The simple text message has emerged as a potential antidote to cancer patients’ “time toxicity” – the detrimental amount of time spent commuting to, waiting for and receiving treatment.
In recent years, researchers have worked to quantify the disproportionate level of time cancer patients spend on their treatment, which can also include picking up prescriptions, getting test results and meeting with clinicians.
But a new pilot study has shown that it is possible to use digital technology – in the form of a text messaging system – to safely reduce this time burden.
The system enabled patients to save more than an hour at each visit captured by the study, which was led by researchers from the Perelman School of Medicine at the University of Pennsylvania and Penn Medicine’s Abramson Cancer Center.
“Patients with cancer spend an enormous amount of time engaging with the health care system, and for patients with advanced cancer in particular, that time is precious,” said senior author Ronac Mamtani.
“We developed a safe and effective platform that—for certain patients—could really challenge the status quo and give them quality time back.”
The system was inspired by the efficiency of pre-checkin systems at airports which can help to bypass long queues.
Patients receiving immunotherapy for cancer treatment are currently required to complete bloodwork and meet with their health care team in the office before every infusion to confirm they have not developed any concerning symptoms that might signal a reaction to the immunotherapy and a need to pause treatment.
The pre-treatment symptom check is a necessary safety measure that many patients treated with immunotherapy pass with flying colors, given the relatively low rate of side effects for immunotherapy compared to traditional chemotherapy.
In the pilot clinical trial, patients receiving single-agent immunotherapy for solid tumour cancers were enrolled and randomised to either an in-person pre-infusion symptom check in the office with their provider, or to complete a 16-question symptom check, estimated to take less than five minutes, via the text message platform.
If their labs were normal and no symptoms were reported, patients were given the option to fast-track and bypass the in-person visit, proceeding directly to their immunotherapy infusion.
The 16 patients who were fast-tracked saved more than 60 minutes per visit, including 30 minutes less wait time, than the 15 patients who were randomised to continue with the usual in-person visit.
More importantly, the fast-track system was safe, with no difference in post-infusion hospital visits or health-related quality of life impact compared to usual care.
Co-lead author Erin Bange said: “Considering that patients who consented for the study told us that saving even 45 minutes per visit would significantly impact their lives, we were excited to see that our first test of this tool surpassed expectations, giving patients even more time back each time they went in for treatment.”
While patient-reported outcomes have been used in other studies to assess various quality of life measures, the authors note that this study is the first time digital patient-reported outcomes have been used to streamline cancer care delivery.
A total of 19 additional patients who reported their symptoms via the text message platform were eligible for fast-track, but ended up continuing with the in-person visit instead, due to patient preference, provider preference, or other care coordination issues.
The study team emphasised that some patients may prefer to continue in-person visits, and the team’s vision for the text message platform is to be an option for patients who want to use it, rather than a one-size-fits-all approach.
The team also conducted focus groups with health care providers to better understand any concerns about the fast-track process and potential barriers to broader implementation.
