Remote monitoring : how to better care for patients at home

A per­son suf­fe­ring from can­cer must often begin a dif­fi­cult and leng­thy course of treat­ment. This per­iod, which can only be stress­ful for the indi­vi­dual, is neces­sa­ry for the care of the patient, but leads to many incon­ve­niences. In addi­tion to the risks of unjus­ti­fied hos­pi­ta­li­sa­tion, the effects of toxi­ci­ties lin­ked to treat­ments and the way the disease deve­lops are major issues for qua­li­ty of care. 

In onco­lo­gy, the doses pres­cri­bed are some­times high and the patient does not always cope with the side effects. Moni­to­ring of patients during treat­ment, far from the hos­pi­tal at home, is the­re­fore neces­sa­ry. Today, a new field is emer­ging that can coun­te­ract these draw­backs : remote moni­to­ring. It can be applied to many diseases, offe­ring the pos­si­bi­li­ty of remote medi­cal moni­to­ring via digi­tal communication. 

Remote moni­to­ring is a pro­mi­sing field that is attrac­ting a lot of invest­ment from start-ups, but very few stu­dies are avai­lable on the bene­fits of this type of moni­to­ring. With my team, we the­re­fore car­ried out a ran­do­mi­sed control­led trial ¹, on a sample of 559 can­cer patients – of all can­cer types – to test the effec­ti­ve­ness of remote moni­to­ring for a chro­nic disease, along with a lon­gi­tu­di­nal study.

Trea­ting can­cer requires regu­lar visits to the hos­pi­tal. The patient is the­re­fore often in an envi­ron­ment that is spe­cia­li­sed to their needs. Oral treat­ment limits these visits, but once back home, there is a kind of dis­con­nec­tion that takes place due to a lack of infor­ma­tion. This can lead to a fee­ling of aban­don­ment for the patient so, in order to pro­vide the most appro­priate res­ponse, we conduc­ted a pre­li­mi­na­ry sur­vey to find out what ele­ments were mis­sing in this long-dis­tance relationship. 

CAPRI, a remote patient moni­to­ring app, was deve­lo­ped from this sur­vey. It is simple to use and allows patients to get in touch direct­ly with the medi­cal staff to ans­wer their ques­tions and manage treat­ment. In our stu­dy, where the com­mu­ni­ca­tion sys­tem was mixed, CAPRI allows bila­te­ral or sym­me­tri­cal com­mu­ni­ca­tion – two coor­di­na­tion nurses are in charge of the digi­tal inter­ac­tions, fur­ther com­ple­ted with tele­phone calls where necessary. 

To eva­luate and respond to requests in an effi­cient man­ner, the nurse is accom­pa­nied by 80 deci­sion trees. Digi­tal tech­no­lo­gy is the­re­fore only the tip of the ice­berg ; the way the infor­ma­tion is pro­ces­sed by the nurses is essen­tial for good fol­low-up care. This is in contrast to many exis­ting appli­ca­tions, which eva­luate but do not guide the patient in his or her jour­ney. During the stu­dy, 77% of patient requests were direct­ly pro­ces­sed by the nurses without going through the refer­ring onco­lo­gist. This is, of course, due to a large num­ber of ques­tions that do not require in-depth know­ledge of the disease. For example, “can I go swim­ming with the treat­ment?”. But has the direct effect of relie­ving the alrea­dy over­ly hea­vy work­load of the refer­ring onco­lo­gist and vali­dates the rele­vance of the deci­sion tree avai­lable to nurses. 

To ensure the effec­ti­ve­ness of this type of fol­low-up, we esta­bli­shed a ran­do­mi­sed control­led sample of 559 patients ana­ly­sed inclu­ding the patient in the CAPRI group or the control group (usual care). 

Seve­ral bene­fits of this type of remote moni­to­ring device are appa­rent. Constant moni­to­ring of the patient limits the dif­fe­rence bet­ween the dose neces­sa­ry to treat the patient and the dose ini­tial­ly pres­cri­bed (this is cal­led the rela­tive dose inten­si­ty). Moreo­ver, this type of moni­to­ring sys­tem helps to prevent the toxi­ci­ty effects asso­cia­ted with the treat­ments. This is a fun­da­men­tal bene­fit, because toxi­ci­ty, when it becomes severe, is often irre­ver­sible for the patient. Second­ly, there is a reduc­tion in hos­pi­tal visits. With remote moni­to­ring, patients are, on ave­rage, hos­pi­ta­li­zed 1.5 days less than in the control arm. In addi­tion, they visit the emer­gen­cy room less often. Last­ly, patients expres­sed more posi­tive experiences.

These bene­fits obvious­ly come from the fol­low-up care, but behind it, there is the signi­fi­cant amount of work that the coor­di­na­ting nurses pro­vide. This leads to the ques­tion : how many patients per year can be fol­lo­wed by a nurse ? Accor­ding to our stu­dy, it would be about 125 to 150 patients over the year. For this, they work full-time, some­times under extreme condi­tions. They play an excep­tio­nal role in remote moni­to­ring, and it is their invest­ment in this fol­low-up that makes a real difference.

Final­ly, our results lead us to say that this type of moni­to­ring works. We believe that it is the whole desi­gn that wor­ked : the orga­ni­sa­tion adop­ted by the nurses and the omni­pre­sence of digi­tal tech­no­lo­gy. This type of sys­tem desi­gn is the result of sha­red cli­ni­cal and mana­ge­ment science exper­tise. With these solu­tions alrea­dy in place, the desi­gn could be repro­du­ced for other types of fol­low-up care. 

Interview by Pablo Andres