Elsevier

Collegian

Volume 24, Issue 6, December 2017, Pages 541-549
Collegian

Remote real-time monitoring for chemotherapy side-effects in patients with blood cancers

https://doi.org/10.1016/j.colegn.2016.10.009Get rights and content

Abstract

Background

Chemotherapy for patients with blood cancers commonly results in distressing/potentially life-threatening toxicities/side-effects. Patients receiving outpatient chemotherapy are therefore responsible for monitoring/management of complex side-effects between clinical visits. The quality and safety of care in this patient group may be improved by a remote real-time Telehealth system which reports patient data directly to the clinical treatment team.

Aim

This study evaluated the acceptability, useability and feasibility of a real-time, remote Telehealth monitoring/management system.

Methods

Patients with blood cancers receiving chemotherapy, who consented to study participation, were trained to use the Telehealth application on a smart-phone. Patients entered side-effect data for one-cycle of chemotherapy. Data exceeding pre-set thresholds triggered alerts (via Short-Message-Service) to clinic nurses for actioning. At study conclusion patients completed semi-structured interviews about the experience of using the Telehealth system which were: recorded, transcribed and; underwent content analysis.

Findings

Seventeen patients used the system and completed the interview. The system was easy-to-use and fitted with daily routines. Perceived benefits included: reassurance; empowerment; increased health-awareness/adherence to self-care; promotion of timely clinical intervention and improved recall of side-effects and communication with clinicians/family/friends. The system was more beneficial to those experiencing more numerous side-effects. Suggested changes included: language clarification and additional side-effect monitoring.

Discussion

Use of a revised system was supported as an adjunct to current practice. Future use of a similar Telehealth system would enhance current pre-chemotherapy education, patient self-care adherence, alongside improved side-effect communication.

Conclusion

Additional randomised controlled trials are required to elucidate quantitative improvements in health outcomes prior to clinical introduction.

Section snippets

Problem or issue

  • •

    Patients with blood cancers receiving chemotherapy are at higher risk of distressing/potentially fatal side-effects than solid tumour patients.

  • •

    Between clinic visits patients are responsible for the monitoring/management of complex symptoms.

  • •

    Not all patients are equally equipped to make complex decisions in relation to the management of side-effects in the ambulatory setting.

  • •

    Early intervention to alleviate and/or prevent side effect escalation could decrease patient distress and improve outcomes

Literature review

Telehealth devices allowing remote, real-time monitoring and clinical response to side-effects maybe a cost-effective strategy to optimise care and are increasingly used in chronic disease to improve patient outcomes (Jones et al., 2014; Wildevuur & Simonse, 2015). Telehealth systems enabling real-time monitoring are now emerging in oncology. Although the scope of oncology studies is limited (Kofoed, Breen, Gough, & Aranda, 2012), early positive findings include: high levels of

Participants and recruitment

A pragmatic sample of patients with blood cancers were recruited from the Chemotherapy Day Unit/Haematology in-patient ward at an Australian hospital by a Research Assistant. Eligibility criteria included: age over 18 years; diagnosis of Hodgkin/Non-Hodgkin lymphoma/Chronic Lymphocytic Leukaemia and; currently receiving/about to commence chemotherapy treatment. Exclusion criteria included: ECOG > 3; unable to understand the English language sufficiently to use ASyMS-H; unable to use ASyMS-H due

Patient characteristics

Eighteen patients were recruited into the study with one patient dropping out after 3 days (Fig. 4). Interviews were conducted with 17 patients. Average age was 48.4 years (range of 20–78 years; Table 1). The majority of participants were male (72.2%); lived in a metropolitan area (61.1%) with a diagnosis of Non-Hodgkin Lymphoma (55.6%). Nine different chemotherapy protocols were administered to participants with the majority of patients receiving treatment in a day unit (83.3%). ASyMS-H was

Discussion

This study confirmed previous findings of the feasibility and acceptability of ASyMS for solid tumours (McCann et al., 2009) and added new perspectives that will assist in the refinement of ASyMS-H. Similar to the study by McCann et al. (2009), security and reassurance emerged as key findings. ASyMS-H instilled a sense of confidence in patients and their families and they felt safe in the knowledge that someone was monitoring their symptoms and that they were not solely responsible for

Conclusions

Similar to the evaluation of the original ASyMS application for solid tumours, patients described a positive experience using a real-time monitoring system. Patients felt reassured and completing the questionnaire twice-daily did not interfere with daily routine. The device facilitated communication between patients, clinicians and family members and empowered patients by increasing health awareness. The system was easy-to-use and assisted patients in the recall of side-effects, the

Acknowledgements

This project was supported by a competitive grant from the Victorian Cancer Agency. We also wish to thank the patients who gave their time to participate in this project alongside the Chemotherapy Day Unit nurses and Patient Services Managers who responded and triaged patient ASyMS-H alerts. We also wish to thank Yang Tang for her support in drafting the final version of this manuscript. The authors have no conflicts of interest to declare.

References (36)

  • N.R. Chumbler et al.

    Remote patient-provider communication and quality of life: Empirical test of a dialogic model of cancer care?

    Journal of Telemedicine and Telecare

    (2007)
  • C.S. Cleeland et al.

    Automated symptom alerts reduce postoperative symptom severity after cancer surgery: A randomized controlled clinical trial

    Journal of Clinical Oncology

    (2011)
  • B. Coiffier et al.

    CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma

    New England Journal of Medicine

    (2002)
  • X.L. Du et al.

    Population-based assessment of hospitalizations for toxicity from chemotherapy in older women with breast cancer

    Journal of Clinical Oncology

    (2002)
  • S. Elo et al.

    The qualitative content analysis process

    Journal of Advanced Nursing

    (2008)
  • L. Gerlier et al.

    The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia: An expert survey in breast cancer and non-Hodgkin’s lymphoma

    BMC Cancer

    (2010)
  • A. Glaus

    Assessment of fatigue in cancer and non-cancer patients and in health individuals

    Supportive Care in Cancer

    (1993)
  • B.A. Head et al.

    Development of a telehealthintervention for head and neck cancer patients

    Telemed JE-Health

    (2009)

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