Physical behavior and associations with health outcomes in operable NSCLC patients: A prospective study.

OBJECTIVES: Our objectives were to 1) characterize daily physical behavior of operable non-small cell lung cancer (NSCLC) patients, from preoperative to six months postoperative using accelerometry, and explore if physical behavior preoperative or one month postoperative is associated with better health outcomes at six months postoperative. METHODS: A prospective study with 23 patients (13 female) diagnosed with primary NSCLC and scheduled for curative lung resection was performed. Outcome measures were assessed two weeks preoperative, and one, three and six months postoperative, and included accelerometer-derived physical behavior measures and the following health outcomes: six minute walking distance (6MWD), questionnaires concerning health-related quality of life (HRQOL), fatigue and distress. RESULTS: On group average, physical behavior showed significant changes over time. Physical behavior worsened following surgery, but improved between one and six months postoperative, almost reaching preoperative levels. However, physical behavior showed high variability between patients in both amount as well as change over time. More time in moderate-to-vigorous physical activity in bouts of 10 min or longer in the first month postoperative was significantly associated with better 6MWD, HRQOL, distress, and fatigue at six months postoperative. CONCLUSION: As expected, curative lung resection impacts physical behavior. Patients who were more active in the first month following surgery reported better health outcome six months postoperative. The large variability in activity patterns over time observed between patients, suggests that physical behavior 'profiling' through detailed monitoring of physical behavior could facilitate tailored goal setting in interventions that target change in physical behavior.

Ambulant monitoring and web-accessible home-based exercise program during outpatient follow-up for resected lung cancer survivors: actual use and feasibility in clinical practice.

PURPOSE: The aim of this study is to evaluate the feasibility of a telehealthcare application for operable lung cancer (OLC) patients, consisting of ambulant symptom and physical activity monitoring (S&PAM) and a web-accessible home-based exercise program (WEP), and identify possible barriers for successful adoption and implementation. METHODS: A two-stage mixed methods design was used, in which 22 OLC patients and their treating healthcare professionals (HCPs) participated from pre-surgery to three (stage 1; n = 10) or six (stage 2; n = 12) months post-surgery. Actual use and acceptability (usability, usefulness, and satisfaction) were evaluated. RESULTS: Seventeen OLC patients (age (SD): 59 (8) years; 8 female) actively used the modules. S&PAM use varied from 1 to 11 monitoring days prior to outpatient consultations. Patients used WEP most frequently during the first 5 weeks, with an average of four logins a week. Fifty-eight percent used WEP beyond 7 weeks. No adverse situations occurred, and patients felt confident using the applications. Perceived added value included active lifestyle promotion, decreased anxiety, and accessibility to specialized HCPs. Physiotherapists used WEP as intended. Contrarily, physicians scarcely used information from S&PAM. To promote future adoption, strategies should focus on high-level patient tailoring of the technology, and formalization of including the applications in the clinical workflow. CONCLUSIONS: Ambulant monitoring and web-accessible home exercise is clinically feasible for OLC patients. However, low level of adoption by referring physicians may hamper successful implementation. IMPLICATIONS FOR CANCER SURVIVORS: Patients perceived both ambulant monitoring and web-accessible exercise as an added value to regular care and feasible to use in the period before and after lung resection.

Relationship between patterns of daily physical activity and fatigue in cancer survivors.

PURPOSE: This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue. METHOD: Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0-10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS). RESULTS: Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening (p < .01) and increased levels of fatigue throughout the day were reported (p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening (p < .05). Objective and subjective measured physical activity showed low correlations. CONCLUSIONS: This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue.