Supportive oncology care at home after discharge for patients with advanced cancer.

Authors

Daniel Lage

Daniel E Lage

Harvard University, Boston, MA

Daniel E Lage, Patrick Connor Johnson, Shira Hornstein, Isabel Neckermann, Alane Schmelkin, Connor Grayzel, Patricia Brown, Meghan McGrath, Eliza Shulman, Melissa Smith, Ryan David Nipp, Areej El-Jawahri

Organizations

Harvard University, Boston, MA, Massachusetts General Hospital, Boston, MA, Medically Home, Severna Park, MD, Medically Home, Boston, MA, Massachusessets General Hospital, Boston, MA

Research Funding

Other
Medically Home Group, Inc.

Background: Patients with advanced cancer often experience frequent and prolonged hospitalizations, and the transition from hospital to home represents a critical period for these individuals, as they prefer to maximize time at home and avoid readmissions. We sought to demonstrate the feasibility and acceptability of a Supportive Oncology Care at Home intervention to address the post-discharge needs of recently hospitalized patients with advanced cancer. Methods: We conducted a single-arm pilot trial at Massachusetts General Hospital (MGH). We enrolled English-speaking adults with advanced solid tumors experiencing their second or later unplanned hospitalization, who were being discharged home without hospice services and residing within a 50 mile radius of MGH. The three-week intervention consisted of: 1) hospital in the home care model for proactive symptom assessment and management, including clinician visits to assess patients, draw labs, administer intravenous medications and hydration, and ensure optimal symptom management; 2) remote monitoring of daily patient-reported symptoms, vital signs, and body weight; and 3) structured communication with the oncology team. The primary endpoint of the study was feasibility, defined as ≥60% of approached and eligible patients enrolling and ≥60% of participants completing daily symptom assessments. After intervention completion, patients rated the helpfulness and convenience of the intervention and symptom monitoring technology. Results: From 12/2021-6/2022, we enrolled 40 out of 66 approached patients (60.6% enrollment rate). Enrolled patients (median age = 58.5 years, 50% female, 75% white, 68% married, 50% gastrointestinal cancers) completed 93.8% of daily symptom assessments. 12 patients (30%) did not complete the intervention due to withdrawal (5), hospice transfer (4), or death (3). Among enrolled patients, 20.0% were enrolled in hospice and 15.4% died at 30 days after hospital discharge. In exit interviews, 100% and 75% rated the intervention and symptom monitoring as helpful, respectively. 83% of patients found the in-home monitoring technology convenient. Conclusions: We found that a three-week Supportive Oncology Care at Home intervention is a feasible approach to providing post-discharge care for high acuity, seriously ill hospitalized patients with advanced cancer. These patients also found the intervention highly acceptable. Future studies will test the efficacy of the intervention for reducing hospital readmissions, improving symptom management and quality of life, and increasing days spent at home near the end of life. Clinical trial information: NCT04637035.

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Cost, Value, and Policy,Health Care Access, Equity, and Disparities,Patient Experience

Sub Track

Symptom Prevention, Assessment, and Management

Clinical Trial Registration Number

NCT04637035

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 295)

DOI

10.1200/JCO.2022.40.28_suppl.295

Abstract #

295

Poster Bd #

G34

Abstract Disclosures

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