The Food and Drug Administration (FDA) has approved six chimeric antigen receptor (CAR) T-cell therapies since 2017 for the treatment of leukemia, lymphoma, and multiple myeloma. This innovative form of immunotherapy has demonstrated the ability to effectively treat cancer and keep it at bay for many years.
Although CAR T-cell therapies have shown to be highly effective against certain types of cancer, the treatment is not without risks. It possesses a unique set of acute toxicities that include cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can be fatal in some cases necessitating close management of the patient following treatment.
As a result, patients traditionally have required extended hospital stays following treatment so they can be closely monitored. But that could soon be changing – Vanderbilt University’s Ingram Cancer Center is at the forefront of a growing movement examining whether patients can be safely and effectively monitored at home following CAR T-cell therapy.
Vanderbilt is leveraging the Biofourmis Connect solution to monitor patients in a home-like setting following treatment for large B-cell lymphoma. The Biofourmis platform—which connects drug development to care delivery—leverages remote monitoring and management, advanced analytics and a library of digital biomarkers to notify clinicians if a patient is likely to decompensate and require clinical intervention. This trial will guide the development of a subsequent, larger study that will determine the tolerability and safety profile of a specific CAR T-cell therapy.
Other leading clinical research institutions, such as the Cleveland Clinic, are also studying how CAR T-cell therapies can be safely delivered on an outpatient basis.
These pace-setting healthcare organizations are focused not only on avoiding prolonged hospitalizations, but eliminating the need for an inpatient admissions. This would allow these life-extending treatments to be more feasibly extended to communities that currently lack access, improving health equity.
If this line of research results in hospital at home and remote patient management become the new standard of care following CAR T-cell therapy, the move could significantly reduce healthcare spending and improve outcomes—while enhancing the treatment and recovery experience for patients.
Decreasing Costs While Improving Patient Satisfaction
Across the care continuum, clinical care is increasingly shifting to patients’ homes. Likewise, clinical research is leveraging advances in remote patient monitoring and management in a move towards decentralizing clinical trials.
Research has shown that utilizing remote patient management in place of hospitalization resulted in a 38% average cost reduction for those acute care patients receiving hospital-level care at home. When applied to cancer treatment, this approach has the potential to significantly decrease healthcare costs for providers and payers: Consider that post-treatment hospitalization costs alone were $53,360 per patient in one analysis of patients with large B-cell lymphoma treated with CAR T-cell therapy.
Similarly, clinical research costs could benefit from the care-at-home revolution. For example, decentralizing trials involving CAR T-cell therapy and other cancer treatments could ease recruitment pressures that increase R&D costs by pulling from a larger population spread across a geographical area. It could also increase the diversity of the cohort—and could encourage participation by enabling patients to recover at home.
Patient satisfaction is a cornerstone of this approach. Not only do many patients not want to be in a hospital—they don’t need to be.
Patients and families facing a cancer diagnosis and lengthy treatment are under an enormous amount of stress. Allowing them to remain in a home setting surrounded by family and a familiar environment can be comforting. Shifting post-treatment monitoring to the home and supporting patients with effective and engaging remote management can significantly improve the care experience.
Looking to the Future
CAR T-cell therapy has entered the mainstream as a viable and effective treatment, generating substantial excitement among researchers and clinicians. However, there are still issues around patient burden financial toxicity that need to be addressed.
Establishing clear, safe remote patient management guidelines for patients receiving CAR T-cell therapy would be a major achievement in cancer research and treatment.
The editorial staff had no role in this post's creation.