How Can Remote Monitoring Help Patients After Cancer Surgery?

Among nearly 300 patients who underwent major abdominal or pelvic surgeries for gastrointestinal, genitourinary or gynecologic cancers, researchers found that remote monitoring before and after surgery was associated with improved recovery.

Study results, detailed in a news release issued by the University of Miami Miller School of Medicine and published in npj Digital Medicine, showed that patients who worse wristband accelerometers and reported symptoms via a mobile app before surgery and at regular intervals after discharge experienced a 6% greater functional recovery rate by two weeks after surgery and fewer major complications compared to patients who received only automated messages. Additionally, patients reported improved symptom management and less interference with daily activities.

CURE spoke with co-author Tracy Crane about the findings. Crane, who holds a doctorate degree, is co-leader of the Cancer Control Program at Sylvester Comprehensive Cancer Center, part of the University of Miami School of Medicine.

What were you and your colleagues hoping to learn with this study?

More and more cancer care is moving out of the four walls of a cancer center, and especially in the postoperative setting, for patients who are faced with things such as a GI surgery for cancer or gynecologic cancer or even genitourinary or prostate cancer, we want to make sure that we can get our patients healing faster and healing better. And one of the things that we wanted to know was, could we implement some sort of remote-based monitoring, because more patients are at home? How could we better monitor patients such that their postoperative outcomes improved? I have an Oura ring on and a Fitbit on, and all these gadgets that we assume are going to make life better, but could they really be used in such a way to help with remote monitoring? So that was really the question that we wanted to answer in the postoperative setting. And if so, how could we best implement this?

There were two arms of the trial. One arm of the trial had your standard monitoring postoperatively that you would get, so everybody got at least standard of care, of course. The other arm was also completing symptom journals online, like they're monitoring their symptoms, daily reporting on their symptoms, and they also had a device that was tracking their activity. So in the arm that was getting the remote patient monitoring if they dropped below a certain level of daily activity in addition to the symptoms, the nurses were alerted in that arm, so they were then informed that your patient appears to also be having lower levels of activity.

And that, in fact, resulted in about a 6% improvement in faster recovery, fewer postoperative complications. Interestingly, this additional level of remote monitoring also helped people stay engaged in the trial, which I think is an interesting finding. We don't know if it's the additional level of surveillance that helped them feel like they were still part and being monitored by their health care team, but we did find that it did improve postoperative outcomes.

Why are strategies that streamline patient monitoring so important?

We need scalable, effective solutions that allow us to help continue to optimize patient outcomes. So, having a higher level of engagement starts to begin to provide what we call risk-stratified care, meaning those who are at the highest level of need are, in fact, getting the care that they need by having this additional layer of this scalable solution, utilizing things like a wearable device.

A lot of them passive sensors. You don't even have to do anything. You just put the device on, and assuming you're synced to whatever platform it is, you don't have to do anything else. The burden can be quite low. Reporting your symptoms, it's another thing, you do have to go in and say how you're feeling. But at the at the lowest level, these passive sensors, I do think, hold a lot of potential for helping us to monitor our patients.

With these findings in hand, what comes next?

I think in the digital health space, it's about the postoperative setting, as this study showed that technology isn't just about data, but it's about connecting. And it's about when do you connect the patient to the clinician at the right time? I think patients feel safer knowing that their care team is kind of watching over them, and that potentially could be leading to better recovery, I think too, that knowing that this healing and recovery doesn't end when hospital discharge happens, and that's often when patients need us most, and that by having digital tools such as this, could we actually implement a new care paradigm where we implement this in the postoperative setting? And so, I think these digital tools can really help us to step in earlier, address problems sooner, and then support patients where they're at.

Reference

1. “Remote Monitoring Improves Recovery from Cancer Surgery,” news release; https://news.med.miami.edu/remote-monitoring-improves-recovery-from-cancer-surgery/

Transcript has been edited for clarity and conciseness.

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