Patient-reported outcomes (PROs) are an important part of patient management but may be burdensome for patients to track. Wearable activity monitors provide objective, continuous activity data that may correlate with PROs, and researchers assessed the use of this technology in a study. Carrie A. Thompson, MD, at the Mayo Clinic in Rochester, MN, discussed the findings at the ASH Annual Meeting.
The researchers recruited patients from the Mayo Clinic’s hematology and oncology practices. Adult patients were eligible if they had a diagnosis of lymphoma, multiple myeloma (MM), brain cancer, pancreatic cancer, breast cancer, or ovarian cancer within the past five years; had a life expectancy of more than six months; and owned an iPhone 5 or newer.
Patients received an Apple Watch and downloaded the study app onto the phone and watch at enrollment. Baseline PRO data were collected on the iPhone, including PROMIS physical function; fatigue; sleep; social and role function short forms; single-item linear analog self-assessment (LASA) of quality of life (QoL), fatigue, and physical function; and two emoji scales: a mood scale and a physical, emotional, and overall QoL scale.
Patients were asked to wear the watch at least eight hours per day, and activity levels were analyzed using the square root of the average daily values.
The results presented at the meeting include baseline activity and PRO results from patients with lymphoma and MM, because the study is ongoing.
Between February and August 2017, 89 patients (median age = 55 years, range = 21–79) with lymphoma and 26 with MM were recruited; 52% were male, and the median time since diagnosis was 8.4 months (range = 0–60). Most patients (74%) were receiving active therapy, 16% were undergoing observation, and 10% had not been treated. Most patients had an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 (47%), and the majority (64%) were overweight or obese. All patients described being “extremely” confident in filling out forms, 99% had used a computer in the past 12 months, and 26% had previously used a smart watch.
During the first week, patients wore the watch for an average of 9.3 hours per day, walked a mean of 3,760 steps per day (standard deviation [SD] = 3,417), exercised 8.3 minutes per day (SD = 11.8), were sedentary 224.9 minutes per day (SD = 154.2), and burned 115.8 calories per day (SD = 111.5). The mean heart rate was 82 beats per minute (SD = 8.2).
The strongest correlation between PROs and the activity data was between steps per day and PROMIS physical function (Spearman correlation = 0.33, p = 0.0005), and this association remained significant after adjusting for age and ECOG score (p = 0.0076). No variables significantly affected active energy, workout minutes, cycling distance, or heart rate.
The researchers found that emoji responses were significantly associated with PROs: the Spearman correlations between the emoji and LASAs were –0.84 for fatigue, 0.68 for physical well-being, 0.72 for emotional well-being, and 0.77 for overall QoL (p < 0.0001 for all). “Emoji scales are a promising tool to collect PROs,” the researchers noted.
All 15 patients who completed the study reported that they would recommend filling out forms using the smartphones and watches and collecting data using emoji scales. All patients said they were willing to complete future surveys using the Apple Watch compared to 87% who would complete it using an iPad, 33% by computer, 20% by paper, 20% by live telephone interview, and 0% by automated telephone interview.
“Collecting data utilizing wearable technology and smart phones is feasible and preferred by patients,” the researchers concluded. Further studies will need to analyze the ability of activity data to predict longitudinal changes in PROs.