Aims:
The Teleoncology model of care provides timely oncology specialist review and chemotherapy administration via telehealth systems to patients who live in rural and remote towns. This study aimed to evaluate the safety of administering immune checkpoint inhibitors (CPIs) and monitoring for immune related adverse events (irAEs) using this system by comparing its patient toxicity related mortality and morbidity outcomes to that of a tertiary cancer centre.
Methods:
All patients who received CPI treatment (nivolumab, pembrolizumab or ipilimumab) via the Townsville Teleoncology Network (TTN) at peripheral hospitals of Mount Isa, Bowen and Ingham between January 2015 and April 2019 were extracted from electronic records. Patients who received CPI treatment directly at the Townsville Cancer Centre (TCC) over the same time period were used for comparison. Patients who were on trials or received concurrent dual CPI treatment were excluded. Patient demographics, treatment details, irAE related hospitalisation and mortality rates were recorded in a chart audit.
Results:
28 patients received a total of 331 cycles of CPIs through the TTN. Over the same time period, 142 patients received a total of 1697 cycles directly at the TCC. There were no significant differences in all demographic characteristics between both groups, including tumour profile and indigenous status. There were no statistically significant differences between the rates of high grade irAE across multiple systems (p>0.05) and rate of hospital admissions (11% (TTN) vs 7% (TCC), p=0.312) with a median duration of 7 days (range 1-25) for TTN patients and 4 (2-17) for TCC patients. There were no irAE related deaths in both groups.
Conclusions:
The Teleoncology model of care allows safe administration of CPIs and monitoring for iAREs at rural and remote towns comparable to that of a tertiary cancer centre, thereby minimising the need for long distance travel and its inconveniences for patients.