Some cancer patients receiving CAR-T infusions can now avoid hospital stays because of a telemedicine program launched by Vanderbilt-Ingram Cancer Center.
The program doesn’t offer long-distance care, but it does offer close-proximity monitoring. Instead of being confined to a hospital room for a week or longer, patients stay within 30 miles of Vanderbilt University Medical Center — close enough to receive care quickly if complications occur.
“Our goal is to use technology to do what is best for the patient,” said Olalekan Oluwole, MBBS, MPH.
Patients must still report to the hospital for twice-daily clinical visits before they receive a nightly telemedicine checkup in their homes or hotel rooms. A team of Vanderbilt clinicians and technology experts designed the protocols for the CAR-T telemedicine service, which could be a prototype for other cancer centers.
“With this being new, we had to build in extra safety mechanisms, so we decided to provide this to only those patients staying sufficiently close by,” Oluwole said.
Matt Ryan, senior project manager with VUMC Telehealth, consulted with clinicians to learn what was needed and leveraged a newly streamlined process utilizing Zoom, a video conferencing platform.
The encounters can occur with multiple types of devices, ranging from smartphones to laptops, through My Health at Vanderbilt.
CAR-T, which stands for chimeric antigen receptor T-cell therapy, is a new immunotherapy that entails re-engineering a patient’s immune cells to recognize and attack a specific protein on cancer cells. It’s prescribed for certain types of non-Hodgkin lymphoma that have relapsed or proven resistant to treatment and for B-cell acute lymphoblastic leukemia in patients 25 and younger.
It’s an effective treatment that renders complete remission in many patients. Since some patients can experience serious complications, the treatment is limited to elite cancer centers with clinicians experienced in recognizing and managing those complications.
Patients need to be monitored most closely for the first month after receiving the one-time CAR-T infusion, Oluwole said. Potential complications include cytokine release syndrome, an overreaction by the immune system, and neurological toxicities. Both can be life-threatening.
Sarah Murawski, PA, did the first telemedicine consult in January with a patient who had received a CAR-T infusion.
She and two nurse practitioners, who also do telemedicine assessments, work closely with Oluwole and Michael Byrne, DO, the physicians who provide CAR-T therapy.
“We go through the whole visit and ask the patients if there are any concerns,” Murawski said. “We also carry a special cell phone all night. They can call us with literally any question they want to ask — if they’re feeling anxious, if they’re feeling nauseous, whatever it may be.”
Besides using hospital-grade equipment to take their vitals under the supervision of Murawski and her colleagues, the patients answer a series of questions and complete some exercises to measure neurocognitive function.
One of those exercises requires patients to draw the hands of a clock along with the accompanying numbers on a screen. Setting up the system required more interaction between the first patient and the person on the technology end than typically occurs.
“This was different for me because usually I just see the patient for about 30 seconds on the screen during a first telemedicine visit,” Ryan said. “Then I get out of the way and let the clinicians do their thing. With this first patient, I went to the clinic, met the patient and went through the set up on her device with her. It really brought a face to the care. I got to see very clearly who this was impacting.”