Department of Medicine, University Health Network, Toronto, Ontario, Canada.
Department of Geriatrics, Salvador Zubirán National Institute of Medical Science and Nutrition, Mexico City, Mexico.
J Geriatr Oncol. 2023 Sep;14(7):101576. doi: 10.1016/j.jgo.2023.101576. Epub 2023 Jul 6.
Physical activity may be associated with cancer treatment toxicity, but generalizability to geriatric oncology is unclear. As many older adults have low levels of physical activity and technology use, this area needs further exploration. We evaluated the feasibility of daily step count monitoring and the association between step counts and treatment-emergent symptoms.
Adults aged 65+ starting treatment (chemotherapy, enzalutamide/abiraterone, or radium-223) for metastatic prostate cancer were enrolled in a prospective cohort study. Participants reported step counts (measured via smartphone) and symptoms (Edmonton Symptom Assessment Scale) daily for one treatment cycle (i.e., 3-4 weeks). Embedded semi-structured interviews were performed upon completion of the study. The feasibility of daily monitoring was evaluated with descriptive statistics and thematic analysis. The predictive validity of a decline in daily steps (compared to pre-treatment baseline) for the emergence of symptoms was examined using sensitivity and positive predictive value (PPV). Associations between a 15% decline in steps and the emergence of moderate (4-6/10) to severe (7-10/10) symptoms and pain in the next 24 h were assessed using logistic regression.
Of 90 participants, 47 engaged in step count monitoring (median age = 75, range = 65-88; 52.2% participation rate). Daily physical activity monitoring was found to be feasible (94% retention rate; 90.5% median response rate) with multiple patient-reported benefits including increased self-awareness and motivation to engage in physical activity. During the first treatment cycle, instances of a 15% decline in steps were common (n = 37, 78.7%), as was the emergence of moderate to severe symptoms overall (n = 40, 85.1%) and pain (n = 26, 55.3%). The predictive validity of a 15% decline in steps on the emergence of moderate to severe symptoms was good (sensitivity = 81.8%, 95% confidence interval [CI] = 68.7-95.0; PPV = 73.0%, 95% CI = 58.7-87.3), although the PPV for pain was poor (sensitivity = 77.8%, 95% CI = 58.6-97.0; PPV = 37.8%, 95% CI = 22.2-53.5). In the regression models, changes in daily physical activity were not associated with symptoms or pain.
Changes in physical activity had modest ability to predict moderate to severe symptoms overall. Although participation was suboptimal, daily activity monitoring in older adults with cancer appears feasible and may have other uses such as improving physical activity levels. Further studies are warranted.
体力活动可能与癌症治疗毒性有关，但在老年肿瘤学中的普遍性尚不清楚。由于许多老年人的体力活动和技术使用水平较低，因此需要进一步探索这一领域。我们评估了日常步数监测的可行性以及步数与治疗后出现的症状之间的关联。
接受转移性前列腺癌治疗（化疗、恩扎鲁胺/阿比特龙或镭-223）的 65 岁以上成年人参加了一项前瞻性队列研究。参与者在一个治疗周期（即 3-4 周）内每天报告步数（通过智能手机测量）和症状（埃德蒙顿症状评估量表）。研究结束后进行嵌入式半结构式访谈。使用描述性统计和主题分析评估日常监测的可行性。使用灵敏度和阳性预测值 (PPV) 检查每日步数下降（与治疗前基线相比）与症状出现之间的预测有效性。使用逻辑回归评估步数下降 15%与下 24 小时出现中度（4-6/10）至重度（7-10/10）症状和疼痛之间的关联。
在 90 名参与者中，有 47 名参与者参与了步数监测（中位数年龄为 75 岁，范围为 65-88 岁；参与率为 52.2%）。发现日常体力活动监测是可行的（保留率为 94%；中位数响应率为 90.5%），并具有多种患者报告的益处，包括提高自我意识和参与体力活动的动力。在第一个治疗周期中，步数下降 15%的情况很常见（n=37，78.7%），总体出现中度至重度症状（n=40，85.1%）和疼痛（n=26，55.3%）也很常见。步数下降 15%对中度至重度症状出现的预测有效性较好（灵敏度为 81.8%，95%置信区间[CI]为 68.7-95.0；PPV 为 73.0%，95%CI 为 58.7-87.3），但疼痛的 PPV 较差（灵敏度为 77.8%，95%CI 为 58.6-97.0；PPV 为 37.8%，95%CI 为 22.2-53.5）。在回归模型中，日常体力活动的变化与症状或疼痛无关。
体力活动的变化可以适度预测总体上的中度至重度症状。尽管参与度不理想，但在老年癌症患者中进行日常活动监测是可行的，并且可能具有提高体力活动水平等其他用途。需要进一步研究。
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