Moore Susan L, Peterson Glen J, Montoya Sarah R, Conte Bellinda K, Brahler Rachel K, Hutchison Carolyn, Hoople Katherine L, Smith Clayton A
Division of General Internal Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
mHealth Impact Lab, Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Front Immunol. 2025 Jun 18;16:1403249. doi: 10.3389/fimmu.2025.1403249. eCollection 2025.
Febrile neutropenia, neurotoxicity, and cytokine release syndrome are dangerous and damaging side effects seen in more than half of patients with cancer who receive critical chemotherapies or immunotherapies respectively. Early intervention and care can reduce complications, but timely treatment in the outpatient setting is often delayed due to dependency on interval-based, patient-driven self-assessments. Using digital health technologies (DHT) to monitor patients remotely can improve time-to-intervention and health outcomes. Providing follow-up treatment and essential support to patients at home can further reduce patients' and caregivers' burden and improve patient satisfaction.
This pilot feasibility study examined the results of a patient-centered program for technology-assisted remote patient monitoring and symptom reporting for patients undergoing autologous or allogeneic stem cell transplant (SCT) or CAR T-cell therapy. Technical and operational feasibility and user experience were assessed for patients, caregivers, and providers. Ten patients between 30 and 80 years old participated in the study for up to 30 days after CAR T-cell therapy or autologous SCT or up to 90 days after allogeneic SCT. Patients wore biometric sensors around the clock to monitor vital signs and engaged with a chatbot through bidirectional SMS text messages for symptom reporting and regular health check-ins. Virtual care center personnel monitored patient status and followed up with patients or their care providers as needed. Patients, caregivers, and providers completed surveys about their program experience; patients also completed brief interviews.
Nine of 10 patients engaged with DHT based monitoring as intended. A total of 219 alerts were generated, 171 from wearables and 48 from the chatbot and check-ins. Fifty-seven alerts required follow-up with patients, 26 required care team follow-up, and 10 required patients to be seen in a clinical setting. Users found the program acceptable overall, with patients and caregivers reporting perceptions of being more cared for and providers feeling that it improved quality of care. Suggestions received included a desire for more information and improved communication and alerting processes.
Overall, DHT-based remote patient monitoring was feasible for use with patients receiving SCT and CAR T-cell therapy. Effective practice integration requires adaptation to clinical workflows. Further evaluation of patient acceptance over time and effectiveness at improving health outcomes is recommended.
发热性中性粒细胞减少、神经毒性和细胞因子释放综合征分别是接受关键化疗或免疫治疗的半数以上癌症患者中出现的危险且有害的副作用。早期干预和护理可以减少并发症，但由于依赖基于间隔、患者驱动的自我评估，门诊环境中的及时治疗往往会延迟。使用数字健康技术（DHT）对患者进行远程监测可以缩短干预时间并改善健康结果。在家中为患者提供后续治疗和基本支持可以进一步减轻患者及其护理人员的负担并提高患者满意度。
这项试点可行性研究考察了一个以患者为中心的项目的结果，该项目用于对接受自体或异基因干细胞移植（SCT）或CAR T细胞疗法的患者进行技术辅助的远程患者监测和症状报告。对患者、护理人员和医疗服务提供者评估了技术和操作可行性以及用户体验。10名年龄在30至80岁之间的患者在接受CAR T细胞疗法或自体SCT后参与研究长达30天，或在异基因SCT后参与研究长达90天。患者全天候佩戴生物识别传感器以监测生命体征，并通过双向短信文本消息与聊天机器人互动以进行症状报告和定期健康检查。虚拟护理中心人员监测患者状态，并根据需要对患者或其护理提供者进行随访。患者、护理人员和医疗服务提供者完成了关于他们项目体验的调查；患者还完成了简短访谈。
10名患者中有9名按预期参与了基于DHT的监测。总共产生了219条警报，其中171条来自可穿戴设备，48条来自聊天机器人和健康检查。57条警报需要对患者进行随访，26条需要护理团队随访，10条需要患者在临床环境中就诊。用户总体上认为该项目是可接受的，患者和护理人员表示感觉受到了更多关怀，医疗服务提供者认为这提高了护理质量。收到的建议包括希望获得更多信息以及改进沟通和警报流程。
总体而言，基于DHT的远程患者监测对于接受SCT和CAR T细胞疗法的患者是可行的。有效的实践整合需要适应临床工作流程。建议进一步评估患者随时间推移的接受度以及在改善健康结果方面的有效性。
