Engagement with daily symptom reporting, passive smartphone sensing, and wearable device data collection during chemotherapy (Preprint)

Abstract

Chemotherapy can cause a variety of symptoms that can 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 successfully engage with technology to report symptoms via smartphone and to charge and wear or carry mobile devices.

The objective of this study was to identify factors that were associated with participant engagement with collecting three data streams over 90 days during chemotherapy: daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device.

We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to rate daily symptoms via a smartphone app, to install an application on their smartphones 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.

Overall engagement was high, with participants completing daily surveys on 61% of days and collecting sufficient smartphone data and wearable sensor data on 73% and 70% of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both the daily symptom surveys and wearable data collection. Patients with Stage IV cancer also exhibited lower odds of engagement with daily symptom reporting than those with earlier stage disease, and patients were less likely to complete symptom ratings on the weekend. Odds of engagement with smartphone and Fitbit data collection were greater the less time had elapsed since the patient’s last chemotherapy appointment. Older patients and those who reported better cognitive functioning at study entry 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.

Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with monitoring systems. Results suggest significant associations between demographic and clinical factors and sustained engagement with smartphone and wearable device assessments during chemotherapy, suggesting that 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.