Using technology for patient-centered care at home after CAR T-cell therapy or bone marrow transplant: a prospective feasibility study

Susan L. Moore¹Glen Peterson^2*Sarah Montoya³Bellinda Conte⁴Rachel Brahler⁴Carolyn Hutchison⁵Katherine Hoople^1*Clayton Smith⁵

• ¹Department of Community & Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
• ²Department of Hematology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
• ³University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
• ⁴Reimagine Care, Inc., Nashville, Georgia, United States
• ⁵CU Innovations, University of Colorado, Aurora, Colorado, United States

Febrile neutropenia, neurotoxicity, and cytokine release syndrome are dangerous, damaging side effects seen in over half of patients with cancer who receive critical chemotherapies or immunotherapies respectively. Early intervention and care can reduce complications, but timely outpatient treatment is often delayed due to dependency on interval-based, patient-driven self-assessments. Using digital health technologies (DHT) to monitor patients remotely can improve time-to-intervention and health outcomes. Providing follow-up treatment and essential support to patients at home can further reduce patients' and caregivers' burden and improve patient satisfaction. This pilot feasibility study examined the results of a patient-centered program for technology-assisted remote patient monitoring and symptom reporting for patients undergoing autologous or allogeneic stem cell transplant (SCT) or CAR T-cell therapy. Technical and operational feasibility and user experience were assessed for patients, caregivers, and providers. Ten patients between 30 and 80 years participated in the study for up to 30 days after CAR T-cell therapy or autologous SCT or up to 90 days after allogeneic SCT. Patients continuously wore biometric sensors to monitor vital signs and engaged with a chatbot through bidirectional SMS text messages for symptom reporting and regular check-ins. Virtual care center personnel monitored patient status and followed up with patients or their care providers as needed. Patients, caregivers, and providers completed surveys about their program experience; patients also completed brief interviews. Nine of 10 patients engaged with DHT-based monitoring as intended. A total of 219 alerts were generated, 171 from wearables and 48 from the chatbot and check-ins. Fifty-seven alerts required follow-up with patients, 26 required care team follow-up, and 10 required patients to be seen in a clinical setting. Users found the program acceptable overall, with patients and caregivers reporting perceptions of being more cared for and providers feeling that it improved quality of care. Suggestions received included a desire for more information and improved communication and alerting processes. Overall, DHT-based remote patient monitoring was feasible for use with patients receiving SCT and CAR T-cell therapy. Effective practice integration requires adaptation to clinical workflows. Further evaluation of patient acceptance over time and effectiveness at improving health outcomes is recommended.