Tracking Symptoms, Physical Activity With Wearable Technology in Oncology Nursing

Close up of hand touching smartwatch with health app on the screen, gadget for fitness active lifestyle. © sitthiphong - stock.adobe.com

Wearable technology can be a valuable tool to help oncology nurses track symptoms and physical activity in their patients, but it is important for nurses to be involved in the development of such an effort from the very beginning, an expert said.

“There’s definitely lots of opportunities for oncology nurses to leverage wearable technology,” Virginia Sun, PhD, M.S.N., RN, professor in the department of population sciences and the department of surgery at City of Hope, said in an interview with Oncology Nursing News. “From a scientific perspective—because I am a a researcher as well as an oncology nurse—we still have a lot to learn in terms of how best to leverage that information.”

At the present time, oncology nurses can utilize wearable technology in the care of their patients in several ways. For instance, triage nurses may be able to perform remote monitoring for patients before and after surgery or a major abdominal pelvic procedure for cancer treatment.

“We have nurses that are leveraging wearable sensor and electronic mobile application platform information to help with their triage,” Sun said. “This is a potentially important and efficient way for nurses to leverage technology to assist with their care responsibilities.”

In a traditional triage nurse setting, patients with cancer know to call their nurse at all hours of the day if they are experiencing any symptoms or challenges. Even though the open communication is available, it can take some time before nurses know how to react to a patient’s challenge.

“By leveraging technology, wearable sensors, [and a] mobile application, we are able to gather that information such that at the time of that encounter that the nurses have in, for example, a triage setting, the nurses already have that information,” Sun said. “So that can potentially make the encounter more efficient. The nurses can be able to start really thinking about and working on that management before they even talk to a patient.”

Electronic symptom monitoring is the area of technology with the most high-level evidence, Sun added. Researchers like her are trying to replicate and contribute to the space to show that electronic symptom monitoring can improve symptom management, decrease symptom severity, and potentially improve survival in patients with advanced cancers.

“That area definitely is an area that could become standard of care,” Sun said. “Institutions and nurses can begin to think about that and how to integrate [wearable technology] into their regular care.”

Pedometers and accelerometers may also be used to track a patient’s step counts and to motivate them to perform physical activity. This information can also be used as a biomarker of functional status.

Sun and her team researched the use of accelerometers and pedometers in patients with cancer who underwent surgery. Patients in the study reported that these data-collecting methods are a “very motivating approach,” Sun said.

“Being able to know that they have this device or they’re wearing a wristband device that is helping them track their physical activity really motivates them in terms of using that as a way to improve their post-op recovery,” she added.

Pedometers and accelerometers can also help nurses care for patients shortly after undergoing surgery and assist them in hitting their ambulatory goals.

“When a patient comes out of surgery—and this is purely for surgical populations—the nurses in the hospital are the ones who are tasked with getting patients out of bed, having them ambulate,” Sun explained. “And these kinds of wearable sensor devices can really augment what the nurses are already doing.”

Use for Vital Signs

Many patients may already be accustomed to wearable technology’s ability to track some vital signs like heart rate, among other metrics. Although sleep and physical activity monitoring can contribute to a patient’s wellbeing, more research is needed to determine how clinicians can use these functions in practice.

“From our experience, the area in terms of vital signs monitoring is still relatively novel,” Sun explained. “We don't really know what to do with [those] data yet. So, while we know we can collect that information, how that can improve care, help our oncology team, and help our oncology nurses guide the care that they provide to patients still needs a little bit of research to be done.”

In particular, research needs to focus on whether all vital sign data need to be collected and if continuous data are needed.

“Some of our information is telling us probably not,” Sun added. “It's very hard, in terms of the workflow, to be able to understand, to react to the continuous data, because when we collect something, we got to act upon it, especially when we're seeing some abnormal information coming in.”

Workflow Impact

Assessing additional data in the management of patients with cancer can impact a nurse’s workflow, highlighting the importance of adjustments to their day-to-day. Sun gave an example of the triage nurses in a study where her City of Hope team monitored 398 patients over 26 months.

“What we found is that many of our nurses have the perception—and rightfully so—that when they are being tasked to do this kind of work, they’re going to be staring at a computer monitor 24/7, waiting for the data to come in, when in fact, our nurses didn’t do that,” she said. “As long as they had various different devices, whether it’s a computer and other [abilities] to be able to have an alert be given to them, they don’t necessarily have to be staring at the computer.”

In addition to the data monitoring aspect of wearable technology, Sun and her team also took into consideration the number of patients a nurse can oversee. Although it was assessed in a controlled setting like a research study, the team found that “it’s actually not that much,” she said.

“Not every patient is going to have an alert at all times,” Sun added. “We can, based on our data for a specific population, understand what time point we will expect patients to have the most alerts.”

In the case of Sun’s research, the team was able to determine that patients after surgery may have the most alerts the first 2 weeks after they go home. These alerts may be associated with higher symptom severity and mobility challenges during this postoperative period.

“One nurse can actually monitor a good number of patients without feeling overburdened,” Sun said. “And of course, if we're able to identify which timeframes for a given population that we know we're going to see an increase in alerts, then perhaps the nursing workflow can be adjusted based on that knowledge.”

If oncology nurses are interested in wearable technology as symptom management at their institution, Sun urges them to be part of the core team that develops this from the very beginning, not during the final stage of implementation.

“This whole process, as we have learned, involves many stakeholders. But I think nurses must be at the table at the beginning to really think about contributing that workflow component and their feedback and their perspectives in terms of how this is going to help their efficiency, but also improve patient care. I think that’s going to be key.”