Perioperative telemonitoring of older adults with cancer: Can we connect them all?

Abstract

Although the increasing cancer incidence in older patients is widely recognised, older patients remain underrepresented in clinical cancer trials and eHealth studies. The aim of this research is to identify technological and patient-related barriers to inclusion of this population in a clinical eHealth study. Material and Methods: This is a retrospective analysis of a prospective cohort study with older patients (≥ 65 years) undergoing cancer-related surgery, who were identified for a perioperative telemonitoring study. Reasons for ineligibility and refusal had been prospectively registered. Characteristics and postoperative outcomes were compared between participants and non-participants. Results: Between May 2018 and March 2020, 151 patients were assessed for eligibility, resulting in 65 participants and 86 non-participants. The main reason for ineligibility was lack of internet access at home (n = 16), while main reasons for refusal were perceived high mental burden (n = 46) and insufficient digital skills (n = 12). Compared with participants, non-participants were significantly older (mean age 75 vs. 73, p = 0.01); more often female (64% vs. 35%, p = 0.00), unmarried (42% vs. 8%, p = 0.01) living alone (38% vs. 19%, p = 0.02); had a higher ASA classification (43% vs. 19%, p = 0.00); often had polypharmacy (67% vs. 43%, p = 0.00); and were more often discharged to skilled nursing facilities (0% vs. 15%, p = 0.00). Conclusion: Our results confirm the underrepresentation of older female patients with little support from a partner and higher comorbidity. We should be aware of technological and patient-related barriers to including older adults with cancer, in order to avoid further dividing patients with low and high digital health literacy.

Post-discharge Telemonitoring of Physical Activity, Vital Signs, and Patient-Reported Symptoms in Older Patients Undergoing Cancer Surgery

“…The main reasons for refusal and ineligibility have been extensively described previously. 21 After informed consent was obtained, seven patients were excluded from the study because of cancellation of surgery ( n = 4), missing baseline assessment after rescheduling of surgery ( n = 2), or regulations due to the coronavirus disease 2019 (COVID-19) outbreak ( n = 1) (Fig. 1 ).…”

“…First, more than half of the identified patients undergoing cancer surgery in our hospital did not participate in the study because of perceived mental or technological barriers. 21 Second, usability problems, technical issues, study dropout, and variable compliance with performance of measurements resulted in missing data. 19 The main reason for dropout was a complicated postoperative course in 10 of 13 patients, but the dropout rates in patients with or without post-discharge complications did not differ significantly (29% vs. 19%; p = 0.36; not presented in the Results section).…”

“…Results regarding acceptability and usability of remote home monitoring 19 and postoperative recovery of physical activity 20 of the first 50 patients of this cohort have previously been published, as well as the results of the recruitment process of 151 patients of the current cohort. 21 Patients were eligible for inclusion if they were aged 65 years and older, were scheduled for surgical resection of a solid malignant tumor in the Department of Surgical Oncology or Department of Gynecological Oncology, and had internet access at home. Exclusion criteria were cancellation of surgery, emergency surgery, or perceived incapability to use components of the remote home monitoring system due to contact dermatitis, insufficient understanding of the Dutch language, or severe auditory, visual, cognitive, or ambulatory impairment.…”

Feasibility of a Digital Patient–Provider Communication Intervention to Support Shared Decision-Making in Chronic Health Care, InvolveMe: Pilot Study

“…In this study, 41% of the eligible patients declined to participate or did not complete study requirements (ie, nonparticipants), which is a low percentage of people declining compared with similar studies examining eHealth interventions (ie, 60%-68%) [56,57]. However, evidence on how patients accept eHealth interventions is limited [58], and increasing knowledge related to reasons for nonparticipation (eg, user friendliness, complexity) is necessary in order to improve intervention acceptance.…”

A Smarter Health through the Internet of Surgical Things

“…Postoperative monitoring of physiological parameters with the use of biosensors can be further expanded to include automated action after the received sensor signal. In an example by Wang et al [75], patient-controlled analgesia was administered after indica- Within the surgical patient subgroup, there have been a few clinical studies looking into the applicability of telemonitoring, usually in the postoperative period [3,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] (Supplemental Table S3). Patients enrolled in an at-home monitoring program after chest wall surgery were also monitored effectively by utilizing the Internet to input certain parameters in an online platform [65,67] Cardiac surgery patients were also studied in an IoST rehabilitation program that included wearable biomedical and motion tracking sensors [68].…”