The Use of Remote Monitoring in Care Management for Bone Marrow Transplant Patients

Cytotoxic chemotherapies and immunotherapies cause harmful side effects in over half of patients with cancer. Early intervention is critical for improving outcomes, but in outpatient settings, patient self-assessment and patient-initiated pursuit of follow-up care often cause delays. Digital health technologies for remote patient monitoring (RPM) can minimize these delays. This study assessed the feasibility and perceived user experience of RPM technology for early detection of febrile neutropenia and infection in allogeneic bone marrow transplant (BMT) patients. Ten BMT patients between the ages of 18 and 89 years wore biometric monitoring devices for up to 90 days post-transplant. Devices sent real-time alerts to clinicians in response to elevated temperature, heart rate, or respiratory rate. Patients and caregivers completed surveys about their experience at 30 and 90 days post-transplant; patients were asked to participate in interviews at these time points. Providers completed surveys at the end of the study. Biometric and health utilization outcomes and responses to survey items were analyzed through descriptive statistics. Rapid content analysis of survey data and interview data was conducted to explore emergent themes. Seven patients wore RPM devices until study completion. 369 alerts were generated, with 101 requiring follow-up. Two patients had infections during the study. One had infection detected through alert data and received outpatient treatment; the second stopped wearing their device prior to symptom onset and required hospitalization. Overall, RPM technology was perceived as generally acceptable, comfortable, and easy to use. Refinements to alerting practices and technology performance are recommended to improve adoption and use as intended in the outpatient setting.