A central strategy for health care surge control would be to provide remote effective
monitoring of Covid-19 patients and their follow-up. Telemedicine allows patients
not only to be carefully screened, but also enabling a patient-centered system as
well as being conducive to self-quarantine. Also patients, clinicians, and the community
are protected from exposure (1).
Patients with cancer during or after treatment, have an increased risk of complication
and death related to Covid-19 contagion (2; 3).
In this report, physicians in Gustave Roussy Center Institute (GR), France, a leading
European tertiary cancer center, describe the use of telemedicine for monitoring and
optimizing referral of Covid-19 cancer patients. The CAPRI telemedicine program has
been set-up to monitor cancer patients undergoing oral therapy (4) (Figure 1
). Faced with the Covid-19 crisis, we adapted the system accordingly in a period of
two weeks, also drawing inspiration from another program (5).
Figure 1
CAPRI Process for monitoring cancer patients.
Figure 1
Capri-Covid19 consists of a web application for patients and a telephone platform
with a dedicated call number, the entire procedure being managed by four GR’s nurse
navigators (NN). It can allow NN and patients to communicate 24/7 (from 8:30 am to
6 pm; outside the center, the patient must contact the emergency service) through
secure messaging (i.e. the platform complies with the French regulation on data protection).
The web application allows patients to fill in questions specific to Covid-19 based
on a Patient-Reported Outcome’s approach which has demonstrated its added value in
an oncology context (6). Finally, the application provides NN with a complete panel
to view individual electronic patient medical records.
If Covid-19 is suspected, either when the patient comes to the hospital (emergency
department or consultation; in which case, the patient is asked to return home while
the test results are pending) or at home, the patient is tested. Covid-19 positive
patients are included in the CAPRI program after having provided informed consent
and follow a 4-phase remote monitoring strategy (see figure 2
).
Figure 2
Algorithm for remote monitoring of Covid-19 positive cancer patients.
Figure 2
Initial assessment. NN calls each patient in order to assess their specific cancer
concerns (e.g. medical prescriptions), comorbidities and social conditions (isolation
and ability to acquire personal needs during the confinement period). In addition,
information on the program is given when the individual account is created, following
the guidelines provided by the French authorities (https://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=779).
Lastly, the patient is offered to choose between two monitoring modes: either by phone,
or by completing an application form (web or smartphone).
Follow-up. This is based on six questions asked patients: (i) fever ≥ 38.3° (100.94°
F); (ii) appearance or worsening of respiratory discomfort since the last assessment
(LA); (iii) appearance or worsening of a cough since LA; (iv) drowsiness; (v) any
new symptoms since LA (e.g. muscle aches, headaches); (vi) appearance or worsening
of diarrhea since LA. The data are reported following the application twice a day
whereas the call is daily in the case of a telephone follow-up.
Patient orientation decision. The system generates alerts if one out of the six above
questions is answered positively or if the patient has not responded for more than
24 h. The alert is automatically generated via the application, or during daily NN
phone calls. In this case, the NN contacts the emergency department manager in order
to organize the patient’s arrival to the emergency room or the Covid-19 ward directly.
Evaluation. A longitudinal assessment is organized, based on five indicators: hospital
admissions, emergency visits, access to Intensive Care Unit following a Covid-19 complication;
deaths following a Covid-19 complication; recoveries. These indicators provide a real-time
reading of the evolution of the epidemic and will then allow the impact of this intervention
to be assessed.
To date, more than hundred patients have been enrolled in the ongoing program. Our
experience shows that Covid-19 crisis is a clinical, epidemiological and organizational
issue to overcome. Although telemonitoring cannot solve every problems, it is well
suited to the context of Covid-19, and organizations that have already invested in
telemedicine are well positioned to expand them and ensure that patients with Covid-19
receive the appropriate care. This decision tree allows not only a collection of data,
but also a secured organizational process for patient orientation and an optimal physician
medical time. Our experience could help other cancer centers, or even healthcare organizations,
to implement a rapid effective program with health care professionals monitoring patients
at distance while being less exposed. Gustave Roussy Cancer Institute should provide
for free the Capri-Covid app worldwide in order to help Covid-infected cancer patients.
The authors are grateful to Richard Medeiros, Medical Editor from Medical Editing
International.
Declaration of interests
The authors declare the following financial interests/personal relationships which
may be considered as potential competing interests: Dr. SCOTTE reports personal fees
from helsinn, personal fees from MSD, personal fees from Roche, personal fees from
AMGEN, personal fees from Pierre Fabre Oncology, personal fees from Pfizer, personal
fees from Mundi Pharma, personal fees from Mylan, personal fees from Leo Pharma, outside
the submitted work;
Dr Minvielle has no disclosure to declare.
Dr. MIR reports personal fees from Amgen, Astra-Zeneca, Bayer, Blueprint Medicines,
Bristol Myers-Squibb, Eli-Lilly, Incyte, Ipsen, Lundbeck, MSD, Novartis, Pfizer, Roche,
Servier, Vifor Pharma., other from Amplitude surgical, Ipsen, Transgene, outside the
submitted work;
Dr ANDRE has no disclosure to declare.
Dr. Barlesi reports personal fees from Astra-Zeneca, Bayer, Bristol-Myers Squibb,
Boehringer–Ingelheim, Eli Lilly Oncology, F. Hoffmann–La Roche Ltd, Novartis, Merck,
MSD, Pierre Fabre, Pfizer and Takeda, outside the submitted work;
Dr. Soria reports personal fees from In the last 3 years consultancy fees from:
AstraZeneca, Astex, Clovis, GSK, GamaMabs.
Lilly, MSD, Mission Therapeutics, Merus, Pfizer, PharmaMar.
Pierre Fabre, Roche-Genentech, Sanofi, Servier, Symphogen, Takeda.
Full time employee for AstraZeneca between September 2017-December 2019, other from
Shareholder Gritstone, during the conduct of the study; personal fees from null, outside
the submitted work; .