Digital Tracking of Patients Undergoing Radical Cystectomy for Bladder Cancer: Daily Step Counts Before and After Surgery Within the iROC Randomised Controlled Trial

Abstract

BackgroundEfforts to improve recovery after radical cystectomy (RC) are needed. ObjectiveTo investigate wrist-worn wearable activity trackers in RC participants. Design, setting, and participantsAn observational cohort study was conducted within the iROC randomised trial. InterventionPatients undergoing RC at nine cancer centres wore wrist-based trackers for 7 days (d) at intervals before and after surgery. Outcome measurements and statistical analysisStep counts were compared with participant and operative features, and recovery outcomes. Results and limitationsOf 308 participants, 284 (92.2%) returned digital activity data at baseline (median 17 d [interquartile range: 8–32] before RC), and postoperatively (5 [5–6] d) and at weeks 5 (43 [38–43] d), 12 (94 [87–106] d), and 26 (192 [181–205] d) after RC. Compliance was affected by the time from surgery and a coronavirus disease 2019 pandemic lockdown (return rates fell to 0–7%, chi-square p < 0.001). Step counts dropped after surgery (mean of 28% of baseline), before recovering at 5 weeks (wk) (71% of baseline) and 12 wk (95% of baseline; all analysis of variance [ANOVA] p < 0.001). Baseline step counts were not associated with postoperative recovery or death. Patients with extended hospital stays had reduced postoperative step counts, with a difference of 2.2 d (95% confidence interval: 0.856–3.482 d) between the lowest third and highest two-third tertiles (linear regression analysis; p < 0.001). Additionally, they spent less time out of the hospital within 90 d of RC (80.3 vs 74.3 d, p = 0.013). Lower step counts at 5, 12, and 26 wk were seen in those seeking medical help and needing readmission (ANOVA p ≤ 0.002). ConclusionsBaseline step counts were not associated with recovery. Lower postoperative step counts were associated with longer length of stay at the hospital and postdischarge readmissions. Studies are required to determine whether low step counts can identify patients at a risk of developing complications. Patient summaryPostoperative step counts appear to be a promising tool to identify patients in the community needing medical help or readmission. More work is needed to understand which measures are most useful and how best to collect these.