# An App-Based Remote Patient Monitoring System With Wrist and In-Ear Wearables in Gastrointestinal Oncology: Prospective Feasibility Pilot Study

## TL;DR

A new app-based system with wearable devices was tested to monitor cancer patients remotely, showing moderate success and patient satisfaction.

## Contribution

This study introduces and evaluates a novel app-based remote patient monitoring system for gastrointestinal cancer patients using wrist and in-ear wearables.

## Key findings

- The system achieved moderate adherence with 46% ePRO completion and 61% wearable use.
- Patients were generally satisfied with the system, with 60% reporting satisfaction and 70% finding it easy to use.
- The wrist wearable was rated more comfortable than the in-ear wearable.

## Abstract

Outpatient treatments, including targeted therapies, in oncology are on the rise. The implementation of remote patient monitoring (RPM) between therapy sessions has the potential to enhance patient care and therapy outcomes in the future.

This pilot study assessed the feasibility of a new, app-based RPM system (bwHealthApp) by capturing patient-reported outcomes (PROs) and vital parameters using a wrist- or in-ear wearable. The study examined adherence, acceptance, and satisfaction, as well as the differences between the two types of wearables.

Outpatients with gastrointestinal cancer receiving systemic therapies were invited to use and evaluate the bwHealthApp system for 1 month. The system was set up as an Android smartphone app to assess electronic PROs (ePROs) and connect to wearables for continuous vital sign measurements. A wrist wearable (Beurer AS99) that measured activity and heart rate or an in-ear wearable (Cosinuss Two) that measured heart rate, oxygen saturation, and temperature was used. The data were synchronized remotely to a web client. Outpatients were randomly assigned to the wrist wearable (n=17) or in-ear wearable (n=14) group. At the beginning, middle, and end of the study, patients (N=31) completed questionnaires on various feasibility aspects. Adherence to ePRO completion; wearable use, acceptance, and satisfaction; wearable data quantity and quality; and differences between the wearables were evaluated.

The mean adherence to bwHealthApp including dropouts was 46% (449/971 days) for ePRO completion and 61% (593/971 days) for wearable use. The system was most frequently used during everyday activities. More than half of the participants were satisfied with bwHealthApp (18/30, 60%) and could imagine continued use (21/30, 70%). Notably, 70% (21/30) rated the system as easy to use. Participants recorded more than 20 million wearable measures; however, 29% (SD 22%, range 3%-76%) of temperature values and 33% (SD 25%, range 10%-92%) of oxygen saturation values were outside the physiological range. For heart rate, the mean proportion of excluded values was 10% (SD 11%, range 4%-48%; in-ear) and 11% (SD 8%, range 4%-33%; wrist). The frequency of use of the two wearables did not differ significantly (t29=1.81; P=.08). The wrist wearable scored significantly better than the in-ear wearable regarding wearing comfort (t28=−11.17; P=.03).

This bwHealthApp pilot study demonstrates the feasibility of RPM via a mobile app and wearable devices during outpatient systemic cancer therapy, including targeted therapies. The adherence level was moderate, and patients were generally satisfied with the system, although the wrist wearable received a higher rating. The system’s functionality may be enhanced through the integration of additional wearables. This pilot study serves as a foundational framework for long-term assessments examining RPM and clinical data to improve cancer treatments.