Virtual surveillance well received by testicular cancer patients
An electronic surveillance tool generated better compliance and satisfaction rates than standard in-person care among men with stage 1 testicular cancer, according to the interim results of the WATChmAN* trial presented at ASCO GU 2020.
“Most guidelines recommend active surveillance (AS) as initial management for stage I testicular cancer. [However, this requires] blood work and imaging at regular intervals, requiring multiple clinic visits spanning 5–9 years depending on the surveillance schedule,” said the researchers. “[AS] can be time-consuming, difficult to adhere to, dissatisfying, and costly for patients and healthcare systems.”
Keeping an eye on cancer patients
WATChmAN is an online interface that allows asynchronous communication between patients and clinicians, which may serve as an alternative to the current time-consuming and costly standard in-person care. The platform was designed in hopes of improving patient satisfaction and compliance and potentially reduce costs of cancer care follow up. [WATChmAN Virtual Testicular Cancer Clinic, https://www.canadiancancertrials.ca/trial/Default.aspx?TrialId=NCT03360994&lang=en, accessed 27 February 2020]
To date, 115 of the planned 144 subjects have been enrolled in the study. Participants were randomized to either standard in-person or virtual care. Standard care recipients were required to follow an AS protocol involving face-to-face appointments for receiving results of their blood marker tests and computed tomography scans, as well as online surveys. Virtual care recipients will have to obtain the same tests; however, results shall be delivered via the WATChmAN platform.
Compared with the standard care arm, more patients in the virtual care arm were compliant with AS schedules (79 percent vs 67 percent), with shorter compliance delays (median, 14 vs 17.5 days). Response rates to 6-month surveys were also higher in the virtual vs the standard care arm (80 percent and 65 percent). [ASCO GU 2020, abstract 396]
Virtual care recipients had higher relapse rates (14.04 percent vs 10.33 percent) and shorter time to relapse (median, 8 vs 9.5 months) than standard care recipients. Regarding risk classification** at relapse, all cases were categorized as ‘good’.
In terms of overall satisfaction, virtual care recipients reported a higher level of satisfaction (ie, ‘extremely satisfied’) than those receiving standard care (61 percent vs 39 percent). There were no patients reporting dissatisfaction with either care protocol.
More than 80 percent of virtual care recipients agreed that the care they received was on par with standard in-person appointments. Furthermore, when asked how they would want results to be delivered should “bad news” arise while on AS, 50 percent of participants were amenable to receiving the news virtually, which adds to the level of trust that participants have towards the WATChmAN platform.
“To our knowledge … no one has studied virtual care [for] monitoring cancer relapse … Through semistructured interviews and cost-effectiveness analyses, we anticipate more insight into virtual care … [We hope that WATChmAN may] be … generalizable to other cancers,” said the researchers.