Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
JCO Clin Cancer Inform. 2023 Apr;7:e2200132. doi: 10.1200/CCI.22.00132.
Modern wearable devices provide objective and continuous activity data that could be leveraged to enhance cancer care. We prospectively studied the feasibility of monitoring physical activity using a commercial wearable device and collecting electronic patient-reported outcomes (ePROs) during radiotherapy (RT) for head and neck cancer (HNC).
Patients planned for a course of external beam RT with curative intent for HNC were instructed to use a commercial fitness tracker throughout the RT course. During weekly clinic visits, physician-scored adverse events were recorded during using Common Terminology Criteria for Adverse Events version 4.0, and patients completed ePRO surveys using a clinic tablet or computer. Feasibility of activity monitoring was defined as collection of step data for at least 80% of the RT course for at least 80% of patients. Exploratory analyses described associations between step counts, ePROs, and clinical events.
Twenty-nine patients with HNC were enrolled and had analyzable data. Overall, step data were recorded on 70% of the days during patients' RT courses, and there were only 11 patients (38%) for whom step data were collected on at least 80% of days during RT. Mixed effects linear regression models demonstrated declines in daily step counts and worsening of most PROs during RT. Cox proportional hazards models revealed a potential association between high daily step counts and both reduced risk of feeding tube placement (hazard ratio [HR], 0.87 per 1,000 steps, < .001) and reduced risk of hospitalization (HR, 0.60 per 1,000 steps, < .001).
We did not achieve our feasibility end point, suggesting that rigorous workflows are required to achieve continuous activity monitoring during RT. Although limited by a modest sample size, our findings are consistent with previous reports indicating that wearable device data can help identify patients who are at risk for unplanned hospitalization.
现代可穿戴设备可提供客观且连续的活动数据，可用于改善癌症治疗效果。我们前瞻性研究了使用商业可穿戴设备监测体力活动并在头颈部癌症（HNC）放疗期间收集电子患者报告结局（ePRO）的可行性。
计划接受根治性外照射放疗的 HNC 患者被要求在放疗期间全程使用商业健身追踪器。在每周的就诊期间，使用通用不良事件术语标准 4.0 记录医生评分的不良事件，患者使用诊所的平板电脑或计算机完成 ePRO 调查。活动监测的可行性定义为至少 80%的患者在至少 80%的放疗期间收集到至少 80%的步数数据。探索性分析描述了步数、ePRO 和临床事件之间的关联。
共纳入 29 例 HNC 患者，且均有可分析数据。总体而言，患者放疗期间有 70%的天数记录了步数数据，仅有 11 例（38%）患者在放疗期间有至少 80%的天数记录了步数数据。混合效应线性回归模型显示，在放疗期间，每日步数和大多数 PRO 均呈下降趋势。Cox 比例风险模型显示，每日高步数与降低置管喂养风险（风险比 [HR]，每增加 1,000 步则降低 0.87， <.001）和降低住院风险（HR，每增加 1,000 步则降低 0.60， <.001）相关。
我们未达到可行性终点，这表明需要严格的工作流程才能在放疗期间实现连续的活动监测。尽管由于样本量较小，我们的研究结果存在一定局限性，但与之前的报告一致，表明可穿戴设备数据可帮助识别有计划外住院风险的患者。
