Abstract
PurposeThe expanding armamentarium of wearable activity monitors (WAMs) offers new opportunities to supplement physician-assessed performance status (PS) with real-life patient activity data. These data could guide clinical decision making or serve as a measure of treatment outcome. However, information on the association between physical activity (PA) and sedentary behavior (SB) monitored with wearables (i.e., WAM metrics) and PS in patients with cancer is needed. Therefore, we conducted a systematic review to examine the association between WAM metrics and PS in patients with cancer.MethodsWe searched MEDLINE and Embase for studies that assessed the association between WAM metrics and performance status among adults with cancer. We extracted information on study design and population, WAM type and different activity metrics, outcome definitions, and results. Included studies were subjected to risk of bias assessment and subsequent best evidence synthesis.ResultsFourteen studies were included in this review. All studies reported on different combinations of WAM metrics including: daily steps (n = 8), SB (n = 5), mean activity counts (n = 4), dichotomous circadian rest-activity index (n = 3), and time spent in moderate-to-vigorous PA (MVPA) (n = 3). Much heterogeneity was observed regarding study population, WAM used, and reporting of results. We found moderate evidence for a positive weak-to-moderate association between WAM-assessed PA and PS and a weak-to-moderate negative association between WAM-assessed SB metrics and PS.ConclusionWeak-to-moderate associations between WAM metrics and PS suggest that WAM data and physician-assessed PS cannot be used interchangeably. Instead, WAM data could serve as a dynamic and objective supplement measurement of patients’ physical performance.
Highlights
Patients’ performance status is a significant prognostic and predictive factor for clinically relevant outcomes, such as progression-free and overall survival of patients with cancer [1–3]
We reviewed the available evidence on the association between wearable activity monitor metrics and physician-assessed performance status
These weak-tomoderate associations may suggest that wearable activity monitors and performance status scales assess different constructs of physical performance and cannot be interchanged
Summary
Patients’ performance status is a significant prognostic and predictive factor for clinically relevant outcomes, such as progression-free and overall survival of patients with cancer [1–3]. Patients’ performance status is determined by healthcare professionals using either the Karnofsky Performance Status (KPS) or the Eastern Cooperative Oncology Group Performance Status (ECOG-PS, known as WHO PS) [5, 6] Both methods have proven their clinical relevance over the past decades. Performance status assessment may be susceptible to response and recall bias as it relies on patient-reported physical activity and functioning [13]. Both KPS and ECOG-PS are static measurements that are only captured during scheduled visits, whereas patient’s physical performance is a dynamic process that may change on a daily basis during the course of treatment. Recent reviews have accentuated the need for a tool that can assess patient’s physical performance objectively in a more dynamic fashion [7, 14]
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