Harnessing digital health to objectively assess cancer-related fatigue: The impact of fatigue on mobility performance

Effectiveness of Digital Health Interventions for Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD), marked by dyspnea, cough, and sputum production, significantly impairs patients' quality of life and functionality. Effective management strategies, particularly those empowering patients to manage their condition, are essential to reduce this burden and health care use. Digital health interventions-such as mobile apps for symptom tracking, wearable sensors for vital sign monitoring, and web-based pulmonary rehabilitation programs-can enhance self-efficacy and promote greater patient engagement. By improving self-management skills, these interventions also help alleviate pressure on health care systems.

OBJECTIVE

This systematic review and meta-analysis assesses the clinical effectiveness of smartphone apps, wearable monitors, and web-delivered platforms in four COPD management areas: (1) quality of life (measured by the COPD Assessment Test [CAT] and St George's Respiratory Questionnaire), (2) self-efficacy (assessed by the General Self-Efficacy Scale), (3) functional capacity (evaluated via the 6-minute walk test and Modified Medical Research Council Dyspnea Scale), and (4) health care use (indicated by hospital and emergency department visits).

METHODS

A systematic review was conducted using predefined search terms in PubMed, Embase, Cochrane, and Web of Science up to January 26, 2025, to identify randomized trials on digital health interventions for COPD. Two reviewers independently screened studies and extracted data. Outcomes included quality of life, self-efficacy, functional status, and health care use.

RESULTS

This review included 17 studies with 2027 participants from 11 countries. Eleven trials involved health care professionals in digital platform use, and 12 reported adherence strategies. Digital tools for COPD primarily focused on telerehabilitation (eg, video-guided exercises) and self-management systems (eg, artificial intelligence-driven exacerbation alerts). The study participants were predominantly older adults. Meta-analysis results indicated that digital health interventions significantly improved quality of life at 3 months on the CAT (mean difference [MD] -1.65, 95% CI -3.17 to -0.14; P=.03); at 6 months on the CAT (MD -2.43, 95% CI -3.93 to -0.94; P=.001) and St George's Respiratory Questionnaire (MD 3.25, 95% CI 0.69-5.81; P=.01); at 12 months on the CAT (MD -2.53, 95% CI -3.91 to -1.16; P<.001), EQ-5D (MD 0.04, 95% CI 0.01-0.07; P=.02), and EQ-5D visual analogue scale (MD 5.88, 95% CI 0.38-11.37; P=.04); the General Self-Efficacy Scale at 3 months (MD 1.65, 95% CI 0.62-2.69; P=.002) and 6 months (MD 1.94, 95% CI 0.83-3.05; P<.001); and the Modified Medical Research Council Dyspnea Scale at more than 3 months (MD -0.23, 95% CI -0.36 to -0.11; P=.003). However, no significant differences were observed in the 6-minute walk test, emergency department admissions, hospital admissions, emergency department admissions for COPD, or hospital admissions for COPD.

CONCLUSIONS

Our findings suggest that digital health interventions may benefit COPD patients, but their clinical effectiveness remains uncertain. Further robust studies are needed, particularly those involving larger numbers of older adults with COPD.

TRIAL REGISTRATION

PROSPERO CRD420251032053; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251032053.

Application of Patient-Generated Health Data Among Older Adults With Cancer: Scoping Review

BACKGROUND

The advancement of information and communication technologies has spurred a growing interest in and increased applications of patient-generated health data (PGHD). In particular, PGHD may be promising for older adults with cancer who have increased survival rates and experience a variety of symptoms.

OBJECTIVE

This scoping review aimed to identify the characteristics of research on PGHD as applied to older adults with cancer and to assess the current use of PGHD.

METHODS

Guided by Arksey and O'Malley as well as the JBI (Joanna Briggs Institute) methodology for scoping reviews, 6 electronic databases were searched: PubMed, Embase, CINAHL, Cochrane Library, Scopus, and Web of Science. In addition, the reference lists of the selected studies were screened to identify gray literature. The researchers independently screened the literature according to the predefined eligibility criteria. Data from the selected studies were extracted, capturing study, participant, and PGHD characteristics.

RESULTS

Of the 1090 identified studies, 88 were selected. The publication trend gradually increased, with a majority of studies published since 2017 (69/88, 78%). Almost half of the studies were conducted in North America (38/88, 43%), followed by Europe (30/88, 34%). The most common setting in which the studies were conducted was the participant's home (69/88, 78%). The treatment status varied; the median sample size was 50 (IQR 33.8-84.0). The devices that were used to measure the PGHD were classified as research-grade wearable devices (57/113, 50.4%), consumer-grade wearable devices (28/113, 24.8%), or smartphones or tablet PCs for mobile apps (23/113, 20.4%). More than half of the studies measured physical activity (69/123, 56.1%), followed by patient-reported outcomes (23/123, 18.7%), vital signs (13/123, 10.6%), and sleep (12/123, 9.8%). The PGHD were mainly collected passively (63/88, 72%), and active collection methods were used from 2015 onward (20/88, 23%). In this review, the stages of PGHD use were classified as follows: (1) identification, monitoring, review, and analysis (88/88, 100%); (2) feedback and reporting (32/88, 39%); (3) motivation (30/88, 34%); and (4) education and coaching (19/88, 22%).

CONCLUSIONS

This scoping review provides a comprehensive summary of the overall characteristics and use stages of PGHD in older adults with various types and stages of cancer. Future research should emphasize the use of PGHD, which interacts with patients to provide patient-centered care through patient engagement. By enhancing symptom monitoring, enabling timely interventions, and promoting patient involvement, PGHD have the potential to improve the well-being of older adults with cancer, contributing to better health management and quality of life. Therefore, our findings may provide valuable insights into PGHD that health care providers and researchers can use for geriatric cancer care.

TRIAL REGISTRATION

Open Science Framework Registry OSF.IO/FZRD5; https://doi.org/10.17605/OSF.IO/FZRD5.

Augmenting Prognostication: Utilizing Activity Trackers to Enhance Survival Prediction in Metastatic Non-Small Cell Lung Cancer

INTRODUCTION/BACKGROUND

Prognostication by performance status (PS) assessment is a fundamental element of treatment decisions and clinical trial design in oncology, but it is limited by subjectivity and potential miscommunication between patient, physician, and family. Activity tracker offers the potential to collect a broad range of patient-generated data to supplement the assessment of PS.

PATIENTS AND METHODS

Patients with metastatic NSCLC (mNSCLC) participated in a single institute, prospective, observational feasibility study conducted at Huntsman Cancer Institute. Patients were given a Fitbit® activity tracker, which collects their steps taken, distance moved, heart rate, and activity intensity. At baseline, PS was assessed by physicians and patients, and demographics and clinical data were collected. We defined novel indices of health: Heart rate Activity zone Mismatch (HAM) and excessive Sedentary Heart Rate (eSHR). We used multivariable Cox proportional hazards models adjusted for age, sex, and treatment line to estimate and test the prognostic ability of clinical and fitness metrics on overall survival (OS). Each prognostic model was evaluated using Harrell's concordance index (C-index).

RESULTS

Fifty-five patients with mNSCLC were enrolled. The median OS was 10.4 months (95% CI: 7.2, 15.2). PS-physician (HR = 2.0; P < .001) and Fitbit metrics were associated with OS, including daily total steps (1,000-steps) (HR = 0.8; P = .004), HAM (HR = 2; P = .02), eSHR (HR = 0.3; P = .001). The prognostic model that includes PS-physician was associated with the best concordance (C-index = 0.75), followed by daily total distance (C-index = 0.74) and steps (C-index = 0.73) CONCLUSIONS: Tracker-based measures were prognostic of survival in mNSCLC and may be useful as a supplement or alternative to PS in practice and clinical trials.

Relationship between chemotherapy-induced peripheral neuropathy and physical activity in cancer survivors: A prospective longitudinal study

Objective

The purpose of this research is to evaluate the relationship between the degree of peripheral neuropathy associated with treatment and physical activity through the use of objective indicators such as wristband activity tracker and subjective evaluations obtained through interviews.

Methods

This study included 11 patients with gynecological cancer, gastrointestinal cancer, and malignant lymphoma. Participants were requested to wear a wristband activity meter at two time points: early and mid-treatment. Activity-meter step counts were compared with factors such as energy expenditure and Functional Assessment of Cancer Therapy-General during early and mid-treatment. Interviews were analyzed qualitatively and inductively.

Results

There was no difference in the number of steps taken by participants in the early and mid-treatment periods (P = 0.050), but they took more steps in the mid-treatment period than in the early period. Participants expended more energy during mid-treatment than early treatment, but these differences were not significant. We noted a correlation between the number of steps and energy expenditure in the mid-treatment period (r = 0.883). Comparisons between measures showed significant differences in "Impact" between early and mid-treatment on Distress and Impact Thermometer (P = 0.034). The impact of numbness on activity was assigned to three categories: loss of routine caused by numbness, coping with the numbness-related inconvenience using various resources, and acceptance of life with numbness with the support of others and self-strength.

Conclusions

The participants devised strategies to maintain activities despite experiencing chemotherapy-induced peripheral neurotoxicity. The use of activity meters may enhance patient motivation, which in our opinion, is beneficial for self-care education.

Harnessing physical activity monitoring and digital biomarkers of frailty from pendant based wearables to predict chemotherapy resilience in veterans with cancer

This study evaluated the use of pendant-based wearables for monitoring digital biomarkers of frailty in predicting chemotherapy resilience among 27 veteran cancer patients (average age: 64.6 ± 13.4 years), undergoing bi-weekly chemotherapy. Immediately following their first day of chemotherapy cycle, participants wore a water-resistant pendant sensor for 14 days. This device tracked frailty markers like cadence (slowness), daily steps (inactivity), postural transitions (weakness), and metrics such as longest walk duration and energy expenditure (exhaustion). Participants were divided into resilient and non-resilient groups based on adverse events within 6 months post-chemotherapy, including dose reduction, treatment discontinuation, unplanned hospitalization, or death. A Chemotherapy-Resilience-Index (CRI) ranging from 0 to 1, where higher values indicate poorer resilience, was developed using regression analysis. It combined physical activity data with baseline Eastern Cooperative Oncology Group (ECOG) assessments. The protocol showed a 97% feasibility rate, with sensor metrics effectively differentiating between groups as early as day 6 post-therapy. The CRI, calculated using data up to day 6 and baseline ECOG, significantly distinguished resilient (CRI = 0.2 ± 0.27) from non-resilient (CRI = 0.7 ± 0.26) groups (p < 0.001, Cohen's d = 1.67). This confirms the potential of remote monitoring systems in tracking post-chemotherapy functional capacity changes and aiding early non-resilience detection, subject to validation in larger studies.

Application of wearables for remote monitoring of oncology patients: A scoping review

Objective

This review aims to systematically map and categorize the current state of wearable applications among oncology patients and to identify determinants impeding clinical implementation.

Methods

A Medline, Embase and clinicaltrials.gov search identified journal articles, conference abstracts, letters, reports, dissertations and registered studies on the use of wearables in patients with malignancies published up to 10 November 2021.

Results

Of 2509 records identified, 112 met the eligibility criteria. Of these, 9.8% (11/112) were RCTs and 47.3% (53/112) of publications were observational. Wearables were investigated pre-treatment (2.7%; 3/112), during treatment (34.8%; 39/112), post-treatment (17.9%; 20/112), in survivors (27.7%; 31/112) and in non-specified or multiple treatment phases (17.0%; 19/112). Medical-grade wearables were applied in 22.3% (25/112) of publications. Primary objectives ranged from technical feasibility (8.0%; 9/112), user feasibility (42.9%; 48/112) and correlational analysis (40.2%; 45/112) to outcome change analysis (8.9%; 10/112). Outcome change was mostly investigated regarding physical activity improvement (80.0%; 8/10). Most publications (42.9%; 48/112) and registered studies (39.3%; 24/61) featured multiple cancer types, with breast cancer as the most prevalent specific type (22.3% in publications, 16.4% in registered studies).

Conclusions

Most studies among oncology patients using wearables are focused on assessing the user feasibility of consumer-grade wearables, whereas rates of RCTs assessing clinical efficacy are low. Substantial improvements in clinically relevant endpoints by the use of wearables, such as morbidity and mortality are yet to be demonstrated.