Department of Computer Science, University of Southern California, Los Angeles, CA.
Integrated Media Systems Center, University of Southern California, Los Angeles, CA.
JCO Clin Cancer Inform. 2020 Sep;4:839-853. doi: 10.1200/CCI.20.00023.
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.
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.
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.
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.
癌症化疗治疗期间，常会出现急诊室就诊等非计划性医疗保健就诊（UHE）。临床医生通常使用基于描述性量表（如东部肿瘤协作组（ECOG）量表）的表现状态（PS）评估来识别 UHE 风险较高的患者。这些评估可能存在偏差，导致评估者之间 PS 评分存在分歧。因此，我们提出使用可穿戴活动追踪器的身体活动测量值（例如，能量消耗）来评估 PS。具体而言，我们研究了使用腕带（腕带）和智能手机应用程序进行 PS 评估的可行性。
我们对接受高度致吐化疗的实体瘤患者队列进行了一项观察性研究。患者被指示佩戴腕带进行为期 60 天的活动跟踪期。在就诊期间，我们获得了医生、协调员和患者自己评估的 ECOG 评分。随后编制了在活动跟踪期和 90 天随访期内发生的 UHE。我们将主要结果定义为在活动跟踪期内，佩戴腕带的患者比例≥ 80%，每天上午 10 点至晚上 8 点佩戴≥ 80%，且在活动跟踪期内≥ 80%。在探索性分析中，我们计算了每小时代谢当量（MET），并计算了上午 10 点至晚上 8 点之间超过 1.5 MET 的小时数作为非久坐体力活动小时数。
41 名患者完成了研究（56.1%为女性；61.0%年龄在 40-60 岁之间）；68%的患者佩戴腕带。评估者之间的 ECOG 评分分歧范围为 35.3%至 50.0%。在我们的探索性分析中，较低的平均 MET 和非久坐小时数，但不是较高的 ECOG 评分，与较高的 150 天 UHE 相关。
在具有类似特征的癌症患者群体中，使用可穿戴活动追踪器通常是可行的。应进行更大规模的随机对照试验来确认非久坐时间较短与 UHE 较高之间的关联。
