Remote monitoring of oncology patients’ symptoms using digital technologies may be a cost-effective method of improving outcomes. Remote monitoring typically involves recording patient symptoms and vital signs, and then uses algorithms to detect changes in these measures.
According to a recent report from Spyglass Consulting, 88% of healthcare systems have either invested in, or plan to invest in, remote patient monitoring technologies in 2020. Reimbursement for remote patient monitoring is helping to drive this trend, according to providers of technology-based healthcare delivery.
Data are limited, but available evidence supports web-based symptom monitoring to enhance survival in patients with solid tumors while achieving cost-savings.
For example, 2-year follow-up from a multicenter clinical trial conducted in France found that survival improved in a group of patients with advanced lung cancer who were randomized to web-based patient-reported outcomes (PROs) symptom monitoring using the Sentinel PRO System compared with a group randomized to standard follow-up with scheduled imaging every 3 to 6 months. The group assigned to remote monitoring was instructed to report the presence of 13 common symptoms weekly between personal visits. An automatic alert was sent to the treating oncologist when patients assigned to the PRO system had symptoms that fit predefined criteria for worsening disease.
The 2-year death rates were 47.5% in the remote monitoring group versus 66.7% in the control group, and median overall survival was 22.5 months versus 14.9 months, respectively (P = .03). Relapse was detected an average of 5 weeks earlier in the PRO arm of the trial, the investigators reported.
An earlier randomized controlled trial (N = 441) conducted at Memorial Sloan Kettering Cancer Center showed a similar improvement in survival and fewer emergency department visits among patients receiving outpatient chemotherapy for advanced solid tumors who used a web-based remote monitoring platform called Symptom Tracking and Reporting (STAR) to report the presence of 12 symptoms on a weekly basis.
Interventions taken in direct response to e-mail alerts of worsening signs or symptoms included telephone counseling about symptom management (in response to 77% of alerts), supportive medication initiation/change (12%), referral to the emergency department/hospital (8%), chemotherapy dose modification (2%), and orders for imaging/tests (2%).
Some 75% of patients in the intervention group were alive at 1 year compared with 69% in the usual care arm (P = .05), and a 7% absolute reduction in emergency department admissions was reported in patients assigned to the STAR platform compared with controls.
According to Advisory Board, a healthcare research firm, the drop in emergency department visits among patients randomized to the STAR platform would translate into a savings of $24,800, assuming a cost of $800 for each chemotherapy-related emergency department visit.
Although recent data suggest that remote monitoring may offer tangible benefits for patients, it also represents a fundamental shift in how providers engage with patients. Most importantly, it requires patients to be more active participants in their own care, which can be empowering for some patients.