Feasibility of Wearable-Based Remote Monitoring in Patients During Intensive Treatment for Aggressive Hematologic Malignancies.

Malte Jacobsen,Guido Kobbe,Christopher Blum,Dirk Müller-Wieland,Ben-Niklas Baermann,Melchior Seyfarth,Niels-Ulrik Hartmann,Till A Dembek,Lutz Heinemann,Marlo Verket,Paul Jäger,Rahil Gholamipoor,Anna L Gerke,Jennifer Kaivers,Pauline Rottmann,Markus Kollmann,Nikolaus Marx

doi:10.1200/cci.21.00126

Abstract

Intensive treatment protocols for aggressive hematologic malignancies harbor a high risk of serious clinical complications, such as infections. Current techniques of monitoring vital signs to detect such complications are cumbersome and often fail to diagnose them early. Continuous monitoring of vital signs and physical activity by means of an upper arm medical wearable allowing 24/7 streaming of such parameters may be a promising alternative. This single-arm, single-center observational trial evaluated symptom-related patient-reported outcomes and feasibility of a wearable-based remote patient monitoring. All wearable data were reviewed retrospectively and were not available to the patient or clinical staff. A total of 79 patients (54 inpatients and 25 outpatients) participated and received standard-of-care treatment for a hematologic malignancy. In addition, the wearable was continuously worn and self-managed by the patient to record multiple parameters such as heart rate, oxygen saturation, and physical activity. Fifty-one patients (94.4%) in the inpatient cohort and 16 (64.0%) in the outpatient cohort reported gastrointestinal symptoms (diarrhea, nausea, and emesis), pain, dyspnea, or shivering in at least one visit. With the wearable, vital signs and physical activity were recorded for a total of 1,304.8 days. Recordings accounted for 78.0% (63.0-88.5; median [interquartile range]) of the potential recording time for the inpatient cohort and 84.6% (76.3-90.2) for the outpatient cohort. Adherence to the wearable was comparable in both cohorts, but decreased moderately over time during the trial. A high adherence to the wearable was observed in patients on intensive treatment protocols for a hematologic malignancy who experience high symptom burden. Remote patient monitoring of vital signs and physical activity was demonstrated to be feasible and of primarily sufficient quality.

Highlights

Therapy of hematologic malignancies has progressed rapidly over the past few decades because of the diversification of treatment concepts, such as blood stemcell transplantation, monoclonal antibody, and chimeric antigen receptor T-cell therapy
Vital signs and physical activity were recorded for a total of 1,304.8 days
Recordings accounted for 78.0% (63.0-88.5; median [interquartile range]) of the potential recording time for the inpatient cohort and 84.6% (76.3-90.2) for the outpatient cohort

Summary

Introduction

Therapy of hematologic malignancies has progressed rapidly over the past few decades because of the diversification of treatment concepts, such as blood stemcell transplantation, monoclonal antibody, and chimeric antigen receptor T-cell therapy. Such treatment protocols harbor a high risk of serious clinical complications, such as infections, systemic immune reactions, and arrhythmias.[1,2] These complications include side effects from administered medications (eg, symptom exacerbation and cytokine release syndrome). Outpatients usually experience limited monitoring for serious clinical complications and determine autonomously when to contact their health care professional. Development of digital measures for this specific population is becoming available so that deployment may be accomplished.[4]

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Results

Discussion

Conclusion