Wearable device may improve at-home temperature monitoring of children with cancer
For children with hematologic malignancies, a fever may indicate a deadly bloodstream infection and should be addressed as soon as possible.
“One of the primary things we educate our patients and families on is that they need to notify us at the first sign of fever, because it’s a hallmark of impending infection in patients with cancer,” Sung Won Choi, MD, MS, professor of pediatrics at University of Michigan, told Healio. “These patients have weakened immune systems, and their ability to fight off infections is compromised. It can cause major problems if a fever is not addressed.”
Choi, Muneesh Tewari, MD, PhD, professor of internal medicine and biomedical engineering at University of Michigan, and colleagues conducted a study, published in Pediatric Blood & Cancer, in which they evaluated the use of a high-frequency monitoring device (TempTraq, Blue Spark Technologies) to detect fever in pediatric patients with cancer being monitored at home.
Choi and Tewari spoke with Healio about the value of continuous monitoring, the importance of detecting infections early and the potential future uses of wearable monitoring devices.
Healio: What is TempTraq and how does it capture more data than a thermometer?
Tewari: With a thermometer, the measurement is taken intermittently — you basically get one measurement. You can take a patient’s temperature over and over, but that’s not the usual practice.
The device is a small, adhesive patch that sticks gently to the skin on the side of the chest. It takes a temperature measurement every 2 minutes 24 hours a day, 7 days a week. We think that prevents it from missing fever events. It also is not subject to certain confounders such as oral temperature fluctuations related to eating and drinking. With this device, you get more measurements and more continuous data, so you can potentially get a more complete picture of what is going on.
Healio: What did your case series consist of and what did you find?
Tewari: In this case series, we used the TempTraq device to measure temperature in three pediatric patients with cancer whose family caregivers used it for monitoring at home. In two of the cases, the device was able to detect fever when the thermometer used at home didn’t show fever. The third case was an infant for whom it proved very impractical for the parent to measure body temperature with a standard thermometer, but the wearable device enabled temperature monitoring. In the first two cases, the device’s detection of fever led to the caregiver bringing the child to the ER and being worked up. In both cases, the child had serious bloodstream infections and received treatment with antibiotics.
Choi: These two cases were very important because they ended up having bacteremia and had the opportunity to get antibiotics potentially sooner. We don’t know what their outcomes would have been if they hadn’t been wearing this temperature sensor, but studies have shown that the sooner you get the antibiotics, the better your outcomes. That’s what led us to want to write these cases up, because they potentially did have important clinical impact.
Before we did this case series, we published a study in Cancer Cell looking at more than 60 patients. Half of these were bone marrow transplant patients at risk for infection, and roughly half were receiving chimeric antigen receptor T-cell therapy. Patients who receive CAR-T therapy are vulnerable to cytokine release syndrome, and fever is also an indicator of this complication. We wanted to evaluate the wearable device’s ability to detect fever in all these patients compared with standard of care.
Tewari: That was a study in hospitalized patients. The standard of care in the hospital setting usually consists of clinical staff taking vital signs, including temperature, every 4 to 8 hours. We found that on average, the device was able to detect a fever about 5 hours before clinical staff detected it, and this was across all patients.
In this study, we looked at continuous temperature monitoring not in the context of a hospital, but in the home environment, where there aren’t nurses monitoring temperature regularly. That was the important next step for us, to find out what happens in an outpatient setting where we feel it could have the most potential to make a difference.
Healio: How does TempTraq interact with other technologies?
Tewari: The device is a wireless continuous thermometer, so it can connect to the patient’s smartphone. There is a downloadable app to go with it. It can also be used with a gateway device, which is a wireless box that functions in place of a smartphone. We have found in our experience that some patients’ families liked using this box because it simplified everything. There are also ways the device can connect directly to electronic health records, but we haven’t done that yet in our studies.
Healio: Do you think wearable devices like this one have a promising future in cancer care?
Tewari: Yes. We believe that the future of these kinds of wearable sensors is in enabling continuous monitoring, especially at home. You get a lot more data very frequently. We believe these wearable devices have a future that is broader than just patients with cancer and febrile neutropenia — it can potentially help any patient at risk for serious infection. Fever is one of the hallmark symptoms of most serious infections. We think there is a lot of potential for broader applications.
References:
- Flora C, et al. Cancer Cell. 2021;doi:10.1016/j.ccell.2021.07.019.
- Nessle CN, et al. Pediatr Blood Cancer. 2022;doi:10.1002/pbc.29835.
For more information:
Sung Won Choi, MD, MS, can be reached at University of Michigan, 1500 E. Medical Center Drive, D4118 Medical Professional Building, SPC 5718, Ann Arbor, MI 48109; email: sungchoi@med.umich.edu.
Muneesh Tewari, MD, PhD, can be reached at University of Michigan, 109 Zina Pitcher Place, Room 1502 Biomedical Science Research Building, SPC 2200, Ann Arbor, MI 48109; email: mtewari@med.umich.edu.
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