CLINICAL

Tracking CINV Via Texts Cuts Admissions, Urgent Care

Apharmacist-led remote monitoring program to track cancer patients experiencing chemotherapy-induced nausea and vomiting (CINV) using text messaging resulted in a marked reduction in urgent care and emergency department (ED) visits, according to researchers at the University of Michigan.

“We were very excited about this,” said lead study author Shannon Hough, PharmD, the pharmacy manager for oncology clinical services at the university’s Rogel Cancer Center, in Ann Arbor. “When you’re looking to modify a metric like ED use, any movement improves patient outcomes and the overall quality of care we’re providing. We were thrilled to see that this intervention looks like it makes a difference in those outcomes.”

During their pilot program, Dr. Hough and her colleagues sent text messages to nearly 400 chemotherapy patients and intervened if patients reported severe symptoms, she reported at the 2020 virtual annual meeting of the American Society of Clinical Oncology (abstract 2001). After eight months of the program, they found that combined hospitalization, ED visits and urgent care use were nearly halved in this population. Visits fell from 234 before the program started to 118 during the program (P=0.029).

Dr. Hough’s team started the program to reduce the number of patients seeking unplanned care, which often is related to nausea and vomiting. Patients at the main infusion center who were receiving chemotherapy agents likely to induce nausea and vomiting and given an NK-1 antagonist were asked to enroll in the program, which sent a daily text message for seven days after treatment. The text included questions based on

the validated MASCC (Multinational Association for Supportive Care in Cancer) anti-emesis tool (MAT), asking if patients experienced vomiting, how many times, and how bad their nausea was on a 1-10 scale. Their responses were tracked in the electronic health record (EHR), and patients who reported significant difficulties were flagged in an email to the team pharmacists. From there, pharmacists called patients to assess whether they could adjust medications, refer their call to a nurse or provider, or ask the patient to come to the clinic.

Of 652 patients who received an NK-1 antagonist, 387 (59%) enrolled in the pilot program. Each patient participated for an average of 1.8 chemotherapy cycles. The text message response rate was 94% (18,143 responses to 19,256 messages sent). During 861 cycles of therapy (51.7% with curative intent; 48.3% palliative), 7% of responses noted vomiting and 33% reported nausea.

Comparing health care utilization before and after the service began, hospital admissions (ED, inpatient and observation units) declined from 124 to 80 visits; nausea-related admissions dropped from 22 to seven visits; urgent care visits dropped from 110 to 38 visits; and nausea-related urgent care visits dropped from 23 to seven visits.

Feedback has been positive, Dr. Hough said. “When I call patients, they are so relieved that I’m reaching out to them. I think patients sometimes feel bad calling, like they’re bothering somebody and they don’t know if something is bad enough to call. We’re removing that worry by just reaching out to them.”

The team plans to expand the service to satellite infusion centers, Dr. Hough said.

“People don’t always think about pharmacists as your front-line and triage team member, but modifying medications already prescribed to patients, providing education and breaking down barriers” when patients may hesitate to take medications that have been prescribed “is something that we frequently do in these visits, and that’s a perfect role for our clinical pharmacists,” she said.

Linking to Electronic Record Beneficial

Using the MAT tool in this program is helpful because nausea and vomiting can be subjective, commented Cindy O’Bryant, PharmD, a professor of clinical pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, in Aurora. “This will help sort out which patients are really having issues and which may not be, and can eliminate bringing in people who may not need additional health care resources.”

Linking to the EHR also is helpful because the entire health care team can see results, Dr. O’Bryant said. Because half of the study population was receiving curative treatment, that helped the team stay on top of treating adverse events so patients remained adherent to their prescribed therapies.

More information, including interventions used to prevent admissions, provider workload and other programmatic resources, as well as the total economic impact of the program, would have been helpful, Dr. O’Bryant said, adding that this information could help determine the feasibility of implementing a similar program at other institutions. —Karen Blum