A Pilot Study in the Use of Activity Trackers for Assessing Response to Palliative Radiotherapy

Abstract

Purpose Radiation therapy (RT) has been a frequently used treatment for painful bone metastasis. The aim of this study was to determine the feasibility of using activity trackers (AT) to assess the patient prognosis and the effects of palliative RT. Methods and materials Twelve patients planned to receive palliative RT for axial metastases and were prospectively recruited to participate in this pilot clinical trial. The patients were eligible if there was no intent to change the analgesic medications prior to or within seven days of palliative RT. All the patients were lent a Misfit FlashTM activity tracker (Misfit, Burlingame, California, United States of America) and were asked to wear it from the time of baseline assessment prior to RT until seven days after RT. The patients completed the European Organisation for Research and Treatment of Cancer quality of life (QOL) questionnaire (EORTC-QLQ C30) and the Short Form Brief Pain Inventory (SF-BPI) before the treatment and at days seven, 30 and 90 after completion of the RT. The patients' Karnofsky Performance Status (KPS) was assessed at each visit. The patients' overall survival at the end of the RT was recorded. Average daily steps before and after RT were compared using paired Wilcoxon signed-rank test. The patients' overall survival was estimated using the Kaplan-Meier curve and analyzed using the Log-Rank test. Results The median age of the patients was 62 years (range: 40-79 years). Of the 12 patients, there were five prostate, three breasts, three lungs, and one colon cancer-related patients. Six patients received 20 Gray (Gy) in five fractions and six received 8 Gy in one fraction. By day seven, post-RT, there was a 30% (p <0.02) reduction in the patients' daily activity level. There was no correlation between improvements in the QOL or with the level of pain and with the number of daily steps. While baseline KPS was not prognostic of the patient survival, the patients who on average took more than 7800 steps per day prior to RT lived significantly (p=0.034) longer than those who were less active. Conclusions The baseline activity level is associated with the patient prognosis. A significant decline in the physical activity was observed at one week after palliative RT. The use of activity trackers was to prognosticate and to monitor the patients' response to the palliative RT and should be evaluated further.

Keywords: activity tracker; bone metastasis; physical activity; prognosis; quality of life; radiation therapy.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. An average number of daily steps normalized to the patient activity level prior to the radiotherapy.

The numbered steps prior to and after the radiotherapy (RT) taken by the patients were normalized to the average number of daily steps taken by the patients prior to the RT. Comparison of the daily activity level of the patient prior to (pre-RT) vs. after RT (seven days post-RT) were made using the Wilcoxon signed-rank test. Error bars represent standard error of the means.

Figure 2. The normalized daily steps were taken by the patients before and after radiotherapy.

The number steps prior to and after the radiotherapy (RT) taken by the patients were normalized to the average number of daily steps taken by the patients prior to the RT.

Figure 3. The patients' pain level prior to and after the palliative radiotherapy.

Subjective pain level, based on the short form brief pain inventory, prior to the radiotherapy (pre-RT) and on day seven, 30 and 90 after the radiotherapy. The data points of the patients at day nine, 11 and 12 overlaps at pre-RT and day seven.

Figure 4. Change in the patients' pain level and activity level following the radiotherapy.

Change in the patients, reported pain level (short form brief pain inventory) and average activity level following the radiotherapy (RT) are shown for the patients with both data available.

Figure 5. Overall survival of the patients as a function of baseline activity level.

The average daily activity level (steps per day) was calculated for each patient (n=12). The patient groups were based on median patient activity level (7801 steps per day).