Benefits of remote real-time side-effect monitoring systems for patients receiving cancer treatment

Abstract

In Australia, the incidence of cancer diagnoses is rising along with an aging population. Cancer treatments, such as chemotherapy, are increasingly being provided in the ambulatory care setting. Cancer treatments are commonly associated with distressing and serious side-effects and patients often struggle to manage these themselves without specialized real-time support. Unlike chronic disease populations, few systems for the remote real-time monitoring of cancer patients have been reported. However, several prototype systems have been developed and have received favorable reports. This review aimed to identify and detail systems that reported statistical analyses of changes in patient clinical outcomes, health care system usage or health economic analyses. Five papers were identified that met these criteria. There was wide variation in the design of the monitoring systems in terms of data input method, clinician alerting and response, groups of patients targeted and clinical outcomes measured. The majority of studies had significant methodological weaknesses. These included no control group comparisons, small sample sizes, poor documentation of clinical interventions or measures of adherence to the monitoring systems. In spite of the limitations, promising results emerged in terms of improved clinical outcomes (e.g. pain, depression, fatigue). Health care system usage was assessed in two papers with inconsistent results. No studies included health economic analyses. The diversity in systems described, outcomes measured and methodological issues all limited between-study comparisons. Given the acceptability of remote monitoring and the promising outcomes from the few studies analyzing patient or health care system outcomes, future research is needed to rigorously trial these systems to enable greater patient support and safety in the ambulatory setting.

Identifying Early Dehydration Risk With Home-Based Sensors During Radiation Treatment: A Feasibility Study on Patients With Head and Neck Cancer

“…Systems that enable remote and real-time monitoring of patients' symptoms and other health-related outcomes may offer cost-effective strategies to optimize cancer care outside of the clinic setting (5,6). Remote collection and transmission of patient health-related data to facilitate clinical decision making have been used in the management of chronic diseases other than cancer (7)(8)(9)(10)(11)(12), and this has been shown to improve patient quality of life and symptom control, decrease emergency room visits and unplanned hospitalizations, and decrease overall health-care costs (12)(13)(14)(15).…”

The Patient Remote Intervention and Symptom Management System (PRISMS) – a Telehealth- mediated intervention enabling real-time monitoring of chemotherapy side-effects in patients with haematological malignancies: study protocol for a randomised controlled trial

“…To date, technology has enabled successful assessment of symptoms in patients with chronic disease resulting in improved patient outcomes and decreased hospital stays/health system costs [ 25 – 32 ]. However, few studies report Telehealth systems for cancer patients and most only focus on acceptability, feasibility or useability data [ 33 ]. Only five papers to date attempt to quantify benefits in patients with cancer (eg during chemotherapy treatment; post-surgery) which include: decreases in fatigue, pain, depression, post-operative symptom threshold events; interference with activities of daily living and; preventable use of health care services (eg clinic visits, bed days of care) [ 34 – 38 ].…”

“…Only five papers to date attempt to quantify benefits in patients with cancer (eg during chemotherapy treatment; post-surgery) which include: decreases in fatigue, pain, depression, post-operative symptom threshold events; interference with activities of daily living and; preventable use of health care services (eg clinic visits, bed days of care) [ 34 – 38 ]. Despite the promising early findings, all Telehealth research in cancer to date has serious limitations including sub-optimal study design (insufficient power, no record of patient adherence to self-care/intervention adherence) or health economic analyses [ 33 ]. In addition, no cancer Telehealth systems have incorporated explicit coaching of patients in the self-care advice delivered; or have been developed for use with high-risk clinical groups or within an Australian context [ 33 ].…”

“…Despite the promising early findings, all Telehealth research in cancer to date has serious limitations including sub-optimal study design (insufficient power, no record of patient adherence to self-care/intervention adherence) or health economic analyses [ 33 ]. In addition, no cancer Telehealth systems have incorporated explicit coaching of patients in the self-care advice delivered; or have been developed for use with high-risk clinical groups or within an Australian context [ 33 ].…”

Approach to Fever Assessment in Ambulatory Cancer Patients Receiving Chemotherapy: A Clinical Practice Guideline

“…Fever was included as one among several symptoms (for example, fatigue, pain, nausea, and vomiting) in some studies of the management of adverse effects of chemotherapy. Approaches to symptom management in those studies included patient-initiated drop-in clinics 22,23 , health care provider-initiated case management programs 24,25 , and various remote monitoring strategies using cellphone applications, Web-based and touch-tone telephone interfaces, and automated programs [26][27][28][29][30] . Evaluation of those symptom management systems is an active area of current research.…”