MSK Thoracic oncologist Robert Daly, MD, MBA, leads clinical trials that are advancing high-quality cancer care at home, which can reduce burdens on cancer patients and their care givers and expand access to more people.
Robert Daly, MD, MBA, a thoracic oncologist at Memorial Sloan Kettering, presented important new research about delivering high quality cancer care at home during the 2024 ASCO conference, the nation’s premier cancer conference.
This research focuses on incorporating telemedicine visits with carefully considered services and technology to provide care in a patient’s own home, reducing the burdens associated with traveling for appointments and widening access to help more people.
“Cancer care has evolved over the last few decades from inpatient therapies delivered in a hospital to outpatient treatment and then care at regional and community sites,” Dr. Daly explains. “The next frontier is delivering safe and effective treatment at home, which can help patients and care givers by making care less stressful and reducing concerns like time and financial toxicities that limit people’s access to high quality care.”
Cancer Care at Home Tested In a Clinical Trial
Dr. Daly presented research at ASCO on two separate but mutually reinforcing projects.
The first was a clinical trial to help determine if quality care in the home could reduce the number of in-clinic visits patients needed to be treated with a type of immunotherapy, which helps the body’s own immune system fight cancer.
The trial, which remains open, enrolled 27 people, ranging in age from 45 to 85, who are facing a variety of cancer types, including lung cancer, bladder and kidney cancer, and melanoma. All participants are being treated with pembrolizumab, a widely used form of immunotherapy known as a checkpoint inhibitor.
“Typically, a patient needs to come into a clinic every 3 weeks for an infusion of pembrolizumab,” explains Dr. Daly. “This can be a real burden on patients and caregivers who may need to take time off from work, figure out how to travel—which can be particularly challenging and painful during cancer treatment—and spend money on transportation, parking, and many other expenses.”
He continues, “our goal in this trial is to see if giving more care at home could mean people would only need to come to clinic every six weeks instead of three – thus reducing by half their number of clinic visits.”
How Patient Benefits From Cancer Care At Home
For the trial, participants were given a pulse oximeter to measure their blood oxygen level and heart rate, and they had regular telehealth visits with their oncologists as well as computer surveys to monitor their condition. MSK also hired technicians called phlebotomists to draw patients’ blood at home for lab tests, which were analyzed at MSK.
“We define this as enhanced telemedicine,” says Dr. Daly. “There is no daylight between the services they would receive in clinic and what they receive at home—this is the same high level of care.”
Patients were asked to rate their experience on a scale of 0-10, and the median score was 9, which is characterized as “excellent.” Overall, 94% of patients said they perceived a benefit to the program, particularly in terms of saved time and patient convenience. More than three-quarters also found the at-home visits less stressful than those in-person.
“Patients and caregivers told me this is of real value to them,” says Dr. Daly. “They say it saves them a lot of time and money and stress to not have to take so much time off work or find childcare or interrupt other competing activities in their lives. As healthcare providers, we ask a lot of people being treated for cancer. High quality care at home where appropriate puts the needs of the patients first.”
Dr. Daly says at home care also delivers on the promise of better access to cancer care for everyone. “One of the patients I treat for lung cancer joined the study, in part because his family would have to drive him 2 hours each way for a clinic visit. Now he and I can have an appointment by telehealth, and his family from all over the country can join us to ask questions.”
Learn more about this family’s experience on the trial
“The care we’re able to deliver at MSK should be available to all patients,” explains Dr. Daly. “Using these technologies really helps us deliver on that goal. We can even treat patients globally—one of the people who took part in the study lives in the Philippines.”
Integrative Medicine at Home Improves Quality of Life
The second project presented at ASCO involved the use of telehealth to deliver Integrative Medicine. MSK has long used complementary therapies, known as Integrative Medicine, alongside conventional cancer treatments to improve outcomes and quality of life, including reducing side effects.
In this research study, these therapies featured live movement classes taught over telehealth that included fitness, yoga, dance therapy and tai chi, as well as mediation and music therapy classes. They were compared to meditation and mindfulness classes that were recorded on video and could be accessed at any time.
“We found that people who took part in live, virtual classes reported fewer symptoms and had less unexpected hospitalizations,” says Dr. Daly. “In fact, unexpected hospitalizations went down by half, which is significant.”
Dr. Daly points out that “nearly half of cancer care expenditures are because of unexpected hospitalizations. And we know that many people facing cancer can’t come into a clinic to attend a yoga or meditation class.” He continues, “Having a live class offered on a telehealth platform really helps. It gives people a chance to be active, form social connections, and reduce stress, which in turns reduces fatigue and other symptoms from their cancer and treatment.”
Both of these trials were undertaken as part of an overarching efforts at MSK focused on telemedicine and in part funded by a grant from the federal government’s National Cancer Institute. With this funding, MSK has established the MATCHES (MAking Telehealth Delivery of Cancer Care at Home Efficient and Safe) Center in order to study the appropriate use of telehealth to improve access to cancer care that is convenient, effective and safe for patients.
Dr. Daly concludes, “I think MSK has made a lot of advances in this field in discovering how technology, including telehealth, can be used to enhance patient-centered care.”