Clinical utility of portable electrophysiology to measure fatigue in treatment-naïve non-small cell lung cancer.

Abstract

Cancer-related fatigue (CRF) biology remains poorly understood. Responsible mechanisms may be central or peripheral and originate anywhere from the brain to muscle fiber. Objective measurement is complex and previously limited to specialized laboratories. Portable electroencephalography (EEG) and electromyography (EMG) may enhance objective measurement. This study evaluated the feasibility and acceptability of portable EMG-EEG in CRF assessment. A prospective observational feasibility study compared ten outpatients with inoperable, treatment-naïve non-small cell lung cancer and CRF to ten healthy volunteers. All completed a sustained isometric hand-grip contraction at 30% maximal level until self-perceived exhaustion. 128-channel EEG and 2-channel EMG signals of forearm muscles were recorded. Device acceptability was evaluated by questionnaire. The task was evaluated in two stages; first and last 20s. CRF cohort perceived exhaustion earlier than volunteers (mean 137 ± 76s vs 208 ± 51s). As fatigue progressed, EMG amplitude increased significantly (CRF p =0.02; volunteers: p =0.04) in both groups as did EMG beta band power (CRF p =0.008; volunteers: p =0.006). The increase was significantly less in CRF (amplitude p =0.032; beta power: p =0.014). EEG beta band power in the contralateral motor cortex increased significantly (CRF p =0.03; volunteers: p =0.019) in both cohorts but to greater extent (p =0.024) in CRF. One hundred percent device acceptability was reported. A laboratory-based evaluation was successfully adapted to the outpatient setting during routine visits. High acceptability supports clinical utility. In CRF, a higher degree of cortical activation was required to drive a much lower level of muscle performance. This suggests impairment of both central and peripheral mechanisms in CRF.