Transforming Neutropenic Fever Assessment with Remote Monitoring Technology

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Neutropenic fever, a commonly occurring and potentially serious chemotherapy complication, requires careful monitoring and close observation. Neutropenia affects a significant number of patients undergoing chemotherapy, with about half experiencing some level of neutropenia, according to the American Society of Clinical Oncology.¹ Neutropenic patients are inherently at risk for developing neutropenic fever, which confers an increased risk of mortality, estimated to be at least 15% higher than in those who do not experience neutropenic fever.²

Early detection and prompt treatment of neutropenic fever are essential for effective management, but the conventional approach of using spot-check thermometers has innate limitations. Despite technological advancements, the fundamental process of using a thermometer has remained largely unchanged: patients are still instructed to check their temperature when symptoms arise or a few times per day. However, neutropenic fever can sometimes occur without symptoms or during non-waking hours, which means spot checks likely miss some episodes.

Unlike traditional thermometers, remote patient monitoring (RPM) offers a novel, modernized approach for detecting and monitoring neutropenic fever by enabling continuous temperature monitoring and more timely intervention. RPM devices represent a convenient, technology-based solution that can provide peace of mind in managing a potentially serious condition.

Advancing Health Care With Wearable Technology

RPM devices such as automated temperature monitors have the potential to bring about a significant shift in how health data are collected. Rather than patients or study participants having to take action with a traditional thermometer, they simply wear a small, unobtrusive wireless patch throughout their day and even during sleep. The device continuously transmits temperature data to secure, HIPAA-compliant remote servers. This innovative approach can not only streamline patient care but also holds promise for decentralizing data collection in studies.

Researchers are conducting a prospective study involving 80 patients with cancer who are receiving outpatient chemotherapy treatment. The study utilizes Vivalink’s continuous temperature monitor—a clinical-grade wearable thermometer that automatically checks patients’ body temperature every 10 minutes. The study specifically focuses on patients with breast cancer, colon cancer, lung cancer, or one of two common types of non-Hodgkin lymphoma who are undergoing TC (docetaxel plus cyclophosphamide), mFOLFOX6 (leucovorin, fluorouracil, plus oxaliplatin), cisplatin/pemetrexed, or R-CHOP (rituximab [Rituxan], cyclophosphamide, doxorubicin, vincristine plus prednisone) chemotherapy regimens.

Study participants will wear a Vivalink temperature monitor continuously during the initial 3 months of chemotherapy treatment. If a fever is detected, real-time notifications will be sent via email to both patients and their treating oncologists. For each fever episode, the system will generate two emails: one notifying that a fever has occurred, and another reporting the maximum temperature during the episode. Patients will subsequently undergo blood tests to confirm neutropenia.

The study seeks to determine the occurrence rate of neutropenic fever in patients undergoing common chemotherapy regimens and to enable earlier detection and treatment of neutropenic fever compared with spot-check thermometers. Additionally, the study intends to evaluate the morbidity, mortality, health care utilization, and cost of care of patients with neutropenic fever detected through automated temperature patches.

Understanding Neutropenic Fever With Wearables

Over the past few decades, extensive research has been conducted on the rates of neutropenic fever associated with various chemotherapy regimens. These studies helped inform guidelines that now separate chemotherapy regimens into different risk categories: high risk (>20% incidence) and intermediate risk (10%-20% incidence) of causing neutropenic fever.3 The guidelines also recommend the use or consideration of myeloid growth factors, which are medications administered alongside each chemotherapy cycle to boost white blood cell counts and reduce the risk of neutropenic fever. These guidelines not only shape medical practice but also impact insurance coverage decisions.

However, since all of these studies used traditional manual temperature readings to detect fevers, they faced the same limitations as using spot-check thermometers in clinical practice. As a result, there is a possibility that the actual incidence of neutropenic fever is higher than previously estimated. This could have significant implications in two ways:

1. Intermediate risk chemotherapy regimens may have a higher risk of neutropenic fever than previously believed. The potential reclassification as high risk could result in revisions to guideline recommendations and insurance reimbursement policies for myeloid growth factors.
2. Wearable technology can identify cases of neutropenic fever that may have otherwise gone unnoticed, revealing a previously unrecognized category of patients with neutropenic fever who may be able to safely forgo treatment.

The use of wearable technology for fever detection has the potential to advance our understanding of neutropenic fever and its related risk categories. While the primary objective of this study is not to formally establish criteria for "low risk" neutropenic fever, it may be able to generate valuable hypotheses regarding the characteristics of such a syndrome.

Neutropenic fever itself contributes to around 5% of all cancer-related hospitalizations and accounts for approximately 8% of the total costs associated with these hospitalizations.⁴ When it is safe to do so, managing patients with neutropenic fever outside of the hospital can enhance patient care and alleviate the burden on existing health care resources.

Unlocking Insights With Remote Patient Care in Oncology

The aforementioned study will monitor temperature only, but remote monitoring of other vital signs can offer valuable real-time health insights for patients with cancer who are at high risk of treatment-related complications. RPM devices have the capability to collect vast amounts of data in real-world situations, providing a comprehensive picture of a patient's real-time condition.

To make the most of RPM data, it is crucial to have access to intuitive and user-friendly management platforms that effectively organize and present this information. Employing algorithms, ranging from simple to complex, can analyze and package RPM data in ways that can assist both clinicians and researchers in their decision-making processes. Moving forward, further design and validation of use cases of these technologies will be essential as remote patient monitoring expands.

Editor’s Note: Adam Singer, MD, PhD, is a medical oncologist, genitourinary cancer specialist, and health technology researcher. He holds an MD from UCLA and a PhD in policy analysis from the Pardee RAND Graduate School.

References

1. Neutropenia. Cancer.net. September 2019. Accessed November 1, 2023. https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/neutropenia
2. Lyman GH, Michels SL, Reynolds MW, et al. Risk of mortality in patients with cancer who experience febrile neutropenia. Cancer. 2010;116(23):5555-5563. doi:10.1002/cncr.25332
3. Griffiths EA, Roy V, Alwan L, et al. NCCN guidelines insights: hematopoietic growth factors, version 1.2022. J Natl Compr Canc Netw. 2022;20(5):436-442. doi:10.6004/jnccn.2022.0026
4. Tai E, Guy GP, Dunbar A, et al. Cost of cancer-related neutropenia or fever hospitalizations, United States, 2012. J Oncol Pract. 2017;13(6):e552-e561. doi:10.1200/JOP.2016.019588