Fitness Trackers Offer Insight Into Performance Status, Toxicities Among Patients With CRC

The use of a fitness tracking device (Fitbit Charge [FC]) as a prognostic tool was feasible and acceptable in a study evaluating 80 patients with colorectal cancer (CRC). Investigators found that patients’ level of activity correlated with performance status. Additionally, baseline activity level was associated with toxicities. Thus, routine assessment of a patient’s performance activity through the use of these devices may provide objective and useful information regarding the patient’s level of fitness and capacity to tolerate treatment.¹

The FC was used to obtain physical activity (PA) data with further evaluation of potential correlation between PA, physician-assessed performance status (PS), and treatment toxicity using a cutoff of 5000 steps per day (SPD). This amount was chosen because it is half of the widely recommended daily goal of 10,000 SPD, which had been previously used as a cutoff that defines a sedentary lifestyle.²

In the study, patients with CRC undergoing treatment at a National Cancer Institute–designated comprehensive cancer center were prospectively enrolled to the medical arm if they were starting new systemic chemotherapy or the surgical arm if they planned to undergo curative resection.

At baseline, patients received an FC device to wear daily for 4 days with instructions to wear it for as many hours as was comfortable.

Mean SPD was calculated and any postoperative complication in patients who underwent surgery or had more than grade 3 toxicity in the medical patients arm was considered toxicities of interest (TOI). This was stratified by the cut-off of 5000 SPD. This incidence was compared with patients who achieved an average of more or less than 5000 SPD.

Overall, 68 (85%) patients met the feasibility criteria, with 35 (87.5%) medical and 33 (82.5%) surgical patients passing the threshold for feasibility.

Investigators reported that many participants wore the device continuously (at or close to 24 hours), and the use of the device did not seem to decrease over time. Overall, FC testing was well received by patients. Of 85 patients approached to participate, only 1 declined participation in this study because of being overwhelmed with diagnosis and treatment.

Nearly all patients (91%) who participated in the study found the FC to be easy to wear and use. A majority (81%) reported that the device did not interfere with their daily activity.

SPD correlated well with physician-assessed PS and the finding persisted in both the medical and surgical cohorts. Although this was not a primary end point, the results are encouraging, according to the investigators (FIGURE 1 and 2).

For example, patients who experienced toxicities had a numerically lower SPD compared with those who did not. The investigators noted that in the medical arm, patients who experienced toxicities demonstrated an increase in SPD count at follow-up assessment, but this difference was not significant and carries low clinical relevance. The investigators noted that patients who experienced TOI and related hospitalizations could have been prescribed physical therapy, leading to improved mobility in the hospital or as an outpatient, which was not a variable captured as part of the study.

The investigators concluded that the use of a monitoring device to determine patient physical activity is feasible and SPD correlated with ECOG performance status.