Teleconsultation: An importatnt tool leading to a paradigm shift in the management of maintenance phase chemotherapy of acute lymphoblastic leukemia

ABSTRACT

Background: The COVID-19 pandemic severely impacted patients with acute lymphoblastic leukemia(ALL) in maintenance phase of chemotherapy. Teleconsultation was introduced to ensure continuity of care for these patients during the lock-down phase of the pandemic and was continued well after its end. Hence, we decided to analyze the impact of teleconsultation in a cohort of ALL patients. Method(s) Our study was a single-centre retrospective analysis of patients with ALL on maintenance chemotherapy. Thirty-five patients records were analyzed, comparison was made between absolute neutrophil counts (ANC) and frequency of consultations before and after the start of teleconsultation, which included 2-weekly phone calls, necessitating visit only once in 3 months as opposed to a monthly visit as required before. Hemograms were done twice a month and sent on WhatsApp. Consultations were done via phone calls and prescriptions sent via WhatsApp. Result(s) The median [IQR] age of our cohort was 7.5 [4.2;9.3] years and age at diagnosis was 5.4 [2.3;7.5] years;23/35 (66%) were male and 30/35 (88%) were phenotypically B-ALL;rest T-ALL/Lymphoma. All patients received chemotherapy as per the ICiCLE (Indian Collaborative Childhood Leukaemia group) protocol. A total of 437 teleconsultations were done (73/month). Before teleconsultation, the mean (SD) ANC was 2272 (644)//microL, and after teleconsultation it was 1754 (461)/microL (p value=0.0001). Teleconsultation improved target ANC (<2000/microL) attainment in our cohort of patients (31% vs 80%, p value=0.0002). Prior to teleconsultation, majority (27/35, 77%) visited the hospital once a month which reduced to once in 3 months, after teleconsultation. Conclusion(s) Teleconsultation is time saving, economical and reduces the gap in schooling in a child with ALL. It also helps optimize compliance during this maintenance phase of chemotherapy, a key in management of leukemia patients, contributing to the continuum of care and improvement in overall survival of these patients. Copyright © 2022