Use of Wearable Activity Tracker in Patients With Cancer Undergoing Chemotherapy: Toward Evaluating Risk of Unplanned Health Care Encounters

Abstract

PURPOSE Unplanned health care encounters (UHEs) such as emergency room visits can occur commonly during cancer chemotherapy treatments. Patients at an increased risk of UHEs are typically identified by clinicians using performance status (PS) assessments based on a descriptive scale, such as the Eastern Cooperative Oncology Group (ECOG) scale. Such assessments can be bias prone, resulting in PS score disagreements between assessors. We therefore propose to evaluate PS using physical activity measurements (eg, energy expenditure) from wearable activity trackers. Specifically, we examined the feasibility of using a wristband (band) and a smartphone app for PS assessments. METHODS We conducted an observational study on a cohort of patients with solid tumor receiving highly emetogenic chemotherapy. Patients were instructed to wear the band for a 60-day activity-tracking period. During clinic visits, we obtained ECOG scores assessed by physicians, coordinators, and patients themselves. UHEs occurring during the activity-tracking period plus a 90-day follow-up period were later compiled. We defined our primary outcome as the percentage of patients adherent to band-wear ≥ 80% of 10 am to 8 pm for ≥ 80% of the activity-tracking period. In an exploratory analysis, we computed hourly metabolic equivalent of task (MET) and counted 10 am to 8 pm hours with > 1.5 METs as nonsedentary physical activity hours. RESULTS Forty-one patients completed the study (56.1% female; 61.0% age 40-60 years); 68% were adherent to band-wear. ECOG score disagreement between assessors ranged from 35.3% to 50.0%. In our exploratory analysis, lower average METs and nonsedentary hours, but not higher ECOG scores, were associated with higher 150-day UHEs. CONCLUSION The use of a wearable activity tracker is generally feasible in a similar population of patients with cancer. A larger randomized controlled trial should be conducted to confirm the association between lower nonsedentary hours and higher UHEs.

A Scoping Review to Assess Adherence to and Clinical Outcomes of Wearable Devices in the Cancer Population

“…The studies included in this review article employed different interventional approaches to improve the clinical outcomes of the participants. Most of the studies used a mobile application to provide the intervention [ 22 , 34 , 35 , 39 , 40 , 46 , 53 , 54 , 57 ]. Of the 38 studies, 3 provided the intervention by sending text messages [ 22 , 45 , 57 ], and 4 conducted a general group session or included a virtual support group [ 39 , 41 , 44 ].…”

“…The average adherence percentage was calculated for each segment. The intervention-based segments included studies with weeks 1 [ 48 , 49 ], 2 [ 27 , 55 ], 3 [ 50 , 52 , 57 ], 4 [ 36 , 37 , 53 ], 7 [ 28 ], 8 [ 32 , 33 , 34 ], 10 [ 24 , 30 , 41 ], 12 [ 20 , 21 , 23 , 25 , 26 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 54 , 56 ], 17 [ 29 ], 24 [ 22 , 31 ] and 43 [ 35 ]. In the graph, (1.84) indicates the studies grouped in this segment that had a one-week intervention with an average adherence of 84%.…”

Deep-Learning Approach to Predict Survival Outcomes Using Wearable Actigraphy Device Among End-Stage Cancer Patients

“…As a result, studies examining the applicability of objective activity evaluation, such as measurements by wearable technology, are being conducted to investigate the usability of activity data for survival prediction. While several studies have identified associations between activity data of cancer patients and their clinical outcomes, such as unplanned healthcare encounters ( 38 ), adverse events, hospitalizations, and survival ( 25 ), no previous studies have utilized the activity data to build a prediction model that suggests survival outcomes. To our knowledge, this is the first study that applied objective activity data of patients in a deep-learning model to provide survival outcome predictions in the end-stage cancer population.…”

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

“…Other studies of wearable technology have been less promising when analyzing step counts. Nilanon et al 10 studied the use of an activity tracker in patients receiving outpatient chemotherapy, and only 68% of all patients were compliant with wearing the device, and there was no correlation between step counts and unplanned health encounters. However, these authors did find a significant correlation between fewer nonsedentary hours and a reduced incidence of health encounters, suggesting that impaired activity level is associated with increased care utilization.…”