Emerging data from multiple studies has shown that information derived from wearable devices can positively impact outcomes for patients with cancer. Through patient monitoring of activity levels, heart rate, and nutritional intake, clinicians can glean objective information that could help inform treatment decisions and allow for appropriate medical intervention.
"Wearable devices such as Fitbits are providing a window to information that even a few years ago we wouldn't have had access to," noted Gillian Gresham, PhD, a postdoctoral fellow at Cedars-Sinai Medical Center, and co-author of a landmark research study discussing the association between wearable devices and performance status in patients with advanced cancer (J Clin Oncol 2019;37(suppl; abstr TPS6651)). "Detailed information that was previously unknown and unavailable about a person's day-to-day activity, sleep, and calories burned is now accessible."
Depending on the model of the device, Gresham said it could be as basic as counting steps or as complex as counting the number of steps climbed, monitoring resting and active heart rates, tracking sleep stages, counting calories expended, using GPS to determine the distance covered during physical activity, and even taking blood pressure.
Gresham said that collected data adds a layer of information that helps provide a complete picture of a patient's health and leads to removing some bias that can be associated with a standard assessment.
"The literature supports the notion that there may be a bias or overestimation of physical activity in patient questionnaires, which could lead to a bias in treatment decisions," she said. "Though it's not intentional, a patient may overestimate her or his own physical function or ability to complete daily activities, which would then influence physicians' decisions regarding treatment and the patient's ability to tolerate that treatment."
Gresham detailed that in the ongoing Cedars-Sinai trial of patients with stages III or IV cancer, participants are required to wear the device continuously for 8 weeks and for 1 week prior to the 6-month and 1-year follow-up visits to gather a full picture of activity, sleep, and pain levels. In doing so, researchers are able to gather objective data regarding patients' baseline activity levels and any differentiations during treatment.
"The information is useful for determining whether or not patients can participate in trials or receive treatments," she said. "If they are not fit for treatment at the baseline, clinicians can use the data to encourage or develop that person to get to a level where she or he could tolerate treatment."
Survivorship & Beyond
"Wearable devices provide a long-term opportunity to intervene and encourage physical activity outside of the clinical setting for all patients with cancer," Gresham stated. "For those patients with a more advanced cancer and those undergoing treatment such as chemotherapy, these devices can be used to predict and monitor toxicity through heart rate and provide additional benefits such as activity monitoring."
But Gresham found that, especially for the cancer survivorship population, information gathered from wearable devices can help for years to come. "There is an immense and growing number of patients living with cancer and beyond who now have a way to be continually monitored by and linked to a care team-and it doesn't involve them having to come in person after treatment," she said.
"There's an increased burden of care and need beyond diagnosis, treatment, and perhaps even cure. Wearable devices give patients, especially those in rural areas who may find it harder to reach clinicians, an opportunity to self-monitor for a clearer sense of their own activity levels, changes in sleep, heart rate, and general activity."
Gresham added that, if patients sense a feeling of physical decline that may be chronic beyond treatment, the information collected by wearable devices would allow them to contact their provider with valuable, qualitative data that could help inform care decisions.
"For the survivorship population especially, there is an important emphasis around physical activity, sleep improvement, and health beyond cancer," she said.
Patient Empowerment
In providing patients with the ability to self-monitor, a feeling of empowerment in a seemingly uncontrollable situation may emerge.
"By providing information from wearable devices, patients are providing a window into their day-to-day activity that clinicians otherwise wouldn't be able to see," Gresham noted. "It opens a conversation between the provider and the patient that allows patients to better communicate struggles they may be facing, such as poor sleeping patterns or pain, and gives clinicians the chance to intervene early and take steps toward treatment.
"It's important for patients to engage in their own care, which can be challenging in the small 15-minute appointments they may have with providers," she said.
By being able to supplement conversations with objective data, patients are better aware of their own physical health, can gauge what their activity levels look like 1 week compared to another, and can demonstrate a feeling of fatigue directly following treatment.
"The supplemental information provided by wearable devices provides a good way of improving communication on both sides and helps monitor throughout diagnosis, treatment, and beyond," Gresham stated.
Looking Forward
Though research is still being gathered about the exact usefulness and implications of wearable devices and patients with cancer, Gresham foresees the ability to begin developing tailored interventions based on the information derived.
"Currently, consumer wearable devices are built around the healthy population and step count recommendations, for example, are not reflective of what a step count might be around different populations such as patients with cancer," Gresham said. "But they do allow us to inform, on a general level, what patterns of activity would be appropriate across different types of cancers, ages, and treatments, and how providers can provide physical activity intervention. It's not just about walking more or participating in resistance training, but about sleep and behavioral components that help us better understand patient-reported outcomes."
Gresham predicted that, in the near future, qualitative information from patients' wearable devices will inform what interventions will look like across different stages of cancer, how treatment will differ among patient populations, and how patients will be able to function after treatment and beyond.
"Though we aren't quite there yet in terms of making treatment recommendations based on wearable devices alone, the objective data derived from them allows us to better assess patients before, during, and after treatment to improve pain levels, avoid possible toxicity, maintain physical activity, improve sleep, and avoid worsening of symptoms," Gresham noted. "In coming years, devices could be standardized, validated, and designed specifically for the purpose of caring for patients with cancer."
Kelly Wolfgang is a contributing writer.