Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA.
JCO Clin Cancer Inform. 2021 Oct;5:1134-1140. doi: 10.1200/CCI.21.00069.
Patients with cancer are at greater risk of developing severe symptoms from COVID-19 than the general population. We developed and tested an automated text-based remote symptom-monitoring program to facilitate early detection of worsening symptoms and rapid assessment for patients with cancer and suspected or confirmed COVID-19.
We conducted a feasibility study of Cancer COVID Watch, an automated COVID-19 symptom-monitoring program with oncology nurse practitioner (NP)-led triage among patients with cancer between April 23 and June 30, 2020. Twenty-six patients with cancer and suspected or confirmed COVID-19 were enrolled. Enrolled patients received twice daily automated text messages over 14 days that asked "How are you feeling compared to 12 hours ago? Better, worse, or the same?" and, if worse, "Is it harder than usual for you to breathe?" Patients who responded worse and yes were contacted within 1 hour by an oncology NP.
Mean age of patients was 62.5 years. Seventeen (65%) were female, 10 (38%) Black, and 15 (58%) White. Twenty-five (96%) patients responded to ≥ 1 symptom check-in, and overall response rate was 78%. Four (15%) patients were escalated to the triage line: one was advised to present to the emergency department (ED), and three were managed in the outpatient setting. Median time from escalation to triage call was 11.5 minutes. Four (15%) patients presented to the ED without first escalating their care via our program. Participant satisfaction was high (Net Promoter Score: 100, n = 4).
Implementation of an intensive remote symptom monitoring and rapid NP triage program for outpatients with cancer and suspected or confirmed COVID-19 infection is possible. Similar tools may facilitate more rapid triage for patients with cancer in future pandemics.
与一般人群相比，癌症患者患 COVID-19 后出现严重症状的风险更高。我们开发并测试了一种基于文本的自动化远程症状监测程序，以方便及早发现症状恶化，并对疑似或确诊 COVID-19 的癌症患者进行快速评估。
我们在 2020 年 4 月 23 日至 6 月 30 日期间对癌症 COVID Watch 进行了一项可行性研究，这是一个具有肿瘤护士从业者（NP）主导分诊的自动化 COVID-19 症状监测程序。共纳入 26 名患有癌症且疑似或确诊 COVID-19 的患者。在 14 天内，患者每天接受两次自动文本消息，询问“与 12 小时前相比，您的感觉如何？好一些、差一些还是一样？”如果差一些，会再问“您呼吸困难比平时更困难吗？”如果患者回答差一些且回答“是”，则在 1 小时内由肿瘤 NP 联系他们。
患者平均年龄为 62.5 岁。17 名（65%）为女性，10 名（38%）为黑人，15 名（58%）为白人。25 名（96%）患者回复了至少 1 次症状检查，总体回复率为 78%。有 4 名（15%）患者病情加重至分诊线：1 名建议去急诊就诊，3 名在门诊治疗。从病情加重到接到分诊电话的中位数时间为 11.5 分钟。有 4 名（15%）患者在未通过我们的程序首先升级其护理的情况下直接到急诊就诊。患者满意度高（净推荐值：100，n=4）。
为疑似或确诊 COVID-19 感染的癌症门诊患者实施密集远程症状监测和快速 NP 分诊程序是可行的。类似的工具可能有助于在未来的大流行中为癌症患者进行更快速的分诊。
