Feasibility of Fitness Tracker Usage to Assess Activity Level and Toxicities in Patients With Colorectal Cancer

Abstract

PURPOSE Performance status (PS) is a subjective assessment of patients' overall health. Quantification of physical activity using a wearable tracker (Fitbit Charge [FC]) may provide an objective measure of patient's overall PS and treatment tolerance. MATERIALS AND METHODS Patients with colorectal cancer were prospectively enrolled into two cohorts (medical and surgical) and asked to wear FC for 4 days at baseline (start of new chemotherapy [± 4 weeks] or prior to curative resection) and follow-up (4 weeks [± 2 weeks] after initial assessment in medical and postoperative discharge in surgical cohort). Primary end point was feasibility, defined as 75% of patients wearing FC for at least 12 hours/d, 3 of 4 assigned days. Mean steps per day (SPD) were correlated with toxicities of interest (postoperative complication or ≥ grade 3 toxicity). A cutoff of 5,000 SPD was selected to compare outcomes. RESULTS Eighty patients were accrued over 3 years with 55% males and a median age of 59.5 years. Feasibility end point was met with 68 patients (85%) wearing FC more than predefined duration and majority (91%) finding its use acceptable. The mean SPD count for patients with PS 0 was 6,313, and for those with PS 1, it was 2,925 (122 and 54 active minutes, respectively) ( P = .0003). Occurrence of toxicity of interest was lower among patients with SPD > 5,000 (7 of 33, 21%) compared with those with SPD < 5,000 (14 of 43, 32%), although not significant ( P = .31). CONCLUSION Assessment of physical activity with FC is feasible in patients with colorectal cancer and well-accepted. SPD may serve as an adjunct to PS assessment and a possible tool to help predict toxicities, regardless of type of therapy. Future studies incorporating FC can standardize patient assessment and help identify vulnerable population.

Wearable devices to monitor recovery after abdominal surgery: scoping review

“…Multiple studies showed that greater postoperative physical activity was correlated with shorter length of stay 28 , 58 , 73–75 , and a reduced risk of readmission following discharge 15 , 73 , 76 , 77 . Higher postoperative step counts were associated with a lower risk of complications 30 , 72–74 , 78–81 , faster gastrointestinal recovery 73 , and lower long-term skeletal muscle loss 82 . Patients with postoperative delirium had similar mobilization in the early postoperative interval and had lower physical activity at 1 month after surgery 83 .…”

“…Many papers investigated changes in physical activity perioperatively, showing reduced step counts after surgery, with a long return to baseline that may take weeks to months 21 , 25–27 , 29–31 , 58–68 . The recovery trajectory in physical activity differed depending on type of operation 64 , use of laparoscopy 69–71 , need for ICU admission 64 , as well as overall performance status 72 . Romain et al .…”

Pilot Study of a Wearable Activity Monitor During Head and Neck Radiotherapy to Predict Clinical Outcomes

“…In a heterogeneous prospective study of patients with colorectal cancer either undergoing colectomy or starting chemotherapy, there was no significant association between change in step counts in the pretreatment or post-treatment periods and the development of protocol-specified toxicity. 11…”

Measuring Clinical, Biological, and Behavioral Variables to Elucidate Trajectories of Patient-Reported Outcomes: The PROFILES Registry

“…Ambulatory activity trackers enable researchers to monitor the type, quantity, and quality of patients’ everyday activities ( 47 , 48 ), and some also assess sleep quality and quantity. Activity trackers may capture many of the preclinical signs of treatment toxicities with limited patient burden ( 49 ). Machine learning–derived algorithms applied to this data could contribute to earlier detection and management of toxicity.…”