1. Abhishek Joshi1,2, Sabe Sabesan1,2, Suresh Varma1, Zulfiquer Otty1.
Feasibility and safety of chemotherapy administration using Tele-oncology for rural lung cancer patients in North Queensland.
Abhishek Joshi1,2, Sabe Sabesan1,2, Suresh Varma1, Zulfiquer Otty1.
Department of Medical Oncology, Townsville Cancer Centre, Townsville Hospital, QLD, Australia
2. Discipline of Medicine, School of Medical Health Sciences, James Cook University, Townsville, QLD, Australia.
Material and Methods
Background
Results
Toxicity and Safety
This study evaluates the feasibility and safety of chemotherapy for lung cancer patients treated via Teleoncology.
Out of total 170 patients treated using Teleoncology, 33 (22%) had lung cancer. Of these 3 (9%) were small cell (SCLC) and remaining non small cell lung carcinomas.
A total of 287 chemotherapy cycles (148 in first line, 97 in second line and 42 in third line) were administered under distant supervision. Of these, 8 cycles were neoadjuvant, 15 cycles in adjuvant and 254 cycles in palliative setting. One patient of SCLC had emergency chemotherapy initiated via Teleoncology.
Carboplatin(C) and Gemcitabine(G) was the commonest regimen (72 cycles 25%) followed by Pemetrexate (66 cycles 23%) and C and Paclitaxel (56 cycles 19%). Other types of regimen administered were Cisplatin (Cis) and G, C and Etoposide (Eto), Cis and Vinorelbine (Vnb), and single agent Docetaxel, Gem, Vnb, Eto, C and Erlotinib.
Commonest toxicities were fatigue, neuropathy, neutropenia, thrombocytopenia and anaemia. Grade 3-4 toxicity requiring dose reduction was 4% in first line, 32% in second line and 58% in third line setting. Accounting for dose reductions based on toxicity, anticipated chemotherapy dose intensity could be maintained in 261 cycles (91%). There were 7 episodes of inpatient admission at Mount Isa (3 febrile neutropenia and 2 each pulmonary embolism and recurrent pleural effusion), all supervised via Tele-oncology from Townsville. 29 of these 33 patients had all of their chemotherapy treatment at Mount Isa without travelling to Townsville.
Only 3 patients needed to travel to Townsville during palliative treatment, two for brain radiotherapy and one for VATS pleurodesis.
INCIDENCE OF GRADE III/IV TOXICITY
Chemotherapy is the standard treatment for most (stage II and beyond) lung cancer patients and treatment duration can be long ranging from months to years. Rural lung cancer patients in north Queensland often have to travel long distances for such specialist treatment. Geographical isolation is implicated as one of the factors leading to inferior outcomes in these patients. Since 2007 Townsville cancer centre has been providing chemotherapy services to Mount Isa at a distance of 1000 km via Teleoncology ( using video conferencing). This model has previously been shown to be effective, safe, cost saving and sustainable.
Conclusion
Tele-oncology is a novel model of care for rural lung cancer patients. Using this model, standard chemotherapy for lung cancer can be safely administered with expected dose intensity. The feasibility and safety results from this study are comparable to published literature in lung cancer. Use of tele-oncology has the potential to overcome the barrier of travel time associated with long distances and possibly improve outcome for rural lung cancer patients.
References
All patients with a diagnosis of lung cancer from Townsville Tele-oncology data resource (comprising all patients treated with chemotherapy at Mount Isa Base hospital using videoconferencing from Townsville cancer centre) between April 2007 and March 2012 were eligible. Patient and tumour characteristics were studied and feasibility was evaluated using number and type of cycles, dose intensity and completion rates for chemotherapy administration. Toxicity was graded as per common terminology criteria for adverse events (CTCAE) v 4.0.
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Marr I, Sabesan S et al. Patient satsifaction, safety of chemotherapy delivery and cost effective analysis of video-linked clinics – a North QLD experience. Asia Pacific J Clin Oncol 2008; 4 Suppl 2: A29-A83.
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