Saving Time for Patients and Improving Well-Being Through Mindfulness and Fitness: Research from the 2023 ASCO Quality Care Symposium

October 23, 2023
Greg Guthrie, ASCO staff

The 2023 American Society of Clinical Oncology (ASCO) Quality Care Symposium will be held in person and online on October 27 and 28 in Boston, Massachusetts. This meeting brings together health care professionals from around the world to discuss research in improving cancer care and reducing disparities in care for all people with cancer.

Below are summaries of 3 studies that will be presented at the symposium:  

You can learn more about research from this symposium by following the #ASCOQLTY23 hashtag on X, formerly known as Twitter.

Evaluating symptoms using text messaging may help patients spend less time in clinics when receiving immunotherapy infusions

Who does this study affect: People receiving immunotherapy to treat cancer.

What did this study find: Researchers found that patients who used a text-messaging triage system were able to save more than 1 hour on days they were scheduled to receive an immunotherapy infusion.

Immunotherapy is a type of cancer medication that uses substances made by the body or in a laboratory to boost the immune system and help the body find and destroy cancer cells. Because immunotherapy affects the body’s immune system, patients who receive immunotherapy are carefully screened for side effects. On days when patients are scheduled to receive an immunotherapy infusion, their days often involve lab tests, having their vital signs taken, a clinic visit, and then the actual infusion. The time spent going from visit to visit for an immunotherapy infusion can add up to many hours spent at the clinic.

In this study, the researchers used a text-message system to communicate with patients in the 4 days before their infusion visit. Patients received texts asking them questions about their symptoms. Those who did not have symptoms and had normal blood test results were allowed to skip the pretreatment office visit and go straight to the immunotherapy infusion.

There were 40 participants in this study. They were all adults with solid tumors who were receiving a single immunotherapy drug, not a combination. The average age of the participants was about 68 years, and about 85% were White. There were 19 participants who were randomly assigned to use the text-messaging system and 21 participants who received usual care, which involved receiving the usual screening visits on the day of the infusion.

There was a total of 52 scheduled infusions where the text-messaging system interacted with participants. Of those 52 scheduled infusions, there were 23 completed pre-infusion assessments using the text-messaging system. The researchers found that, on infusion days, those who were in the text-messaging group spent an average of 70 minutes less time receiving care and 30 minutes less time waiting. There was no significant difference in the number of emergency department or hospital visits between those who used the text-messaging system and those who received usual care. Participants in both groups also reported similar satisfaction with their care and their quality of life.

What does this mean for patients? For patients receiving immunotherapy who feel comfortable with text messaging, a tool like this may help reduce time spent in the clinic on infusion days if they have no symptoms and normal blood test results.

“The current standard of care is that patients treated with immunotherapy is screening with laboratory testing and a visit with their clinician prior to starting treatment. This can result in excessively long days in the clinic with wait times in between each step. Our hypothesis was that some patients could safely proceed to their infusion without having to wait to see their clinician, giving them the option for a shorter day.”

—   lead study author Erin Mary Bange, MD
Memorial Sloan Kettering Cancer Center
New York, New York

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Virtual mind-body fitness classes help reduce urgent care visits and hospitalizations among people receiving cancer treatment

Who does this study affect: People receiving active cancer treatment.

What did this study find: Researchers at Memorial Sloan Kettering Cancer Center used an online mind-body fitness program to find out if being physically active at home could reduce patients’ common symptoms from cancer treatment. The program was called Integrative Medicine at Home (IM@Home). Integrative medicine is a combination of medical treatments to treat the cancer and complementary therapies to cope with the symptoms and side effects of cancer and its treatment. The IM@Home program included classes in yoga, tai chi/qi gong, meditation, and music therapy, as well as fitness classes that included aerobic and strength training. Classes were 30 to 60 minutes long and offered in the morning, midday, and early evening.

This study included 200 participants who were receiving cancer treatment and who had reported that they had cancer-related fatigue. Fatigue is a common side effect among people with cancer and a common reason for reducing physical activity. There were 181 women in the study group. Most of the participants were White (155), and there were 18 Black and 14 Asian participants. There were 73 patients with breast cancer, 49 with lung cancer, 43 with gynecologic cancer, 25 with head and neck cancer, and 10 with melanoma. There were 99 patients randomly assigned to use IM@Home for 12 weeks. They could join as many classes as they wanted but were encouraged to choose at least 3 classes per week. The remaining 101 participants were assigned to receive enhanced usual care for 12 weeks. Enhanced usual care included standard-of-care treatment and provided access to prerecorded online meditation resources.

After the study period had ended, the researchers reviewed electronic medical records to see how much the study participants needed to visit urgent care, how many had to be hospitalized, and how long hospital stays were. They found that those who used IM@Home were less likely to be hospitalized than those who received enhanced usual care (5.1% vs. 13.9%, respectively). The participants in the IM@Homegroup also spent fewer days in the hospital (5.4 days per patient) than those who received enhanced usual care (9.4 days per patient). The percentage of participants who needed to visit urgent care was similar between the IM@Home (9.1%) and enhanced usual care (11.9%) groups. However, those who used IM@Home had nearly half as many urgent care visits per patient, compared with those who received enhanced usual care. The researchers also found that those in the IM@Home group had significantly less fatigue and psychological and physical symptoms.

What does this mean for patients? A virtual mind-body fitness program that can be done at home helped reduce visits to urgent care and hospitalizations for people receiving cancer treatment. 

“Evidence shows that fitness, meditation, yoga, tai chi, and music therapy can improve common symptoms of cancer treatment such as fatigue, insomnia, anxiety, and depression. However, there is no research examining how to make these activities accessible to patients with cancer from the comfort of their homes. Further, no research has evaluated whether practicing these therapies from home can reduce a patient’s likelihood of being admitted to the hospital.”

—   lead study author Jun J. Mao, MD, MSCE
Memorial Sloan Kettering Cancer Center
New York, New York

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Guided yoga sessions improve health in people with head and neck cancer receiving radiation therapy

Who does this study affect: People receiving radiation therapy to treat head and neck cancer.

What did this study find: Researchers at MD Anderson Cancer Center found that patients and caregivers who participated in guided yoga sessions saw an improvement in physical function and had a reduced need for additional health care interventions.

When radiation therapy is used to treat head and neck cancers, it can lead to substantial side effects, such as mouth sores or difficulty swallowing, that can affect a person’s ability to eat and drink. These effects can lead to hospitalization and needing to have feeding tubes placed. In this study, researchers wanted to find out if yoga could help reduce these side effects and help patients avoid hospitalization and feeding tubes. To do this, they developed a yoga program to specifically prevent and relieve the common side effects of treatment for head and neck cancer. There were 15 sessions that could be done in person or online through a video conference during the radiation therapy schedule. The yoga program followed hatha yoga principles, focusing on stretching and strengthening the face and neck areas, including tongue, lip, and jaw exercises, as well as whole-body stretching and strengthening. Breathing exercises and guided imagery were also included to help patients cope with anxiety.

This study included 100 patients and their caregivers. The patients were mostly men (85%) and White (79%) and had an average age of 60 years. The caregivers were mostly women (83%) and White (73%) and had an average age of 55 years. The participants were divided into 3 groups. The paired yoga group included 34 patients and their caregivers who would attend the yoga sessions together. The patient-alone group included 33 patients who would attend the yoga sessions without a caregiver. The remaining 33 participants were assigned to the usual care group, which received standard care but no yoga. Participants also completed weekly questionnaires on their ability to eat food, particularly regular amounts of solid foods. People who are treated for head and neck cancer whose swallowing muscles remain strong have a better chance of not needing a feeding tube.

The researchers found that 88% of participants attended at least 10 yoga sessions, with participants attending an average of 13 of the 15 sessions. The patients in the paired yoga group reported significantly better physical function and nutrition intake than those in the usual care group. Patients in both yoga groups had significantly fewer feeding tubes placed than those in the usual care group. There were no significant differences seen in physical function and nutrition intake between the 2 yoga groups, which the researchers believe was due to the high participation rate in both groups.

What does this mean for patients? Guided yoga sessions, particularly with caregivers, may help lessen or prevent side effects in people receiving radiation therapy for head and neck cancer. 

“This study is one of the first to compare a patient-oriented behavioral intervention delivery to one that includes patients and their caregiver.”

—   lead study author Kathrin Milbury, PhD
MD Anderson Cancer Center
Houston, Texas 

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