Canopy's ePRO-Based RTM Cuts Hospitalizations, Costs in Metastatic Cancer

Remote therapeutic monitoring (RTM) using the Canopy platform's electronic patient-reported outcomes (ePROs) significantly reduced hospitalizations in patients with metastatic solid tumors—with the greatest gains seen among the sickest patients, yielding savings estimated at $3 million per 1000 treated patients annually, according to a new study.¹

Lead study author James H. Essell, MD, of Cincinnati Cancer Advisors, presented these real-world results on May 31, 2026, during an oral abstract session at the American Society of Clinical Oncology in Chicago.¹

Essell described the myriad health issues patients with metastatic solid tumors face, such weight loss, decline in their functional status, “and, of course, toxicity from chemoimmunotherapy.”

“This can lead to unplanned emergency department visits and hospitalizations, which interrupt therapy, and we know therapy interruptions can ultimately result in decreased life expectancy,” he said during the presentation.

The retrospective cohort study examined 1549 adults with metastatic solid tumors who began systemic therapy at 5 community oncology practices in Arkansas between January 2024 and July 2025. Patients were invited to complete weekly ePRO symptom surveys through the Canopy platform.¹

Those who enrolled and submitted at least 2 surveys within 45 days of starting treatment were assigned to the RTM group (n=558); the remaining 991 patients served as controls. Inverse probability of treatment weighting was applied to account for differences between the groups, achieving balance across age, cancer type, sex, race, and time from diagnosis to treatment.

A Triage System Built to Flag Urgent Cases

What sets Canopy’s model apart is that once patients report symptoms, a structured triage algorithm helps nursing staff respond in order of clinical urgency, Essell said.

“It’s not just an easy, convenient way for the patient to communicate with the providers—that , communication comes with a triage algorithm that helps the nurse decide which order to treat the patient. For example, if the patient presents with chest pain and shortness of breath, that's going to be marked red and go to the top of the nurse navigator’s list. It’s not going to be mixed in with a prescription refill or someone with diarrhea once in the last week.”

From there, the nurse navigator can decide if the case merits a visit to the ED or home management, “or bring the patient in for an office visit.”

The workflow is also designed with equity in mind: Essell said the platform supports Spanish, and, depending on location, has been customized to support Korean, and Armenian-language reporting, among others.

Stratifying Patients by Hospitalization Risk

Beyond the overall findings, researchers took an additional step to identify which patients benefit most. Using logistic regression that incorporated age, sex, race and ethnicity, tumor type, treatment regimen, and Charlson Comorbidity Index, the team divided patients into tertiles by predicted hospitalization risk.

The benefit of RTM was sharply concentrated in the highest-risk tertile—the most medically complex patients with the greatest comorbidity burden. In that group, the number needed to treat to prevent 1 hospitalization was approximately 11, a clinically meaningful threshold. In the intermediate-risk group, the number needed to treat rose to 37. In the lowest-risk tertile—younger patients with fewer comorbidities and stronger performance status—no significant benefit was observed. The finding suggests that targeting RTM resources toward higher-risk patients could amplify impact and improve program efficiency.

Hospitalization Reduction and Cost Savings

Overall, 9.0% of RTM patients had a recorded hospitalization over the 18-month follow-up period, compared with 13% of controls—a statistically significant 28% relative reduction (risk difference: −3.63; 95% CI, −7.06 to −0.39; P = .032). Emergency department visits trended lower in the RTM group (12% vs. 13%), though that difference did not reach statistical significance (P = .310), which Essell attributed in part to the difficulty of disentangling ED visits tied to causes unrelated to symptom management, such as fractures.

The economic analysis projected annualized savings of approximately $3.11 million in hospitalization costs per 1000 patients per year, with an additional $41,000 attributable to avoided ED visits, for a combined estimated savings of roughly $3.15 million per 1000 patients annually. Cost estimates were based on prespecified unit-cost assumptions applied to weighted event rates rather than claims-level accounting.

Discussant Amylou C. Dueck, PhD, of Mayo Clinic Arizona, framed the Canopy findings as an example of what well-implemented ePRO monitoring can look like, noting that the platform's linkage of symptom reporting to triage nursing with clear escalation workflows represented an “optimized” real-world model. She cautioned, however, that even in this setting only a minority of eligible patients actively engaged in ePRO reporting, raising questions about selection. Residual confounding remains possible in this observational design despite the use of weighting.

Essell acknowledged these limitations and noted that hospitalization data were extracted from the Arkansas health information exchange, meaning out-of-network acute care events may have been undercounted, although presumably equally so across both groups.

RTM Adds 99 Days to Time to Discontinuation

A separate abstract presented June 1, 2026, found that use of RTM allowed for higher detection rates of potential immune-related symptom—such as rash, diarrhea, or difficulty breathing—alongside increased use of outpatient patients, with the net result being patients stayed on treatment nearly 4 months longer on average than without monitoring.²

Results from 1598 patients monitored by Canopy’s system while receiving immune checkpoint inhibitors showed 64% higher utilization of steroids (relative risk, 1.64; P < .001), and a 79% longer median time to stopping treatment (224 days vs 125 days).

Results showed approximately $12.6 million in estimated annual savings for acute care for every 1000 patients.

“What stands out in this study is the higher detection of potential immune-related symptoms through the Canopy RTM platform,” study presenter Benjamin Derman, MD, assistant professor of Medicine at the University of Chicago Medicine, said in a statement. "The combination of higher outpatient steroid utilization, longer time to treatment discontinuation, and reduction in hospitalizations and associated costs suggests that RTM may enable more outpatient management of immune-related symptoms during [checkpoint inhibitor] therapy.”³

References

1. Essell JH, Derman BA, Kolodziej MA, et al. Impact of remote therapeutic monitoring with patient-reported outcomes on hospitalization in real-world patients receiving therapy for metastatic solid tumors. J Clin Oncol. 2026;44(suppl 16):abstr 11005. doi:10.1200/JCO.2026.44.16_suppl.11005
2. Derman BA, Kolodziej MA, Essell JH, et al. Impact of remote therapeutic monitoring on time to discontinuation and acute care events among patients treated with immune checkpoint inhibitors. J Clin Oncol. 2026;44(suppl 16):abstr 11108. doi:10.1200/JCO.2026.44.16_suppl.11108
3. Canopy studies selected for oral and poster presentations at 2026 ASCO annual meeting. News release. PRNewswire. May 21, 2026. Accessed June 4, 2026. https://www.prnewswire.com/news-releases/canopy-studies-selected-for-oral-and-poster-presentations-at-2026-asco-annual-meeting-302779600.html