Digital Remote Monitoring in Cancer Care: What Difference Do the Nurses Navigators Make? (Preprint)

BACKGROUND Background: Digital Remote Monitoring (DRM) is improving cancer care management. However, the determinants of its effectiveness, particularly the role of Nurse Navigators (NN) within these systems, still need to be explored. OBJECTIVE Objective: This study focuses on the CAPRI DRM program, aiming to fill the gap in our understanding of the role of Nurse Navigators (NN) within this specific system and its effect on patient care in oncology. METHODS Methods: The CAPRI DRM, targeting patients on oral anticancer agents, combines digital interfaces with NN interventions. A phase 3 randomized controlled trial (RCT) involving 559 patients assessed its safety and efficacy, with the primary endpoint being the relative dose intensity. This report focuses on 272 patients in the intervention arm, evaluating the impact of NN interventions on outcomes like toxicity, hospitalization, and emergency visits. Data from patients’ characteristics, NN interventions, and patient satisfaction surveys were analyzed using structural equation modelling RESULTS Results: The study included 172 patients. Patient characteristics significantly correlated with outcomes. NN interventions were consistently associated with improved patient satisfaction. The number of grades ≥3 toxicity events correlated positively with NN referrals to oncologists. Hospitalization lengths were positively related to NN referrals and inversely to NN advice. Emergency visits showed a negative correlation with NN actions and a positive correlation with NN calls and referrals. CONCLUSIONS Conclusion: The analysis validates the pivotal role of NN in DRM, suggesting a hybrid model of automated digital tools and human support. The study's limitations include its single-center nature and potential digital divide issues. Future research should explore the applicability of DRM in various clinical settings and the balance between automated systems and NN expertise.