Managing Cancer Care at Home With Kathi Mooney, PhD, RN, FAAN
At the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Kathi Mooney, PhD, RN, FAAN, Professor in the College of Nursing at the University of Utah, sat down with Oncology Data Advisor to discuss her presentation and abstract about remote symptom management and the Huntsman at Home Rural Experience.
This podcast episode was recorded live at the 2022 ASCO Annual Meeting in Chicago by Oncology Data Advisor and ConveyMed.
Oncology Data Advisor: Welcome to Oncology Data Advisor, I'm Keira Smith. Today, I'm here at the ASCO Annual Meeting in Chicago, and I'm speaking with Kathi Mooney from Huntsman Cancer Institute. Thank you so much for joining us. Would you like to tell us a little bit about what you do?
Kathi Mooney, PhD, RN, FAAN: Yes. Thank you for having me. I am Kathi Mooney, and I am from the University of Utah where the Huntsman Cancer Institute is, and I am here presenting two pieces of our research that we have done. My interest area is in home-based cancer care, and I have studied two aspects. One is remote symptom monitoring for patients who are at home, and the other is an oncology hospital at home program. We had a poster yesterday on our rural-based program. We have a program, both for the hospital at home in Salt Lake City, and we also have one in three remote counties in Utah, in southeastern counties, where patients come to Huntsman and it's a two- to five-hour drive. We're trying to provide more support to them, particularly in the area of symptom management within their communities.
Oncology Data Advisor: Great. Could you tell us a little bit about the background for this first abstract, about remote symptom management, and then also the results that you found?
Dr. Mooney: Yes. That's a presentation that we have researched that's been working on this remote symptom management program called Symptom Care at Home for about 20 years. We have developed it, trying to address the symptoms that occur commonly for patients at home, while they're on active treatment, that often take them to the emergency department and cause re-hospitalization. So, Symptom Care at Home monitors patients' symptoms on a daily basis, identifying what symptoms are present and their severity levels. Then the system provides automatic coaching to the patient on those particular symptoms they've expressed they had at the severity level they've had. It takes the symptom management education and gives it to patients at the moment they need it because they're experiencing the symptom at the level of severity, whether it is mild symptoms or moderate symptoms.
The third piece is symptoms that are at moderate to severe levels; Symptom Care at Home triggers an alert to a nurse practitioner who calls the patient back for more assessment and improvement in the symptom management. We've been doing this research for about 20 years—it's a very effective system. We published on it in 2017 and showed that it about cut in half the symptom experience of patients who utilized the system while they were at home. The presentation at ASCO this year is breaking down those components—the assessment, the automated coaching, and the nurse practitioner follow-up—to identify, "Do you need all three of those pieces for optimal symptom management, or would just the coaching be enough, just the nurse practitioner be enough?"
Oncology Data Advisor: Great. Are there any future plans for this research and how it can be implemented into practice?
Dr. Mooney: That's a good question because that's exactly the point we're at. And the reason we did the study is to see if we're going to now implement this into practice, what components do we need? So, our next step is to do a study about what is the best workflow and ways to actually embed it within clinical practices.
Oncology Data Advisor: Thank you so much for explaining. And I know you have another abstract here about the Huntsman at Home Rural Experience; would you like to tell us about that one?
Dr. Mooney: Yes, and that goes back to our Huntsman at Home Program that we began in 2018. We initially started with patients who lived within a 20-mile radius of our cancer center, so the Salt Lake City area. And one of the things we wanted to address after we established the efficacy for that program is that we wanted to improve access to patients who lived at a distance from the cancer program. As you develop programs and outreach, you don't want it just to be people who are within a 30-minute drive of the hospital. You really have to look at how to address patients who live remotely. In our area of the country, there are a lot of rural communities at a distance from the cancer center, but we're the cancer center and so they come for treatment. The question, is how can we provide them support within their communities that are low resourced in terms of oncology services?
In these three communities in Southeastern Utah, where we have our rural program, there are no oncologists, or oncology nurses; there are two very small local hospitals, and we probably have 250 or 300 patients at any one time living in those areas and receiving active treatment, having all the same side effects and symptom issues as our patients who live closer to Huntsman, but without the resources to help address them. So, part of our program, which is what we reported on this poster, was the first 47 patients we had and their experiences with it, and how we set it up in the rural area.
Oncology Data Advisor: What were the results that you found that were in the poster?
Dr. Mooney: Well, we found that the Huntsman at Home Rural Experience was very effective, and it was very effective for traditional problems that we see: dehydration, nausea and vomiting, not-well-controlled pain issues, infections that need IV antibiotics, and other common side effects. Side effects were both of treatment, and then also issues related to disease progression. We are able, with a nurse practitioner and a nurse navigator, to effectively deal with that and prevent hospitalizations both back at Huntsman, but also within the rural area of the local hospitals. I think the important thing is these communities are also low-income communities. And one of the things that was very evident to us is social determinants of health and how they impact and add to the cancer burden.
Now, the main thing, as you would guess, is transportation to go to Huntsman for appointments. And that is a serious issue. It's a serious issue for everybody in putting gas in their cars. But imagine if you were coming up every other week on a five-hour trip, 10 hours round trip, and the additional out-of-pocket cost to receive your cancer care with the gas prices. So, transportation is a major issue for about half of the patients out there.
We also found about 20% who have issues with food insecurity. An example is of a patient who'd had surgery at Huntsman and was discharged home, and it was towards the end of the month; their finances had run out by then, and they came home to a house with no food in it. The issue of how to tide them over and yet also have adequate nutrition during a surgical recovery time is very important. So, you see the intersectionality of the issues of resources for these patients and getting their cancer care.
Oncology Data Advisor: Absolutely, and I'll ask the same question for this one. How can this program be implemented into practice on a broader level?
Dr. Mooney: Well, the major thing that has held back hospital at home–type programs is adequate reimbursement for them, because they require much more resources and care than traditional home health. Reimbursement right now, which is primarily based on home health and people's insurance, is inadequate for the intensity of the level of the care. If otherwise, you would need to be hospitalized or in a long emergency department (ED) stay to be rehydrated. And you can see that just home health visits do not adequately cover the cost. So there really is a national effort to try to improve reimbursement and look at home-based care now as more of a given in cancer care and other parts of care. These are really demonstration projects to get the data that shows they're very effective and then to work within insurance and government Centers for Medicare and Medicaid Services (CMS) about appropriate reimbursement for them.
So, to disseminate them, it takes a lot of education of people who want to start these programs. The issue is how you suddenly stand up a program that is home-based, if your cancer care has always been clinic- or hospital-based. It is an effort to set up the structure for that. We try to have really good communication and education about how to go about doing that as we've done it, and then the main issue is to get it adequately reimbursed.
Oncology Data Advisor: Great. These are very obviously very important issues to address. So, thank you so much for your work in it.
Dr. Mooney: Thank you.
Thank you for listening to this podcast recorded live at the 2022 ASCO Annual Meeting by Oncology Data Advisor and ConveyMed. For more expert perspectives on the latest in cancer research and treatment, be sure to subscribe to the podcast at conveymed.io and oncdata.com. Don't forget to follow us on social media for news, exclusive interviews and more.
About Dr. Mooney
Kathi Mooney, PhD, RN, FAAN, is a Chair of Nursing as well as a Distinguished Professor of Nursing at the University of Utah. She is also a co-leader at the Cancer Control and Population Sciences Program at the Huntsman Cancer Institute. Dr. Mooney's research encompasses evaluating new cancer care delivery models and understanding and reducing morbidity from cancer.
For More Information
Mooney K, Dumas K, Fausett A, et al (2022). Oncology hospital at home in rural communities: the Huntsman at Home rural experience. J Clin Oncol (ASCO Annual Meeting Abstracts), 40(suppl_16). Abstract 1535. DOI:10.1200/JCO.2022.40.16_suppl.1535
Mooney K, Iacob E, Wilson CM, et al (2021). Randomized trial of remote cancer symptom monitoring during COVID-19: impact on symptoms, QoL, and unplanned health care utilization. J Clin Oncol (ASCO Annual Meeting Abstracts), 39(suppl_15). Abstract 12000. DOI:10.1200/JCO.2021.39.15_suppl.12000
Mooney K, Whisenant MS & Beck SL (2019). Symptom care at home: a comprehensive and pragmatic PRO system approach to improve cancer symptom care. Med Care, 57(suppl_5):S66-S72. DOI:10.10197/MRL.0000000000001037
Mooney KH, Beck SL, Wong B, et al (2017). Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT. Cancer Med, 6(3):537-546. DOI:10.1002/cam4.1002
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.