In Patients With Advanced Cancer, Fitness Trackers May Help Assess Performance Status

Because the majority of a patient’s time is spent outside the clinic, physicians may find it difficult to arrive at an accurate assessment of performance status (PS) for patients who have advanced cancer. Objectively evaluating PS, which measures a patient’s level of function and ability of self-care, can be challenging, but new research suggests that fitness trackers may help clinicians gain better insight into their patients’ PS.

Because the majority of a patient’s time is spent outside the clinic, physicians may find it difficult to arrive at an accurate assessment of performance status (PS) for patients who have advanced cancer. Objectively evaluating PS, which measures a patient’s level of function and ability of self-care, can be challenging; PS may be overestimated—potentially leading to patients’ exposure to increased risk of toxicities or treatment intolerance—or underestimated—potentially leading to reduced treatment that can negatively impact quality of life. Now, new research suggests that fitness trackers may help clinicians gain better insight into their patients’ PS.

Researchers from Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, reporting their findings in npj Digital Medicine, followed 37 patients, all of whom were being treated for advanced cancer at their center, for 6 months. Each patient wore a fitness tracker with a heartrate monitor throughout the study, although the monitor could be removed for bathing or swimming.

The patients, most of whom had gastrointestinal malignancies and had stage 4 disease, had Eastern Cooperative Oncology Group (ECOG) PS scale scores of 0 (24%), 1 (35%), 2 (24%), or 3 (16%) at baseline. The investigators found that the average number of steps taken each day varied significantly across the PS groups: patients scoring 0 on the ECOG scale averaged 5345 steps, whereas those who scored 1, 2, and 3 averaged 4835, 1553, and 902 steps, respectively. As ECOG scores increased, average daily activity declined. Statistically significant correlations were also present between PS score and average distance travelled, number of stairs climbed, and resting heart rate.

Additionally, average daily step counts were independently associated with clinical outcomes; an increase of 1000 steps per day was associated with lower odds of hospitalization, fewer grade 3 or grade 4 adverse events, and increased survival. Finally, correlations were also present between average steps taken and patient-reported outcomes (PROs), with higher levels of fatigue significantly correlated with reduced step count, shorter distance walked, and fewer stairs climbed. Patient-reported depression was significantly correlated with number of stairs climbed.

As a next step, investigators plan to study long-term use of the fitness trackers in a larger group of patients with advanced cancer and will attempt to correlate the resulting data with clinical outcomes and PROs, says the team. If their efforts are successful, they hope that continuous activity monitoring can be used to predict and monitor possible treatment complications and facilitate timely, appropriate interventions.

According to a statement by Andrew Hendifar, MD, medical director for pancreatic cancer at the Institute, "Our hope is that findings from future studies with wearable activity monitors could lead to development of individualized treatment and exercise plans that may result in increased treatment tolerability and improved survival outcomes for patients.”

Dan Theodorescu, MD, PhD, director of the Institute, added, "We are at the beginning of a revolution in healthcare in which digital wearables, coupled with broadband telecommunication, will allow remote monitoring of cancer patients and anticipate the need for intervention before symptoms occur." This approach could lead to “truly 'precision follow-up' that is better for patients, providers, and society," he said.

Reference

Gresham G, Hendifar AE, Spiegel B, et al. Wearable activity monitors to assess performance status and predict clinical outcomes in advanced cancer patients [published online July 5, 2018]. npj Digit Med. doi: 10.1038/s41746-018-0032-6.