Abstract
Background: In patients with hematological malignancies, infections due to treatment toxicities or underlying disease are a common reason for unplanned hospitalizations. Prompt use of prophylactic oral broad-spectrum antibiotics can reduce the need for hospitalization. We examined the impact of using Canopy's proprietary ePRO-based Remote Therapeutic Monitoring Program (RTM) system on the use of oral antibiotics and associated impact on hospitalizations in a cohort of hematology patients being treated with systemic therapy.
Methods: Patients treated at Highlands Oncology Group, a community oncology practice in Arkansas, were offered enrollment on Canopy RTM. Participation was voluntary, and patients who elected to submit symptom reports constituted the RTM group. Patients with hematological malignancies, including multiple myeloma, lymphoma, chronic leukemias, and other malignant hematological disorders, receiving systemic therapy were included. RTM symptom notifications were monitored by a dedicated triage nursing staff. Symptoms that exceeded a pre-determined severity threshold were evaluated by this nursing staff for further evaluation including telephonic triage, urgent outpatient office evaluation or referral to the emergency department or hospital. Hospitalization events were documented in the Arkansas health information exchange. Inverse probability of treatment weighting was used to account for potential non-random selection of patients into the RTM group when performing statistical tests of difference.
Results: Over the two years following first anticancer treatment after diagnosis through data cutoff date, 349 patients submitted RTM reports within 30 days of first treatment and 1,296 patients were treated but not enrolled. The median age of enrolled and reporting patients was 67 and not enrolled was 70. Males and females were equally represented. Diagnoses in the two groups were similar, with the most common being NHL, multiple myeloma and CLL. RTM patients had a significant reduction infection-related inpatient stays (2.6% vs 4.5%, weighted p = 0.0147, RR 0.48, 95% CI 0.24 to 0.96) as well as significantly fewer infection-related emergency room visits (6.6% vs. 9.4%, weighted p = 0.047, RR 0.72, 95% CI 0.45 to 1.15). In addition, RTM patients received significantly more oral antibiotics (38% vs. 29%, p < 0.0125).Conclusions: Use of RTM in patients with hematological malignancies reduces the risk of hospitalization due to infection, likely due to earlier administration of outpatient oral antibiotics. In addition, RTM reduces the need for emergency room evaluation of infection related symptoms. Broad implementation of RTM presents a readily scalable strategy to decrease infection-associated hospitalizations, reduce costs, and enhance the safe administration of therapeutics linked to an increased risk of infection.
