OnCare Connect: A Text-Based Platform to Allow for Earlier Interventions to Decrease Toxicity Progression in Oncology Patients Receiving Chemoradiation

Abstract

Patients undergoing combined chemotherapy and radiation therapy experience treatment-related toxicities and commonly have unplanned hospital visits as a result of these toxicities. Such unplanned hospital visits can lead to treatment delays and breaks, possibly compromising oncologic outcomes. A text-based platform, OnCare Connect, was used to target this clinical problem and propose a new approach to help manage cancer treatment-related toxicity. Fourteen Head & Neck and Lung cancer patients with locally advanced disease receiving concurrent chemoradiation treatment were enrolled onto OnCare Connect. Text messages were delivered using Way to Health, a HIPAA-compliant texting platform. Patients were enrolled onto OnCare Connect during their 6-7 weeks of treatment and had the option of continuing for 1 month after the end of treatment. Patients were texted at least 3 times each week for check-ins and were able to text in from 8am-8pm daily with questions. In this early phase, we explored the feasibility, safety, and acceptability of this novel technology, and used Fisher’s exact test to compare the CTCAEv4.0 toxicity outcomes of these 14 patients with matched control patients treated at our institution. From April-July 2019, 7 patients with lung cancer and 7 with head and neck cancer treated with concurrent chemoradiation were enrolled onto OnCare Connect. A total of 1,759 text messages were sent and received using Way to Health. OnCare Connect provided medical support 693 times across 867 text messages. The average time to respond to a patient-initiated text message was 3 minutes. A total of 413 treatment related symptoms were detected by OnCare Connect, of which 64 symptoms were detected prior to provider detection. These symptoms were detected an average of 4.5 days prior to first detection by a provider in clinic. Based on natural language processing, symptoms that were most frequently discussed with patients over text included fatigue, pain, nausea, diarrhea, and anorexia. Compared to 42 matched historical control patients, the 14 patients enrolled on OnCare Connect had fewer CTCAE grade 3+ toxicities (p<0.05). Patient enrolled on OnCare Connect had an average weight loss of 2.9lbs compared to 5.2 lbs. for historical control patients (p=0.12). The use of OnCare Connect resulted in fewer patient calls (p=0.08) and patient portal messages (0.04) during and after treatment completion. OnCare Connect connected, supported, and strengthened care at our institution. The patient-centered support texting platform that was created was able to detects symptoms earlier and creates pathways to support patients. OnCare Connect was additionally able to extend care capacity for care teams and provide quality and reliable care, resulting in fewer grade 3+ toxicities compared to matched control patients.