Correlating wearable activity monitor data with PROMIS detected distress and physical functioning in advanced cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21689-e21689 ◽  
Author(s):  
Arvind Manohar Shinde ◽  
Gillian K. Gresham ◽  
Andrew Eugene Hendifar ◽  
Quanlin Li ◽  
Brennan Spiegel ◽  
...  
Keyword(s):  
Physical Function ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Physical Functioning ◽  
Medical Center ◽  
Sleep Time ◽  
Patient Reported Outcome ◽  
Therapeutic Trial ◽  
Advanced Cancer Patients ◽  
Patient Reported

e21689 Background: Patients with advanced cancer experience significant distress. Timely identification and treatment of distress can improve outcomes and quality of life. Domains of distress (i.e. pain, fatigue, physical function) can be assessed using patient reported outcome (PRO) questionnaires. However, PROs can be burdensome to patients, particularly when performed serially. Given the relationship between physical activity and sleep with domains of distress, wearable activity monitors may assist in the real-time detection of distress in advanced cancer patients. Methods: We conducted a prospective, observational study at Cedars-Sinai Medical Center and enrolled patients with measurable stage 3+ cancer, ≥18yr, English speaking, ambulatory, with a smartphone, and prognosis of > 3 months. Patients wore a Fitbit Charge HR continuously through 3 consecutive clinic visits, and completed NIH PROMIS tools (Physical Function, Pain, Sleep, Fatigue, and Emotional Distress) during visits. Fitbits recorded average daily step counts, stairs climbed, and sleep time. We conducted regression analyses that adjusted for baseline confounding variables and accounted for correlated responses. Results: 35 patients (Mean age 62; 53% males; 82% GI cancers) were evaluated. Patients had ECOG PS of 0 (20%), 1 (40%), 2 (23%), and 3(17%). The table below displays regression coefficients for steps, floors, and sleep in each PROMIS distress domain. Conclusions: There is a significant association between steps and floors climbed with multiple domains of distress and physical functioning. The lack of association between total sleep time and these PROs, may suggest that other metrics of sleep quality (i.e. awakenings), may be more relevant. These findings support further exploration of wearable data as a continuously monitored PRO surrogate in advanced cancer patients; wearable data should be further validated for use in both clinical and therapeutic trial settings. Clinical trial information: NCT02659358. [Table: see text]

scholarly journals Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months—a comparative study

2021 ◽  
Author(s):  
J. Frikkel ◽  
M. Beckmann ◽  
N. De Lazzari ◽  
M. Götte ◽  
S. Kasper ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Physical Functioning ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Psychological Conditions ◽  
Patient Reported

Abstract Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017

Performance of the patient reported CAPLET2.0 physical functioning assessment tool.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 194-194
Author(s):  
Alexandra McCartney ◽  
Julia Singer ◽  
Reenika Aggarwal ◽  
Katrina Hueniken ◽  
Raiza Commiting ◽  
...  
Keyword(s):  
Physical Function ◽  
Cancer Patients ◽  
Physical Functioning ◽  
Assessment Tool ◽  
Performance Status ◽  
Patient Reported Outcome ◽  
Cancer Center ◽  
Patient Reported ◽  
Hematological Cancers ◽  
Screening Questions

194 Background: CAPLET is a published patient reported outcome measure which assesses domains of physical function efficiently in cancer patients through a branching logic algorithm using a patient-reported outcome version of ECOG performance status and EQ5D-3L health utility score (PMID: 29982902; a total of 6 screening questions). We assessed the sensitivity and specificity of this tool after updating it with screening questions from the EQ5D-5L (CAPLET2.0) as opposed to the previously published EQ5D-3L screener (CAPLET). Methods: Eligible cancer patients across all outpatient clinics and disease sites (solid and liquid cancers) at the Princess Margaret Cancer Center completed a questionnaire on touch-screen technology containing the EQ5D-5L, patient-reported outcome (PRO)-ECOG performance scale, the gold standard WHODAS 2.0 (12 items) and HAQ-DI (20 items) physical functioning questionnaires, and a clinico-demographic survey. Results: Of 261 patients, 53% were female, 61% were Caucasian, and 71% had English as a first language. Disease sites included: 12% breast, 10% gastrointestinal, 12% genitourinary, 19% gynecological, 13% head and neck, 13% lung and 13% hematological cancers. The optimal branching logic cut-points were identified when PRO-ECOG, scored as 0-1 and individual EQ5D items scored with the best functioning category allowed specific WHODAS/HAQ-DI questions to be skipped. Against individual WHODAS-HAQ-DI items, CAPLET2.0 had sensitivities ranging from 83-100% (median 93%), and specificities of 50-82% (median 58%). Using CAPLET 2.0, 45% of patients could have skipped all but five questions measuring mental health and cognition which are always asked. Sensitivities, specificities and the proportion of questions that could have been skipped were all similar to the original CAPLET tool. Conclusions: CAPLET2.0, which uses the updated EQ5D-5L and PRO-ECOG as screening questions to assess physical function in cancer patients has comparable performance to the original CAPLET tool. CAPLET2.0 is therefore a viable alternative physical functioning screening tool for both routine and research use.

Actigraphy findings and cancer-related fatigue (CRF) in advanced cancer patients treated with methylphenidate (MP) and nursing telephone intervention (NTI).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20528-e20528 ◽  
Author(s):  
Eduardo Bruera ◽  
Sriram Yennurajalingam ◽  
Dave Balachandran ◽  
Nikhil S Padhye ◽  
Janet L. Williams ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Interaction Effect ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Cancer Type ◽  
Telephone Intervention ◽  
Advanced Cancer Patients ◽  
Time Activity

e20528 Background: There are limited studies about actigraphic sleep, wakefulness, activity and fatigue and treatment in advanced cancer patients. The objective of this study was to evaluate the changes in the nocturnal sleep/rest, and daytime wake/activity and subjective measures of fatigue before and after treatment with MP+/- NTI. Methods: A subset of patients from a previous reported placebo and control telephone intervention (CTI) controlled RCT of MP and/or NTI for CRF were reviewed. Subjective and objective assessments were analyzed at Day-8 and Day-15 as a result of treatment with MP and/or NTI or their control arms. Actigraphic sleep measures assessed were total sleep time (TST), sleep efficiency, and wake after sleep onset (WASO). Additionally, activity (mean day-time activity), and fatigue (FACIT-F, ESAS-Fatigue item) were included in the multivariate analysis. Results: A total of 60 (MP=30, Placebo=30; NTI=35; CTI=25) patients were evaluated. The median age was 56, 62% were female; most common cancer type was breast 13/60(22%). The baseline mean FACIT-F subscale, ESAS Fatigue item, TST, WASO, sleep efficiency and day-time activity were 22.4 (9.33), 6.5(1.74), 437(162.4), 139(121.4), 71(16.4), 202(438). Multivariate outcomes at Day-8 showed significant change from baseline (η2=0.38, p<0.001) and interaction effect between MP and NTI (η2=0.26, p=0.015). WASO had an interaction effect (β=-101.4, p=0.009), an MP effect (β=80.4, p=0.002) and reduction in time (β=-52.1, p=0.003). FACIT-F and ESAS-Fatigue item showed improvement in time (β=6.9, p=0.010; β=-2.4, p<0.001). Conclusions: WASO was significantly lower in patients receiving methylphenidate and nursing telephone intervention. Further larger studies are needed to validate these findings.

Predictive value of the patient reported outcome “living with cancer” instrument on overall survival in advanced cancer patients: A tool for guiding timing of palliative care consultations.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10025-10025
Author(s):  
Stuart L. Goldberg ◽  
Dhakshila Paramanathan ◽  
Srikesh Arunajadai ◽  
Victoria DeVincenzo ◽  
Ruth Pe Benito ◽  
...  
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
Advanced Cancer ◽  
Cox Model ◽  
Performance Status ◽  
Patient Reported Outcome ◽  
Cancer Type ◽  
Advanced Cancer Patients ◽  
Patient Reported ◽  
Living With Cancer

10025 Background: The Living with Cancer (LWC) patient reported outcome (PRO) instrument evaluates distress from the point of view of the advanced cancer pt. The 7-item Likert survey measures 4 personhood domains (performance status, pain, burden [financial and family], depression) with scores ranging 0-112. In a pilot study of 433 cancer pts at a single center a score of >28 was associated with an increased likelihood of physician’s (blinded) opinion of need for end-of-life care discussions ( J Palliative Med 2016). Methods: The LWC instrument is a statistically validated PRO (ASCO Palliative Care Symposium 2016). LWC was administered to 1024 cancer pts receiving non-curative therapy at 7 centers (Regional Cancer Care Associates, NJ) from Sept 2015 - Oct 2016. LWC surveys were linked to the Cota database, which extracts and enriches data from EHRs. Date of survey was used as the start point in time-to-event analysis. Results: 290 (28%) pts expired during the study (median f/u 9.9 months). 267 (26%) pts exceeded the threshold score of 28 defined in the pilot set (28 was also independently this study’s optimal cut point). Pts with an LWC score >28 had inferior 6 and 12 mo overall survival (69% and 54%) vs pts with scores <29 (88% and 73%) (log rank p<0.001). A Cox model demonstrated that LWC score and cancer type were significant (LWC: p<0.001, cancer types (compared to B): GI p<0.001, GU: p=0.013, T: p<0.001, M: p=0.334) A one point score increase in LWC resulted in a 1.8% increase in expected hazard. Among solid tumor pts with LWC >28, 20% died within the next 3 mo and 35% died within the next 6 mo, indicating appropriate timing for hospice and palliative care consults, respectively. Conclusions: Pt responses to the LWC instrument predict survival among advanced cancer pts and may be useful in guiding timing of palliative care consultations. [Table: see text]

Palliative care referrals and related outcomes among advanced cancer patients: A study revealing our institutional shortcomings.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21506-e21506 ◽  
Author(s):  
Ramy Sedhom ◽  
David Barile
Keyword(s):  
Palliative Care ◽  
Emergency Room ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multivariate Logistic Regression Model ◽  
Advanced Cancer Patients ◽  
Care Services ◽  
Palliative Care Services

e21506 Background: Palliative care (PC) has an important role in the care of cancer patients at the end of life. Unfortunately, referral occurs very late in the illness trajectory, often within days of patient death. We examined palliative care referral among advanced cancer patients and associated outcomes during their final 2 weeks of life at our academic medical center. Methods: We reviewed the medical records of 269 cancer inpatients with solid malignancies that died in the past three years at our institution. We retrospectively compared patients who accessed palliative care services with those who did not. A multivariate logistic regression model including age, gender, type of cancer and metastatic status was conducted. Results: 74/269 patients (28%) had a palliative care consult prior to death. The most common cancer types were respiratory (26%) and gastrointestinal (21%). Patients with breast and gynecologic malignancies had significantly greater referral to palliative care services. The overall aggressiveness of care for the last year was significantly less (p = 0.003) for patients who were referred to palliative care. Patients referred to PC received less chemotherapy in the last 2 weeks of life (8% versus 21%, p < 0.001). We found that patients who were not referred to palliative care services experienced death more frequently in the ICU (16% versus 2%, p < 0.001), and in the emergency room (12% versus 1%), p < 0.001). Conclusions: Despite increased awareness of the importance of palliative care, and their overall improvement in survival among cancer patients, there are still disparities regarding access to palliative care and location of death. Patients receiving palliative services receive less aggressive interventions during their 2 last weeks of life and are less likely to die in the intensive care unit or emergency room. Quality improvement projects are underway addressing our shortcomings to palliative care services for our patients with advanced malignancies.

The stability of treatment preferences of advanced cancer patients over time.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21501-e21501 ◽  
Author(s):  
Lea Jasmina Jabbarian ◽  
Renee Maciejewski ◽  
Paul K Maciejewski ◽  
Holly Gwen Prigerson
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Physical Functioning ◽  
Treatment Preferences ◽  
Care Planning ◽  
Advanced Cancer Patients ◽  
Advance Care ◽  
The Stability ◽  
Over Time

e21501 Background: The stability of patient treatment preferences has important implications for the optimal timing of advance care planning. Nevertheless, longitudinal data on cancer patients in real-life settings have not examined stability of treatment preferences over time. This study examines the stability of treatment preferences of advanced cancer patients over time and the potential influence of changes in physical functioning. Methods: The patient sample (N = 104) was drawn from a multi-institutional, longitudinal cohort study of patients recruited between 2010 and 2015. Patients with metastatic solid tumor cancer that had progressed on prior chemotherapy regimens were interviewed after an initial clinic meeting in which their most recent scan results were discussed (baseline) and, subsequently, completed monthly follow-ups. Patients reported their treatment preferences (i.e., comfort versus life-extending care) and physical functioning at each assessment. Results: The treatment preferences of the majority of patients (80.8%) remained stable within the first month of follow-up. Patient characteristics, such as age or type of cancer, were not significantly associated with treatment preference stability. The proportion of patients whose preferences changed in favor of comfort care (10.6%) was only slightly higher than the proportion of patients whose preferences changed in favor of life-extending care (8.7%). The same pattern held for the two- and three-month follow-up assessments. Improvement in physical functioning was significantly associated with change in treatment preferences. However, the vast majority of patients (72.2%) had stable or declining physical functioning. Conclusions: Most advanced cancer patients have stable treatment preferences regarding comfort versus life-extending care in the months leading up to their death. Thus, advance care planning earlier in the course of illness may not be premature for the vast majority of patients. As physical functioning changes, treatment preferences should be re-evaluated.

Clinician versus patient: Who gets it right when assessing function in palliative care?

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 40-40
Author(s):  
Sara Lauren Mann ◽  
Willem Hardie Collier ◽  
Dominik Ose ◽  
Shane Brogan ◽  
Anna Catherine Beck ◽  
...  
Keyword(s):  
Functional Status ◽  
Physical Function ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Pain Interference ◽  
Average Score ◽  
Karnofsky Performance Score ◽  
Significant Difference ◽  
Patient Reported

40 Background: The Karnofsky Performance Score (KPS) is an important prognostic indicator in cancer care. Additionally, patient-reported outcomes are increasingly incorporated into clinical care and are validated in cancer patients with the NIH’s Patient-Reported Outcomes Measurement Information System (PROMIS). However, little is known about the concordance of the provider-rated KPS and patient-rated PROMIS measures. Methods: Retrospective review of patients with advanced cancer who underwent implantation of an intrathecal pump for refractory pain. We compared KPS and PROMIS scores recorded within 1 week of each other. PROMIS scores included an average score and 3 domains: physical function, fatigue, and pain interference. We divided each measure into 3 previously-described categories (Functionally Independent, Needs Limited Assistance, and Functionally Dependent) and assessed categorical concordance within each measure. The association of patient-related demographic and clinical characteristics were analyzed with KPS–PROMIS concordance using chi-square and Mann-Whitney U tests. Results: 47 patients were included. The provider-rated KPS score consistently indicated a higher functional status compared to the patient-rated PROMIS average score and across all PROMIS domain scores. 40% of patients were rated “Functionally Dependent” using the average PROMIS score, compared to just 19.1% using the KPS, a statistically significant difference (p=0.042). We noted categorical concordance of 55.3% for PROMIS average score, 57.5% for physical function, 44.7% for fatigue and 42.7% for pain interference compared to KPS. We found no statistically significant associations between concordance and patient demographics or characteristics. Conclusions: Our results revealed a notably low concordance in functional status in advanced cancer patients between provider-rated KPS and patient-rated PROMIS measures. Provider-rated scores consistently indicated a higher overall performance status, in particular with measures of the lowest functional status. Additional work is needed to better understand the reasons for this lack of concordance and its implications for ongoing clinical decision-making.

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