A Text Message Intervention to Minimize the Time Burden of Cancer Care.

Patients with cancer spend considerable time commuting to, waiting for, and receiving health care. Patient-reported outcomes have been collected electronically to monitor patients for toxicity related to treatment, but, to the authors' knowledge, they have not been used as a strategy to minimize patients' time spent on cancer care by streamlining care delivery. Researchers at Penn Medicine set an objective to assess the effectiveness and implementation of a text message-based symptom reporting electronic triage (e-triage) versus usual care to minimize the time toxicity associated with ambulatory cancer care. The methods employed included a hybrid type 1 effectiveness-implementation, unblinded, randomized controlled trial and sequential mixed-methods study, which was conducted between December 1, 2021, and December 31, 2022, with a follow-up period of 3 months or three visits (whichever came first, but all within the 2-year window). Adult patients with solid tumors receiving single-agent immune checkpoint inhibitors (ICIs) with access to a text-messaging device were enrolled, with a target sample size of 176. The intervention was a symptom-based e-triage via mobile text messaging combined with routine laboratory testing. Participants in the e-triage group with normal bloodwork and no symptoms of drug toxicity on e-triage were eligible to fast-track to ICI infusion, bypassing the pretreatment office visit. The primary end point was total time per ambulatory encounter; secondary end points included wait time, ED or hospital visits, health-related quality of life, patient satisfaction, and implementation (reach and fidelity). Implementation readiness (acceptability, appropriateness, and feasibility), barriers, and facilitators were evaluated in a mixed-methods analysis among treating oncologists, measured via surveys and focus groups. For the study, 40 patients were randomly assigned, of which 31 were evaluated for the primary end point; the median age among the 40 participants was 67.5 years of age (interquartile range 59.5-71.5 years of age), 80.0% were male, and 84.6% were white. Those randomly assigned to the e-triage group of the pilot randomized controlled trial (n=19, n=16 evaluable) had an average of 66.0 minutes less total time (95% confidence interval [CI], -123.7 to -8.08 minutes;