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UTILIZATION OF CONTINUOUS REMOTE MONITORING FOR A HIGH-RISK PATIENT REQUIRING INTERVAL TUMOR DEBULKING PALLIATIVE THERAPY
Chest ; 162(4):A70-A71, 2022.
Article in English | EMBASE | ID: covidwho-2060537
ABSTRACT
SESSION TITLE Lung Cancer Case Report Posters 2 SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm

INTRODUCTION:

The outbreak of the SARS-CoV-2 virus identified a need for healthcare systems to transform in order to accommodate the large volume of patients. As a result, innovative new methods to monitor patients have emerged. One type of innovation are remote patient monitoring (RPM) devices, which allow for home vital sign (VS) measurements and telemonitoring. We present a case utilizing this technology to monitor a middle-aged male with metastatic colon cancer to the lung, who required regular debulking therapy as a means of palliation. CASE PRESENTATION A 59 year-old male with a history of stage IV colon adenocarcinoma with metastasis to the lungs status post lung wedge resection and radiation therapy 7 years previously was found to have an enlarging left lower lobe (LLL) mass. Fiberoptic bronchoscopy revealed resurgence of his metastasis. While undergoing palliative chemotherapy, the patient became increasingly dyspneic. Serial PET CTs showed evolution of his left lung mass with left upper and lower lobe collapse due to endobronchial disease prompting bronchoscopy with argon plasma coagulation (APC) for tumor debulking within the left mainstem bronchus and dilation of the LLL airways. While the patient's symptoms improved, he became dyspneic over several months, and interval CT scans demonstrated invasion of the left mainstem bronchus with complete collapse of the left lung. Repeat dilation and APC were performed with improvement in symptoms. Due to rapid tumor growth, he was enrolled in the continuous RPM (CRPM) program for 24/7 nursing-led telemonitoring. He completed daily questionnaires on a vendor-provided digital tablet, and his VS, composed of heart rate (HR), respiratory rate (RR), SpO2, and temperature, were automatically uploaded to a network using an FDA-approved wearable device. Intermittent readings using peripheral devices to measure blood pressure and spirometry were gathered. His VS mirrored his tumor progression, indicated by elevation in his mean RR and HR while his SpO2 declined necessitating 2L of oxygen. Further evaluation showed tumor invasion into the left mainstem bronchus and began to invade his right mainstem. Successive APC and cryotherapy were performed every 2-3 months with a total of 8 debulking bronchoscopies. Once his disease progressed to obstruct his entire left mainstem, the patient unenrolled from the CRPM program and enrolled in hospice care.

DISCUSSION:

Several RPM devices have previously been used, but require self-reported VS rather than automated, continuous oximetry. Our CRPM program was piloted as a means to monitor COVID-19 patients following hospital discharge. However, our patient displayed benefit from his 180 day CRPM enrollment while receiving palliative tumor debulking procedures in order to fulfill his wish to maximize time at home.

CONCLUSIONS:

RPM devices offer a novel method of monitoring patients outside of healthcare facilities. Reference #1 Gordon WJ, Henderson D, DeSharone A, et al. Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients. Appl Clin Inform. 2020;11(05). doi10.1055/s-0040-1721039 Reference #2 O'Carroll O, MacCann R, O'Reilly A, et al. Remote monitoring of oxygen saturation in individuals with COVID-19 pneumonia. Eur Respir J. 2020;56(2). doi10.1183/13993003.01492-2020 Reference #3 Grutters LA, Majoor KI, Mattern ESK, Hardeman JA, van Swol CFP, Vorselaars ADM. Home telemonitoring makes early hospital discharge of COVID-19 patients possible. J Am Med Informatics Assoc. 2020;27(11). doi10.1093/jamia/ocaa168 DISCLOSURES No relevant relationships by Kevin Loudermilk Speaker/Speaker's Bureau relationship with Janssen Please note $1001 - $5000 by Michael Morris, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note $1001 - $5000 by Michael Morris, value=Honoraria Removed 03/29/2022 by Michael Morris No relevant relationships by Michal Sobieszczyk No relevant relations ips by Robert Walter No relevant relationships by Whittney Warren
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: Chest Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: Chest Year: 2022 Document Type: Article