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Learning Objective 1: The learner will be able to discuss health care utilization in patients diagnosed with lung cancer.
Learning Objective 2: The learner will be able to discuss potential changes in patient outcomes when patients are compliant and non-compliant during treatment.
Method: A pilot study of home-telemonitoring (randomized clinical trial) enrolled 41 patients with lung cancer from a university hospital/cancer center. Healthcare utilization and patient outcomes, including functional status (PFSS-11), quality of life (QOL; EQ5D VAS), # ER visits/ rehospitalizations were recorded for 60-days post-hospital discharge to determine differences between groups. The ITT analytic approach was used to evaluate outcome differences for patients using compliance with data-reporting (>80% vs. <80% completion of study data). More than half of the sample (56%) was compliant (C) versus 44% non-compliant (NC).
Results: Nonparametric tests indicated no baseline differences between groups. Telemonitored group participants were more compliant than control (66.7% vs. 45%) with data reporting. At 60-days post-hospital discharge, NC-patients used more acute-care services than C-patients (frequency—ER visit: 8>7; rehospitalization: 11>7); C-patients made more calls to doctors and nurses than NC-patients (doctor calls:12> 5;nurse calls:42>13). Compliance with telemonitoring was greater when cancer was diagnosed <one year (92%), dyspnea and pain were lower (80% NRS<5), functioning better (58.3% PFSS-11 mean score >3) and QOL higher (66.7% > 60). Although not statistically significant (p >.05), results trended to more positive outcomes for telemonitoring compared to control.
Conclusion: Data suggest improved outcomes with home telemonitoring and lower acute-care utilization. As a pilot, sample size was limited and lack of statistical significance anticipated. The pilot supports using this RCT protocol for a larger study to validate outcomes. Also, enrolling earlier stage oncology patients might maximize intervention benefits and minimize attrition.