additional diagnostic processing if necessary. “

The results showed that including daily additional calls in nurses ’schedules was effective and cost-effective, Lloyd said.

“The use of oncology nurses relies on their clinical experience and ability of triage to monitor and manage the patient’s medical needs,” Lloyd said. “This type of system could be incorporated into existing nurses’ clinical practice to bridge care gaps.”

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