Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic

Abstract

Purpose Cancer patients have many medical and psychosocial needs, which may increase during the COVID-19 pandemic. We sought to (1) risk-stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between two risk stratification methods, and (3) perform a telephone-based needs assessment with intervention for high-risk patients. Methods Patients were risk-stratified using a general medical health composite score (HCS) and a cancer-specific risk (CSR) stratification based on disease and treatment characteristics. The correlation between HCS and CSR was measured using Spearman's correlation. A multidisciplinary team developed a focused needs assessment script with recommended interventions for patients categorized as high-risk by either method. The number of patient needs identified and referrals for services made in the first month of outreach are reported. Results A total of 1697 patients were risk-stratified, with 17% high-risk using HCS and 22% high-risk using CSR. Correlation between HCS and CSR was modest (ρ = 0.41). During the first month of the pilot, 286 patients were called for outreach with 245 contacted (86%). Commonly identified needs were financial difficulties (17%), uncontrolled symptoms (15%), and interest in advance care planning (13%), resulting in referral for supportive services for 33% of patients. Conclusion There is a high burden of unmet medical and psychosocial needs in hematology/oncology patients during the COVID-19 pandemic. A telephone-based outreach program results in the identification of and intervention for these needs; however, additional cancer-specific risk models are needed to improve targeting to high-risk patients.

Elements for assistance to patients with hematological malignancies to propose care lines: a scoping review

“…The epidemiological relevance of hematological cancer and the interest in improving care for patients affected by this disease are confirmed by the specific care needs, the quantitative of the final sample of this research, the growing number of scientific productions carried out in the last decade and the increase in rates incidence of this type of cancer (8)(9)(10)(17)(18) .…”

Advanced Care Planning (ACP) in the early phase of COVID-19: A rapid review of the practice and policy lessons learned

“…Clinicians, patients and families used on-line platforms and telehealth technology to facilitate ACP. Several PRS and commentaries reported on uptake of outreach telehealth services and/or tool development (Bender et al, 2021; Biswas et al, 2020; DeFilippis et al, 2020; Galbadage et al, 2020; Ho & Neo, 2021; Kuntz et al, 2020; Osterman et al, 2021; Reja et al, 2020).…”

“…Telehealth enabled socially/geographically isolated COVID-19 patientsand carers to maintain contact with healthcare professionals (HCPs), engage in ACP conversations, seek psychological support and symptom management (Biswas et al, 2020;Kuntz et al, 2020;Moorman et al, 2020;Osterman et al, 2021). Telehealth also potentially offered benefits for those in financial difficulties (Osterman et al, 2021), facilitated family e-meetings (Kuntz et al, 2020;Piscitello et al, 2021) and enabled carers to engage in virtual farewells with dying patients (Bender et al, 2021;Chan et al, 2021;Dattolo et al, 2021;DeFilippis et al, 2020;Galbadage et al, 2020;Ho & Neo, 2021;Reja et al, 2020). Patients were reportedly relaxed in their home and more willing to engage in ACP discussions (Mills et al, 2021).…”

Redox stress in COVID-19: Implications for hematologic disorders

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative viral agent for the respiratory illness Coronavirus Disease 2019 (COVID-19) and has millions of cases, deaths, and hospitalizations worldwide [ 1 ]. Individuals with underlying hematologic disorders are at an increased risk for developing severe respiratory conditions and adverse clotting events [ 2 , 3 ]. Several mechanisms promote the thrombogenic and hypercoagulable state in COVID19.…”