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BMJ ; 375: e066588, 2021 12 08.
Article in English | MEDLINE | ID: covidwho-1560914


OBJECTIVE: To evaluate the effectiveness of remote proactive management of toxicities during chemotherapy for early stage breast cancer. DESIGN: Pragmatic, cluster randomised trial. SETTING: 20 cancer centres in Ontario, Canada, allocated by covariate constrained randomisation to remote management of toxicities or routine care. PARTICIPANTS: All patients starting adjuvant or neoadjuvant chemotherapy for early stage breast cancer at each centre. 25 patients from each centre completed patient reported outcome questionnaires. INTERVENTIONS: Proactive, standardised, nurse led telephone management of common toxicities at two time points after each chemotherapy cycle. MAIN OUTCOME MEASURES: The primary outcome, cluster level mean number of visits to the emergency department or admissions to hospital per patient during the whole course of chemotherapy treatment, was evaluated with routinely available administrative healthcare data. Secondary patient reported outcomes included toxicity, self-efficacy, and quality of life. RESULTS: Baseline characteristics of participants were similar in the intervention (n=944) and control arms (n=1214); 22% were older than 65 years. Penetration (that is, the percentage of patients who received the intervention at each centre) was 50-86%. Mean number of visits to the emergency department or admissions to hospital per patient was 0.91 (standard deviation 0.28) in the intervention arm and 0.94 (0.40) in the control arm (P=0.94); 47% (1014 of 2158 patients) had at least one visit to the emergency department or a hospital admission during chemotherapy. Among 580 participants who completed the patient reported outcome questionnaires, at least one grade 3 toxicity was reported by 48% (134 of 278 patients) in the intervention arm and by 58% (163 of 283) in the control arm. No differences in self-efficacy, anxiety, or depression were found. Compared with baseline, the functional assessment of cancer therapy trial outcome index decreased by 6.1 and 9.0 points in the intervention and control participants, respectively. CONCLUSIONS: Proactive, telephone based management of toxicities during chemotherapy did not result in fewer visits to the emergency department or hospital admissions. With the rapid rise in remote care because of the covid-19 pandemic, identifying scalable strategies for remote management of patients during cancer treatment is particularly relevant. TRIAL REGISTRATION: NCT02485678.

Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Breast Neoplasms/drug therapy , Monitoring, Ambulatory/methods , Outpatients , Telemedicine , Telephone , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Breast Neoplasms/psychology , COVID-19 , Chemotherapy, Adjuvant/adverse effects , Drug-Related Side Effects and Adverse Reactions , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Middle Aged , Ontario , Pandemics , Quality of Life , SARS-CoV-2 , Surveys and Questionnaires , Treatment Outcome
JCO Oncol Pract ; 16(7):363-368, 2020.
Article in English | MEDLINE | ID: covidwho-726000


The 2020 severe acute respiratory syndrome coronavirus 2 pandemic has led to an increasing number of telemedicine clinician-patient encounters through telephone or videoconference. This provides a particular challenge in cancer care, where discussions frequently pertain to serious topics and are preferably performed in person. In this review, we use the SPIKES (Setting, Perception, Invitation, Knowledge, Empathy/Emotion, and Strategy/Summarize) protocol as a framework for how to approach the discussion of serious news through telemedicine. We discuss the practical and technical aspects of preparation for a remote conversation and review some differences, limitations, and advantages of these discussions. The greatest challenge with the medium is the loss of the ability to read and display nonverbal cues. Vigilant attention to proven communication strategies and solicitation of patient involvement with the discussion can allow the care provider to display empathy at a distance. Having serious discussions through telemedicine is likely unavoidable for many providers in this unprecedented time. This summary provides some strategies to help to maintain the high standard of care that we all seek for our patients who are receiving serious news.

Non-conventional | WHO COVID | ID: covidwho-291851


Early published data on COVID-19 in patients with cancer are being referenced in clinical guidelines, despite methodological flaws that limit the quality of much of this evidence. In the next phase of research in this area, we argue that the quality of observational evidence should be prioritized over speed of publication.