Author(s)
Sallie M Long, MD
Michael Hannon, MPA
Siddharth S Kumar, BS
Megan Graham, DNP
Marc A Cohen, MD, MPH
Jennifer R Cracchiolo, MD
Affiliation(s)
NewYork-Presbyterian Hospital/Weill Cornell Medical Center; Patient-Reported Outcomes Center, Department of Surgery, Memorial Sloan Kettering Cancer Center; Health Informatics, Memorial Sloan Kettering Cancer Center; Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
Abstract:
Background: In head and neck surgery, despite significant complexity and high symptom burden, a significant portion of patients’ recovery time is spent at home. We present an electronic platform for remote symptom monitoring developed and implemented for patients with head and neck cancer.
Methods: Post hospital discharge days 1-10, patients report their symptoms via an electronic questionnaire delivered through an in-house developed informatics platform. Head and neck-specific content was developed with input from a multidisciplinary team (physicians, nurses, administrators, patients) and adapted from the National Cancer Institute’s validated symptom assessment instrument (Patient-Reported Outcomes version of the Common Terminology for Adverse Events (PRO-CTCAETM)). Fifteen total symptom domains are assessed using a Likert scale for severity. Moderate severity prompts a “yellow alert,” notifying the nursing team that follow-up with the patient is necessary. Severe symptoms prompt a “red alert,” notifying the nursing team to urgently contact the patient. Patients were considered to be “responders” if they completed at least one survey.
Results: From 5/4/21—2/1/22, 339 head and neck surgical discharges have been enrolled in remote symptom monitoring, of which 256 (76%) were responders. The median time for survey completion was 1 minute and a median of 5 out of 10 surveys were completed. 54.7% of responders (n=140) generated an alert, of which 29% (n=40) were “red” (severe) and 71% (n=100) were “yellow” (moderate). Across the whole cohort, pain was the most common cause for alert (n=6 red, 2%; n=29 yellow, 11%), followed by constipation (n=21 yellow, 8%).
Conclusion: The implementation of this platform has allowed for head and neck surgical patients to be closely monitored after discharge. This is feasible and over 3/4 of patients respond at home. Electronic reporting provides an additional mechanism of communication between the patient and the clinical team, with the potential for early intervention. Further research is ongoing to determine if remote monitoring results in improved clinical outcomes and decreased acute care visits.