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