Sean McClaine

Background: Chemotherapy can cause symptoms that impair quality of life and functioning. Remote monitoring of daily symptoms and activity during outpatient treatment may enable earlier detection and management of emerging toxicities but requires patients, including older and acutely ill patients, to engage with technology to report symptoms through smartphones and to charge and wear mobile devices. Objective: This study aimed to identify factors associated with participant engagement with collecting 3 data streams (ie, daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device [Google]) during chemotherapy. Methods: We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to install apps on their smartphones to rate daily symptoms and to collect passive sensor data and to wear a Fitbit device for the duration of the study. Participants completed baseline demographic and quality of life questionnaires, and clinical information was extracted from the electronic medical record. We fit a series of logistic generalized estimating equations to evaluate the association between demographic and clinical factors and daily engagement with each data stream. Results: Participants completed daily surveys on 61% (SD 27%) of days and collected sufficient smartphone data and wearable sensor data on 73% (SD 35%) and 70% (SD 33%) of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both symptom surveys (odds ratio [OR] 0.49, 95% CI 0.29-0.81; P=.006) and wearable data collection (OR 0.35, 95% CI 0.17-0.73; P=.005). Patients with stage 4 cancer also exhibited lower odds of engagement with symptom reporting than those with earlier stage disease (OR 0.69, 95% CI 0.48-1.00; P=.048), and patients were less likely to complete symptom ratings on the weekend (OR 0.90, 95% CI 0.83-0.97; P=.008). Older patients (OR 1.03, 95% CI 1.01-1.06; P=.01) and those who reported better cognitive functioning at study entry (OR 1.18, 95% CI 1.03-1.34; P=.02) were more likely to engage with Fitbit data collection, and patients who reported higher levels of depressive symptoms were less likely to engage with smartphone data collection (OR 1.18, 95% CI 1.03-1.36; P=.02). Conclusions: Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with these systems. Our results suggest significant associations between demographic and clinical factors and long-term engagement with smartphone and wearable device assessments during chemotherapy. Non-White participants, those with metastatic cancer, or those with existing cognitive impairment may benefit from additional resources to optimize engagement. Contrary to hypotheses, older adults were more likely than younger adults to engage consistently with wearable device assessments.

BACKGROUND Chemotherapy can cause symptoms that impair quality of life and functioning. Remote monitoring of daily symptoms and activity during outpatient treatment may enable earlier detection and management of emerging toxicities but requires patients, including older and acutely ill patients, to engage with technology to report symptoms through smartphones and to charge and wear mobile devices. OBJECTIVE This study aimed to identify factors associated with participant engagement with collecting 3 data streams (ie, daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device [Google]) during chemotherapy. METHODS We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to install apps on their smartphones to rate daily symptoms and to collect passive sensor data and to wear a Fitbit device for the duration of the study. Participants completed baseline demographic and quality of life questionnaires, and clinical information was extracted from the electronic medical record. We fit a series of logistic generalized estimating equations to evaluate the association between demographic and clinical factors and daily engagement with each data stream. RESULTS Participants completed daily surveys on 61% (SD 27%) of days and collected sufficient smartphone data and wearable sensor data on 73% (SD 35%) and 70% (SD 33%) of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both symptom surveys (odds ratio [OR] 0.49, 95% CI 0.29-0.81; P=.006) and wearable data collection (OR 0.35, 95% CI 0.17-0.73; P=.005). Patients with stage 4 cancer also exhibited lower odds of engagement with symptom reporting than those with earlier stage disease (OR 0.69, 95% CI 0.48-1.00; P=.048), and patients were less likely to complete symptom ratings on the weekend (OR 0.90, 95% CI 0.83-0.97; P=.008). Older patients (OR 1.03, 95% CI 1.01-1.06; P=.01) and those who reported better cognitive functioning at study entry (OR 1.18, 95% CI 1.03-1.34; P=.02) were more likely to engage with Fitbit data collection, and patients who reported higher levels of depressive symptoms were less likely to engage with smartphone data collection (OR 1.18, 95% CI 1.03-1.36; P=.02). CONCLUSIONS Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with these systems. Our results suggest significant associations between demographic and clinical factors and long-term engagement with smartphone and wearable device assessments during chemotherapy. Non-White participants, those with metastatic cancer, or those with existing cognitive impairment may benefit from additional resources to optimize engagement. Contrary to hypotheses, older adults were more likely than younger adults to engage consistently with wearable device assessments. CLINICALTRIAL

Background: Fluctuating symptoms and side effects are common during outpatient cancer treatment, and approaches to monitoring symptoms vary widely across providers, patients, and clinical settings. To design a remote symptom monitoring system that patients and providers find to be useful, it may be helpful to understand current clinical approaches to monitoring and managing chemotherapy-related symptoms among patients and providers and assess how more frequent and systematic assessment and sharing of data could improve patient and provider experiences. Objective: The goals of this study were to learn about patient and provider perspectives on monitoring symptoms during chemotherapy, understand barriers and challenges to effective symptom monitoring at one institution, and explore the potential value of remote symptom monitoring between provider visits. Methods: A total of 15 patients who were currently undergoing or had recently completed chemotherapy and 7 oncology providers participated in semistructured interviews. Interviews were transcribed and coded using an iterative thematic analysis approach. The study was conducted at a National Cancer Institute–Designated Comprehensive Cancer Center. Results: Four main themes were discussed by patients and providers: (1) asynchronous nature of current methods for tracking and managing symptoms, (2) variability in reported symptoms due to patient factors, (3) limitations of existing communication channels, and (4) potential value of real-time remote symptom monitoring during chemotherapy. Current asynchronous methods and existing communication channels resulted in a disconnect between when symptoms are most severe and when conversations about symptoms happen, a situation further complicated by memory impairments during chemotherapy. Patients and providers both highlighted improvements in patient-provider communication as a potential benefit of remote real-time symptom monitoring. Providers also emphasized the value of temporal data regarding when symptoms first emerge and how they progress over time, as well as the potential value of concurrent activity or other data about daily activities and functioning. Patients noted that symptom monitoring could result in better preparation for subsequent treatment cycles. Conclusions: Both patients and providers highlighted significant challenges of asynchronous, patient-initiated, phone-dependent symptom monitoring and management. Oncology patients and providers reported that more routine remote monitoring of symptoms between visits could improve patient-provider communication, prepare patients for subsequent chemotherapy cycles, and facilitate provider insight and clinical decision-making with regard to symptom management.

BACKGROUND Fluctuating symptoms and side effects are common during outpatient cancer treatment, and approaches to monitoring symptoms vary widely across providers, patients, and clinical settings. To design a remote symptom monitoring system that patients and providers find to be useful, it may be helpful to understand current clinical approaches to monitoring and managing chemotherapy-related symptoms among patients and providers and assess how more frequent and systematic assessment and sharing of data could improve patient and provider experiences. OBJECTIVE The goals of this study were to learn about patient and provider perspectives on monitoring symptoms during chemotherapy, understand barriers and challenges to effective symptom monitoring at one institution, and explore the potential value of remote symptom monitoring between provider visits. METHODS A total of 15 patients who were currently undergoing or had recently completed chemotherapy and 7 oncology providers participated in semistructured interviews. Interviews were transcribed and coded using an iterative thematic analysis approach. The study was conducted at a National Cancer Institute–Designated Comprehensive Cancer Center. RESULTS Four main themes were discussed by patients and providers: (1) asynchronous nature of current methods for tracking and managing symptoms, (2) variability in reported symptoms due to patient factors, (3) limitations of existing communication channels, and (4) potential value of real-time remote symptom monitoring during chemotherapy. Current asynchronous methods and existing communication channels resulted in a disconnect between when symptoms are most severe and when conversations about symptoms happen, a situation further complicated by memory impairments during chemotherapy. Patients and providers both highlighted improvements in patient-provider communication as a potential benefit of remote real-time symptom monitoring. Providers also emphasized the value of temporal data regarding when symptoms first emerge and how they progress over time, as well as the potential value of concurrent activity or other data about daily activities and functioning. Patients noted that symptom monitoring could result in better preparation for subsequent treatment cycles. CONCLUSIONS Both patients and providers highlighted significant challenges of asynchronous, patient-initiated, phone-dependent symptom monitoring and management. Oncology patients and providers reported that more routine remote monitoring of symptoms between visits could improve patient-provider communication, prepare patients for subsequent chemotherapy cycles, and facilitate provider insight and clinical decision-making with regard to symptom management.