Screen: 17
Travis Lambert, MD
Montefiore Medical Center/Albert Einstein College of Medicine
Bronx, NY
Purpose/Objective(s): We have previously shown that interruptions of definitive radiotherapy (RT) detract from treatment efficacy and that step count data from wearable devices can be utilized to predict treatment interruptions. We performed a randomized trial to test the hypothesis that utilizing wearable devices to monitor and increase patients’ physical activity during RT can reduce the risk of treatment interruption.
Materials/
Methods: Patients with an ECOG performance status (PS) of 0-2 who were planned for a course of definitive radiotherapy with concurrent chemotherapy were eligible for this randomized trial. All participants received a commercial activity monitor prior to treatment initiation and received standard supportive care throughout treatment. As in previous studies, patients with baseline daily step count average below the 25th percentile of age-matched controls were considered “inactive.” Experimental arm participants were asked to meet a personalized daily step count displayed on the device. Those who repeatedly failed to meet their step count goal received reminders to increase step counts from the study team. The primary endpoint was missing two or more scheduled RT sessions. Secondary endpoints included hospitalizations, disease progression, and death.
Results: 166 participants were enrolled from 2017-2020. After excluding subjects whose treatment plan changed after enrollment and those who withdrew consent, 141 patients remain for analysis. Mean age was 60, 95% of participants had PS 0-1, and 50% of participants were categorized as inactive at baseline. The most common diagnoses were head and neck cancer (27%) and lung cancer (26%). Experimental arm participants were less likely to miss two or more RT sessions (19% v. 31%, p=0.107) and to be hospitalized during RT (14% v. 24%, p=0.169), though these effects did not reach statistical significance. Subgroup analyses suggested that the study intervention reduced treatment interruptions in male patients (13% v. 33%, p=0.043) and in patients with head and neck cancer (24% v. 57%, p=0.037). Participants who were inactive at baseline were more likely to miss two or more scheduled RT sessions (37% v. 13%, p=0.002) and to be hospitalized during RT (27% v. 7%, p=0.003).
Conclusion: While our primary study objective was not achieved, a simple pedometer-based walking intervention may reduce the incidence of treatment interruptions and hospital admissions during treatment. Baseline activity level was identified as a powerful predictor of treatment interruption and hospital admission. Future studies will focus on supervised physical activity interventions and providing enhanced supportive care to patients found to be at high risk for treatment complications based on activity metrics.