How Remote Patient Monitoring Can Change At-Home Cancer Care

February 05, 2024 - Remote patient monitoring (RPM) is changing the chronic disease management landscape by allowing clinicians to track patient outcomes and assess their needs on a continuous or near-continuous basis.

In cancer care, remote monitoring can help clinicians manage symptoms and provide timely treatment for patients, enhancing patient outcomes and experience. This is what Glen Peterson, DNP, ACNP, RN, an associate professor of hematology at the University of Colorado Medicine, and his research team discovered when they set out to assess an RPM-supported in-come care program for bone marrow transplant and CAR T-cell therapy patients. While the benefits are clear, Peterson noted in a Healthcare Strategies podcast episode that there are several critical considerations to ensuring the successful implementation of these programs.

Anuja Vaidya 

Hello, and welcome to Healthcare Strategies. I'm Anuja, Vaidya, senior editor and special events lead at mHealth Intelligence.

The use of remote patient monitoring [RPM] is growing with research highlighting the numerous clinical care benefits these technologies can offer. These benefits include tracking care outcomes in real time and implementing interventions to support positive outcomes, making RPM especially useful in chronic disease management.

Today, Glen Peterson and associate professor of Hematology at the University of Colorado medicine will discuss how RPM can support cancer care in the home and key considerations for this type of outpatient approach, including patient engagement and technology selection. Dr. Peterson, thank you so much for joining us today.

Glen Peterson 

Thank you, I really appreciate the opportunity.

Anuja Vaidya 

Absolutely. Excited to dive into some of these key benefits of RPM in cancer care. I think this is a super unique use case for the technology. So I'm excited to get into the weeds with you. So let's kick things off first by understanding sort of the larger growing movement of just bringing care into the home. So what are some of the benefits of at home care? And how did this trend evolve over the course of the COVID 19 pandemic?

Glen Peterson 

I think that providing better care that is centered around the patient. And doing this at a lower cost is really one of the priorities and goals of at-home care, providing care that improves quality of life for patients and, at the same time, improves safety, efficiency, and reduces burden to health care facilities and also those health care professionals that work within those facilities--is really the aim of the introduction and kind of progression and the evolution of at-home care. I agree, I think the pandemic has really driven the evolution of technology like remote patient monitoring, and an increase in the use of virtual care and telehealth during the COVID pandemic. And certainly, you know, at the start of the pandemic, especially prior to vaccination, remote patient monitoring was used, especially for those very high risk patients that had high risk of significant complications related to COVID. And in addition, virtual visits became much more common due to the risks associated with COVID positive patients coming into health care facilities, especially around patients who are at increased risk, like cancer patients, for example.

Anuja Vaidya 

Absolutely, absolutely. The two definitely go together. We've been seeing this sort of move to at-home care even before the pandemic, but, as you so rightly said, the rise in virtual care technologies that we saw during the pandemic really skyrocketed its use and kind of drove care even even further into the home, which as you mentioned, has numerous benefits. So definitely something that is very exciting, I think, for anybody in the healthcare industry.

I really want to zero in on cancer care. Like I mentioned, I think this is such an interesting use case. When one thinks of cancer care, you think chemotherapy, you think other types of radiation therapies, and things like that. You don't necessarily think of it as an eligible for at home care is something that can easily be translated to at home care. But you recently presented a study at the 2023 American Society of Hematology [ASH] Annual Meeting describing an RPM enabled outpatient care model for bone marrow transplant and CAR-T cell therapy patients, which I think is super fascinating. So could we first just discuss the study and its findings and then I'd love to turn this into a larger conversation of RPM-enabled cancer care. But first, I really want to hear about the study how it was conducted and what you found.

Glen Peterson 

It was really an honor to be able to present our data at the annual ASH meeting. It's such a conglomeration of specialists and just some really amazing topics. And I was really thankful to see remote patient monitoring and some of the at-home care information being presented at this big conference, because it is so applicable to really everyone involved with cancer care, especially, and I think there are real opportunities.

In regard to our study, we took some of the highest risk patients--if you think about who are some of the highest risk patients, especially in oncology, these are CAR-T cell patients and there's been such a explosion of immunotherapies in oncology over the recent year or two--and so CAR-T cell patients autologous stem cell transplant and allogeneic donor stem cell transplant patients have been considered probably the highest risk patients in oncology care. And so these patients are at risk of variety of serious complications such as infections, or transplant patients are at risk of graft versus host disease. And there are some very specific and unique side effects and potential complications of CAR-T cell therapy, specifically cytokine release syndrome and neurotoxicity.

Glen Peterson 

And so with this study, we assess the feasibility and acceptability of a technology-assisted oncology care program in the home for 30 days in auto transplant patients and CAR-T cell patients and then 90 days in our allogeneic stem cell transplant patients. We used a continuous wear biometric sensor for hemodynamic monitoring, and then also a chat bot texting platform to communicate with patients with the help of a virtual care team with a company called Reimagine Care. And then after the midpoint, and after the study, patients, caregivers and providers completed surveys describing their experience with the program. So that's the basic template of the study.

And then with the virtual care company, based on data either from the bio sensor or the chat bot platform, the virtual care team either text or call patients to assess their symptoms. And depending on the severity of symptoms, or the data from the bio sensor, they notified the CU triage team--so the University of Colorado triage team--to organize follow up clinic evaluation or emergency care.

And the results of our study: between the wearable sensor and the chatbot platform, so really the two methods that we gained information and data on these patients, we had 219 alerts during the study period with about 80 percent of those alerts coming from the biosensor through the remote monitoring platform. And then about 50 percent of all alerts required virtual care team follow up resulting in 26 referrals to the CU triage team. And then 10 of those required care in the clinic or the emergency room. Ninety percent of patients wore the biosensor as intended and the majority of patients used the chat bot communication. Surveys were completed, again as I said, at midpoint and end of study, and patients and caregivers reported that remote patient monitoring made them feel more cared for, that it was helpful and easy to use, and it increased their understanding of their care plan. And then also providers reported that remote patient monitoring improved quality of care and detection of serious signs of infection and other concerning symptoms. And they were satisfied with the communication with the virtual care team. And they also thought that remote patient monitoring should be used more often for care at home.

So that's the gist of the study. We did a lot of different things with the study and I think gathered a lot of really useful information surrounding at-home care and especially remote patient monitoring.

Anuja Vaidya 

Yeah, by all accounts, definitely seems like something patients responded well to, wanted to use, and having those patients that needed the extra help from CU medicine were triaged quickly. And I would assume it helped in potentially stemming any sort of adverse outcomes before it could even get too far down that path for some of these patients. Is that accurate?

Glen Peterson 

Yeah, definitely leaves the patients that would not have necessarily reported any signs or symptoms that we did pick up on the biometric monitoring--or, I should say, if they did, it would have been later and potentially leading to more complications. And I think that's the the real benefit of remote patient monitoring is that, whether patients know it or not, you're able to gather data and assess and evaluate that data to help make decisions that may affect outcomes.

Anuja Vaidya 

And it does seem by and large, the implementation seems to have been smooth. If, I think you mentioned, 90 percent of patients reported wearing the sensors and not seeing too many challenges. But what are some of the challenges you did face when providing these RPM services when ensuring that patients were engaged in the program? And are there any hurdles specific to this population of high risk, bone marrow transplant and CAR-T cell therapy patients that healthcare providers should be aware of?

Glen Peterson 

Yeah, I would say that we did have pretty good compliance with the program. But at any rate, this is a high risk group of patients and they still require a high degree of in-person care really no matter what we do. But remote patient monitoring needs to be built into a system that can accommodate in-person care, and do this quickly. We have remote patient monitoring, but if you can't interpret and do something with that data, it's mostly useless. So it has to be built into a system that can accommodate that. And remote patient monitoring is additive. And it really takes patient care and safety to the next level.

But with more data and information, there is some burden that comes with this. Staffing resources are needed. There are financial resources that are needed to support what remote patient monitoring has to offer. Otherwise, like I said, it's not particularly useful if there's not somebody there to interpret the data and also act on it.

Anuja Vaidya 

Yeah, absolutely. And that's, that's something I just want to zero in on for a second because that is something I hear often when reporting on RPM is: the biggest benefit is all this real time continuous data, which is incredible, but you need the stuff and you need analytic software and other things on on the other side to ingest all that data and make it actually actionable. So is this something you ran into? And did you have a different team on the CU medicine side to manage the patient triage? Did it add to workforce burden in any way?

Glen Peterson 

Looking at remote patient monitoring in at-home care, so I think there are two main resources that you need. It either has to be built into the existing system that is responsible for the remote patient monitoring, or you have to build a system around it. And we did a combination of the two things with this study. We didn't want to take away anything that we normally do for these very high risk patients. So we used the virtual care team to gather information and then, if there were concerns, give it back to our triage team, which our patients call all the time that is their resource to get the care that they need. And so basically, it was an added benefit with remote patient monitoring. So they gathered the data and they had a scale of mild to severe, and anything that was really outside of mild, they were calling our University of Colorado triage team to triage patients appropriately as usual. So again, we we had the added benefit of having access to a virtual care team that could gather this data for us. But then the clinical care and follow up was the responsibility of the University of Colorado triage team ultimately.

Anuja Vaidya 

Absolutely, absolutely. And given that the implementation, like you said, was within a larger system of care or a larger patient care journey that these high risk patients are within and that it's more additive than--not something to replace, but to add to, was patient engagement a challenge at all? You have a very high engagement rate, so how is that achieved? Was there education at the beginning? How did you make sure that patients were really sticking with wearing the wearables and tracking their data sharing that data? Or with anything you needed from the patient side, how did you make sure they were consistent?

Glen Peterson 

Yeah, so again, it was a collaboration between this CU team and the virtual care team. But in general, patients and caregivers--and I think the caregivers are such a motivating factor for patients, also are an influential factor for patients--but patients and caregivers, they really need to understand the benefits of remote patient monitoring to be engaged. Safety, early detection, quick access to care, less burden on caregivers, is important. And I think they hear that and if they know that there's going to be a benefit in that regard, they're more likely to be engaged especially, I think, if they know it will contribute to their safety.

And I think it's something that caregivers struggle with. They feel responsible for monitoring patients and, maybe without any kind of medical care knowledge, they have the responsibility to make sure their loved one or their family member is okay. And so that can be challenging. So if that caregiver is engaged, it makes a big difference and understanding the fact that they have additional resources, they have additional support, to help them manage the care of their loved loved one, it keeps them more engaged.

And I think the ability to have very seamless two-way communication was very helpful in this study. We had the chat bot system that allowed for patients to reach out directly to the virtual care team, and also the virtual care team to reach out to patients if there was either a concern on the biometric monitoring or just on a daily check-in to ask the patient if they're having certain symptoms. So I think having that interaction was quite engaging for patients.

One of the biggest motivators for any patient is if they can see benefit in their quality of life. These are cancer patients and, specifically in this study, cancer patients who are going through some of the most intense therapies we have to offer in cancer care now and so quality of life is very important for them. And I think in general, the whole idea of at-home care really, the holy grail of at-home care, is for patients to spend less time traveling back and forth to appointments or being hospitalized, and more time at home with their family.

Anuja Vaidya 

Yeah. And that's the best thing you can really do for your patients. So, of course, providers are interested and excited in getting access to this technology and being able to offer it to their patients.

And coming to that technology piece, I know for this study you had a virtual care company partner. And I'm just curious if you gleaned any kind of lessons learned from that partnership for healthcare providers that are looking to expand RPM services for their cancer populations? What are some aspects of technology selection, that they really need to consider carefully? What are some key lessons learned to ensure success in that area?

Glen Peterson 

Yeah, I think there are--we learned a lot, I think, with working with a virtual care company and going through this study together. There's a lot of different technologies out there for all kinds of different scenarios and situations. But the technology needs to do what you need it to do, really. And like I said, of course, there are different needs, different scenarios. But generally, I think for at-home care type activities and remote patient monitoring, it's important to have a few different things.

I think hemodynamic variables in being able to monitor these continuously, not just once a day, or twice a day or whatever, but near continuous or continuous monitoring, allowing for that two way communication with patients and the healthcare team is very important. It's engaging, it's the right thing improves early detection of signs and symptoms, and making sure that data is accessible. So you know that the flow of data goes into electronic health record or some other system that is easy to understand and interpret--again, preferably that it integrates with the electronic health record.

So I think these are all important variables when choosing a technology partner. And also it must fit into a system again, or be into an existing system or be part of a system that it comes with that can support the data flowing in. The partner also has to be willing to adapt to the needs of the patient in the facility caring for them. There has to be service behind the technology, because we're all learning here, I think, especially in this kind of new area of remote patient monitoring and potential at-home care, and we're all working together and learning how to best use this technology is really a partnership along the way.

Anuja Vaidya 

Absolutely. It can't just be RPM for RPM's sake, it has to be connected to to the larger care continuum.

Fantastic. So we're coming up against the end of our time here today. But I did want to just zoom out a little bit and ask you how you think RPM enabled cancer care will continue to evolve in the coming years. And what do you see as some of the hurdles to widespread adoption that we really need to overcome to expand access to these technologies?

Glen Peterson 

Yeah, there are definitely some hurdles that we realized along the way as we got to kind of work through some of the nuances of our study, and so on. But the aim is to couple remote patient monitoring with more at home care interventions, and keeping people out of the hospital and clinics unless they really need to be there. There's certainly benefit in the current state of remote patient monitoring in regard to early detection of side effects and complications and quicker access to care. But in-home care should really be the goal with all of this. And I think wider adoption of this area needs to be supported by payers, which will motivate healthcare systems to put more resources into remote patient monitoring and in home care. There is so much potential in this area. And the financial benefit and cost savings of this approach needs more attention to see its full potential.

Anuja Vaidya 

Certainly, it could be a real win-win-win situation for all stakeholders. So here's hoping we see more movement towards that expansion in the coming year.

And with that, we'll close out our conversation today. This has been truly a fascinating conversation. And I'd like to thank Glenn Peterson so much for coming on the podcast today and sharing his thoughts.

Glen Peterson 

Thank you very much for having me. I really appreciate it.

Anuja Vaidya 

And for our listeners, feel free to reach out to share your thoughts on this topic. My email address is avaidya@techtarget.com. That's A, V for victory, A, I, D for door, Y, A @tech target.com You can also use that email address to share any healthcare-related questions or stories that you would like us to consider covering.

Also, if you enjoyed today's conversation, please do let us know. You can rate us and write a review on whichever platform you use to listen to the podcast. Thank you so much for listening.