Remote Monitoring Cuts Infection Hospitalizations

TOPLINE:

Electronic patient-reported outcome (ePRO) remote therapeutic monitoring (RTM) during treatment for hematologic malignancies reduces infection-related emergency department visits by 34% and hospitalizations by 52% compared with traditional monitoring. Patients using ePRO RTM were 20% more likely to receive outpatient antibiotics, suggesting earlier intervention that prevented acute care events.

METHODOLOGY:

Infection remains a leading cause of death in patients with hematologic malignancies, with population-based studies finding a threefold higher infectious disease mortality rate compared with the general population. ePROs have been shown to be readily integrated into outpatient community cancer care, to reliably identify severe symptoms and toxicities, and to reduce healthcare resource utilization, though they have not been previously evaluated for early remote detection of infections during cancer care.
Researchers conducted a retrospective cohort study of adults with hematologic malignancies receiving anticancer therapy at five community oncology clinics in Arkansas with an ePRO-based RTM platform integrated into their electronic medical record between June 1, 2020, and July 20, 2025.
A total of 1645 patients were included: 349 enrolled and active in the ePRO program (submitted ≥ 1 survey within 30 days of treatment initiation) and 1296 not enrolled in the program.
Patients in the active ePRO group received weekly text message prompts to complete electronic surveys consisting of 77 cancer-related symptoms with severity ratings comparable with the National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (range, 0-4).
Dual primary outcomes were infection-related healthcare utilization (emergency department visits and hospital admissions) and outpatient antibiotic use during follow-up, with patients followed from treatment initiation through the earlier of 2 years or the data cutoff date.
Propensity score weighting was used to balance patient characteristics between groups, with covariates including age, sex, race/ethnicity, hematologic malignancy type, and time from diagnosis to treatment.

TAKEAWAY:

Patients in the active ePRO group had significantly higher rates of outpatient antibiotic use than the non-enrolled group (weighted relative risk ratio [RR], 1.20; 95% CI, 1.02-1.42; P = .0254).
The active ePRO group demonstrated a 52% lower relative rate of infection-related hospital admissions than the non-enrolled group (weighted RR, 0.48; 95% CI, 0.25-0.89; P = .0212).
Infection-related emergency department visits were 34% lower in the active ePRO group than the non-enrolled group (weighted RR, 0.66; 95% CI, 0.46-0.96; P = .0316).
Among active ePRO patients with qualifying clinical events, 70% (23/33) and 77% (101/131) submitted ≥ 1 ePRO symptom survey in the 30 days preceding acute care events or outpatient antibiotic orders, respectively, with predefined symptom clusters intensifying in the 0-15 days before encounters.

IN PRACTICE:

“ePRO RTM during treatment for hematologic malignancies was associated with a significant reduction in infection-related healthcare utilization and cost of care. ePRO monitoring may be increasingly beneficial as therapies with more complex toxicity profiles gain traction,” the authors of the study wrote.

SOURCE:

The study was led by Benjamin A. Derman, MD, of The University of Chicago, Chicago, and James H. Essell, MD, of Oncology/Hematology Care, Cincinnati. It was published online on April 10 in JCO Oncology Practice.

LIMITATIONS:

As a nonrandomized observational study, patients were not randomly assigned to groups, and data may contain artifacts as they were not specifically collected for this analysis, though rigorous propensity score methods were used to balance the groups. Antibiotic orders were used to reflect antibiotic initiation; although patient adherence could not be assessed, the observed improvements in infection-related hospitalizations suggest that antibiotics were likely taken. The study was conducted at community oncology clinics in Arkansas rather than nationwide, though the patient population is comparable to the overall US cancer population in demographics. Out-of-state hospitalizations were not captured in the dataset, though this missingness is expected to be random with respect to ePRO engagement due to the clinic’s proximity to the state border. Patients who enrolled more than 30 days after treatment initiation were excluded, and the effects on healthcare resource utilization among them were not assessed.

DISCLOSURES:

Derman disclosed receiving honoraria from Plexus and the Multiple Myeloma Research Foundation; consulting or advisory roles with Janssen Scientific Affairs, COTA Healthcare, Guidepoint Global, Gerson Lehrman Group, Sanofi, Canopy Care, Pfizer, and Legend Biotech; and research funding from GlaxoSmithKline and Amgen. Essell disclosed a consulting or advisory role with Genmab. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.