Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer

Abstract Background Chemotherapy is associated with a significant risk of toxicity, which often peaks between ambulatory visits to the cancer centre. Remote symptom management support is a tool to optimize self-management and healthcare utilization, including emergency department visits and hospital...

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Main Authors: Monika K. Krzyzanowska, Cassandra MacKay, Heekyung Han, Maria Eberg, Sonal Gandhi, Nicole B. Laferriere, Melanie Powis, Doris Howell, Clare L. Atzema, Kelvin K. W. Chan, Vishal Kukreti, Sandra Mitchell, Marla Nayer, Mark Pasetka, Dafna Knittel-Keren, Erin Redwood
Format: Article
Language:English
Published: BMC 2019-03-01
Series:Pilot and Feasibility Studies
Subjects:
Online Access:http://link.springer.com/article/10.1186/s40814-019-0404-y
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author Monika K. Krzyzanowska
Cassandra MacKay
Heekyung Han
Maria Eberg
Sonal Gandhi
Nicole B. Laferriere
Melanie Powis
Doris Howell
Clare L. Atzema
Kelvin K. W. Chan
Vishal Kukreti
Sandra Mitchell
Marla Nayer
Mark Pasetka
Dafna Knittel-Keren
Erin Redwood
author_facet Monika K. Krzyzanowska
Cassandra MacKay
Heekyung Han
Maria Eberg
Sonal Gandhi
Nicole B. Laferriere
Melanie Powis
Doris Howell
Clare L. Atzema
Kelvin K. W. Chan
Vishal Kukreti
Sandra Mitchell
Marla Nayer
Mark Pasetka
Dafna Knittel-Keren
Erin Redwood
author_sort Monika K. Krzyzanowska
collection DOAJ
description Abstract Background Chemotherapy is associated with a significant risk of toxicity, which often peaks between ambulatory visits to the cancer centre. Remote symptom management support is a tool to optimize self-management and healthcare utilization, including emergency department visits and hospitalizations (ED+H) during chemotherapy. We performed a single-arm pilot study to evaluate the feasibility, acceptability, and potential impact of a telephone symptom management intervention on healthcare utilization during chemotherapy for early stage breast cancer (EBC). Methods Women starting adjuvant or neoadjuvant chemotherapy for EBC at two cancer centres in Ontario, Canada, received standardized, nurse-led calls to assess common toxicities at two time points following each chemotherapy administration. Feasibility outcomes included patient enrollment, retention, RN adherence to delivering calls per the study schedule, and resource use associated with calls; acceptability was evaluated based on patient and provider feedback. Impact on acute care utilization was evaluated post hoc by linking individual patient records to provincial data holdings to examine ED+H patterns among participating patients compared to contemporaneous controls. Results Between September 2013 and December 2014, 77 women were enrolled (mean age 55 years). Most commonly used regimens were AC-paclitaxel (58%) and FEC-docetaxel (16%); 78% of patients received primary granulocyte colony-stimulating factor prophylaxis. 83.8% of calls were delivered per schedule; mean call duration was 9 min. The intervention was well received by both patients and clinicians. Comparison of ED+H rates among study participants versus controls showed that there were fewer ED visits in intervention patients [incidence rate ratio (IRR) (95% CI) = 0.54 (0.36, 0.81)] but no difference in the rate of hospitalizations [IRR (95% CI) = 1.02 (0.59, 1.77)]. Main implementation challenges included identifying eligible patients, fitting the calls into existing clinical responsibilities, and effective communication to the patient’s clinical team. Conclusions Telephone-based pro-active toxicity management during chemotherapy is feasible, perceived as valuable by clinicians and patients, and may be associated with lower rates of acute care use. However, attention must be paid to workflow issues for scalability. Larger scale evaluation of this approach is in progress.
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spelling doaj.art-18311f20f6d743bbaaf68fe0a143fc952022-12-21T18:57:58ZengBMCPilot and Feasibility Studies2055-57842019-03-015111210.1186/s40814-019-0404-yAmbulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancerMonika K. Krzyzanowska0Cassandra MacKay1Heekyung Han2Maria Eberg3Sonal Gandhi4Nicole B. Laferriere5Melanie Powis6Doris Howell7Clare L. Atzema8Kelvin K. W. Chan9Vishal Kukreti10Sandra Mitchell11Marla Nayer12Mark Pasetka13Dafna Knittel-Keren14Erin Redwood15Cancer Care OntarioCancer Care OntarioCancer Care OntarioCancer Care OntarioSunnybrook Regional Health Sciences CentreThunder Bay Regional Health Sciences CentreUniversity Health NetworkUniversity Health NetworkSunnybrook Regional Health Sciences CentreSunnybrook Regional Health Sciences CentreUniversity Health NetworkNational Cancer InstituteUniversity of TorontoSunnybrook Regional Health Sciences CentreUniversity Health NetworkCancer Care OntarioAbstract Background Chemotherapy is associated with a significant risk of toxicity, which often peaks between ambulatory visits to the cancer centre. Remote symptom management support is a tool to optimize self-management and healthcare utilization, including emergency department visits and hospitalizations (ED+H) during chemotherapy. We performed a single-arm pilot study to evaluate the feasibility, acceptability, and potential impact of a telephone symptom management intervention on healthcare utilization during chemotherapy for early stage breast cancer (EBC). Methods Women starting adjuvant or neoadjuvant chemotherapy for EBC at two cancer centres in Ontario, Canada, received standardized, nurse-led calls to assess common toxicities at two time points following each chemotherapy administration. Feasibility outcomes included patient enrollment, retention, RN adherence to delivering calls per the study schedule, and resource use associated with calls; acceptability was evaluated based on patient and provider feedback. Impact on acute care utilization was evaluated post hoc by linking individual patient records to provincial data holdings to examine ED+H patterns among participating patients compared to contemporaneous controls. Results Between September 2013 and December 2014, 77 women were enrolled (mean age 55 years). Most commonly used regimens were AC-paclitaxel (58%) and FEC-docetaxel (16%); 78% of patients received primary granulocyte colony-stimulating factor prophylaxis. 83.8% of calls were delivered per schedule; mean call duration was 9 min. The intervention was well received by both patients and clinicians. Comparison of ED+H rates among study participants versus controls showed that there were fewer ED visits in intervention patients [incidence rate ratio (IRR) (95% CI) = 0.54 (0.36, 0.81)] but no difference in the rate of hospitalizations [IRR (95% CI) = 1.02 (0.59, 1.77)]. Main implementation challenges included identifying eligible patients, fitting the calls into existing clinical responsibilities, and effective communication to the patient’s clinical team. Conclusions Telephone-based pro-active toxicity management during chemotherapy is feasible, perceived as valuable by clinicians and patients, and may be associated with lower rates of acute care use. However, attention must be paid to workflow issues for scalability. Larger scale evaluation of this approach is in progress.http://link.springer.com/article/10.1186/s40814-019-0404-yBreast cancerSymptom managementChemotherapy toxicityTelephone case managementQuality improvement
spellingShingle Monika K. Krzyzanowska
Cassandra MacKay
Heekyung Han
Maria Eberg
Sonal Gandhi
Nicole B. Laferriere
Melanie Powis
Doris Howell
Clare L. Atzema
Kelvin K. W. Chan
Vishal Kukreti
Sandra Mitchell
Marla Nayer
Mark Pasetka
Dafna Knittel-Keren
Erin Redwood
Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
Pilot and Feasibility Studies
Breast cancer
Symptom management
Chemotherapy toxicity
Telephone case management
Quality improvement
title Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
title_full Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
title_fullStr Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
title_full_unstemmed Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
title_short Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
title_sort ambulatory toxicity management atom pilot results of a pilot study of a pro active telephone based intervention to improve toxicity management during chemotherapy for breast cancer
topic Breast cancer
Symptom management
Chemotherapy toxicity
Telephone case management
Quality improvement
url http://link.springer.com/article/10.1186/s40814-019-0404-y
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