Towards Higher Safety of Haemato-Oncological Patients Undergoing Treatment
Authors: Popkova Tereza , Hradska Katarina , Mihalyova Jana , Skorupova Michaela , Jelinek Tomas , Duras Juraj , Koristek Zdenek , Navratil Milan , Benkova Katerina , Plonkova Hana , Zuchnicka Jana , Gumulec Jaromir , Hajek Roman 
Published: November 2019

Introduction: Medical care has recently been moving from wards to outpatient clinics due to a growing number of patients, convenient therapeutic approaches and rising emphasis on quality of life. There is an increased need for intensive monitoring of haemato-oncological patients undergoing long-lasting treatment especially when serious infectious complications are expected. Telemedicine is a great tool to keep an eye on patients spending most of their treatment at home, where reaction time plays an important role in reducing the impact of severe adverse events.
Methods: We plan on enrolling 100 haemato-oncological patients undergoing treatment who are at high risk of febrile neutropenia and/or sepsis. In the comfort of their homes, selected patients will measure their body temperature, blood pressure and pulse regularly every morning, plus whenever they feel unwell. Contactless measuring is provided by a digital blood pressure monitor and an infrared thermometer. Both devices communicate via bluetooth with a mobile HUB (cell phone), which then encrypts the information and forwards it to the National Monitoring Center. Physicians have real-time access to the measured values through a web portal using any device with an internet connection. Importantly, values registered outside the individually set-up range are immediately sent by SMS to a designated physician, who can then promptly react.
Results: In our pilot project, we enrolled 21 patients (33-80 y; median 60 y) including 9 treated for acute leukemia, 5 for multiple myeloma, 4 for chronic lymphocytic leukemia, 1 for myelodysplastic syndrome, 1 for malignant lymphoma and 1 for aplastic anemia. The median duration of monitoring was 6 months (1-16). One thousand, six hundred and twenty-three critical values of systolic (<90-95 mmHg) and diastolic (<50-60 mmHg, >91 mmHg) blood pressure in 19 patients were registered. High blood pressure in patients with inadequate antihypertensive therapy was the most frequent warning. Forty-four critical values of body temperature (>37.9°C) in 6 patients were registered, two cases with concomitant low blood pressure. After a telephone conversation with a physician, ambulatory care was recommended 12 times. Two cases of febrile neutropenia were detected, with the patients instantly hospitalized without progression into sepsis. Four cases of infectious complications (genital herpes, upper respiratory tract infection) with the need for anti-infective therapy and 6 cases of viral infections with only symptomatic treatment indicated were also addressed.
Conclusion: Even in a small cohort of patients we demonstrated that the remote monitoring of body temperature, blood pressure and pulse at home enables the early detection of infections and prompt provision of adequate treatment. An evaluation of the financial savings on medical expenses might also be a useful aspect to revise.

Disclosures
Hajek: Celgene: Honoraria, Other: Consultant or advisory relationship, Research Funding; AbbVie: Other: Consultant or advisory relationship; Bristol-Myers Squibb: Honoraria, Other: Consultant or advisory relationship, Research Funding; Novartis: Other: Consultant or advisory relationship, Research Funding; PharmaMar: Honoraria, Other: Consultant or advisory relationship; Takeda: Honoraria, Other: Consultant or advisory relationship, Research Funding; Janssen: Honoraria, Other: Consultant or advisory relationship, Research Funding; Amgen: Honoraria, Other: Consultant or advisory relationship, Research Funding.