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During the Covid19 pandemic the health care sector has been using eHealth to a larger extend than earlier. There have been a renewed focus on how and where to use eHealth. Ongoing technological advances in wearable sensors allow for real-time collection of objective data. Consumer wearables can collect  biometric sensor data, and a smartwatch allows for objective health data monitoring outside hospital with minimal effort for the patient. Patients with head and neck cancer (HNC) experience severe side effects during radiotherapy (RT). We hypothesize that smartwatches might be helpful tools to aid vulnerable HNC patients to better overcome a burdensome treatment such as RT. Before investigating the possible effect of optimizing the trajectory for HNC patients using smartwatches, we designed and performed a feasibility study. This is an evaluation of the recruitment in an RT eHealth study during the Covid19 pandemic. 

In a prospective, single cohort trial conducted at Rigshospitalet, Department of Oncology, Denmark from January 22^nd to October 15^th, 2021 screening-log and inclusion-log have been documented. Patients ≥18 years planned to primary or post-operative curatively intended RT for HNC were eligible. Patients were primarily approached by nurses in the HNC out-patient clinic after a research assistant had screened the program for eligible patients. Consenting patients were asked to wear an Apple Watch continuously during RT and until 2 weeks after end of RT, in total 12-14 weeks.  Demographic data, objective toxicity scores and hospitalizations were documented. Included patients borrowed a smartwatch and a smartphone. These hardware were set-up for the specific study solely and could not be used for private purposes. 

During nine-month recruitment period 64 patients, 50 men and 14 women aged 30-82 years, were screened for enrollment at Department of Oncology, Rigshospitalet, Copenhagen, Denmark. 37 of 64 patients were never asked due to the health care professionals’ assessment and in 15/37 no reason for missing information to patients was recorded. Seven were included, 6 men and 1 woman aged 50-68 years. 20 out of 64 patients declined participation. 12/37 were not asked because of competing protocols. 4/64 patients had disseminated disease, not identified initially.  

Aiming at performing a study to assess the feasibility of using the Apple Watch for home monitoring of patients with HNC during RT we experienced a very low recruitment-rate. Though remote monitoring intuitively may lead to early identification of symptoms and secure timely intervention for symptom management, neither HNC patients undergoing RT nor health care professionals seemed willing to be included or include patients in a feasibility study investigating the use of such a new eHealth tool during RT. Before implementing eHealth solutions, it seems important to investigate if these are warranted, feasible and acceptable by both patients and health care professionals.