Cedars-Sinai to use Fitbits in small trial of cancer patients

By Jonah Comstock
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Cedars-Sinai Medical Center is embarking on a small study to see if a Fitbit Charge HR can help oncologists assess whether their patients are active enough for chemotherapy.

“What we know is that individuals who are up and about tend to be more able to tolerate chemotherapy and have a greater potential for benefitting from it,” Dr. Arvind Shinde, a faculty physician in the departments of Supportive Care Medicine and Hematology and Oncology at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, told MobiHealthNews. “People who are spending more time in bed usually get harmed by the treatment we give, even if the cancer is responsive to the treatment.”

The problem is the status quo for assessing how much patients are moving is just to ask them. And for a number of reasons, that’s not always accurate. 

“Part of the problem is that physicians really want to provide treatment to their patients. And patients themselves -- either because they don’t remember, or they have a subjective understanding of how they’ve been doing, or they want treatment -- say they’re doing better than they were doing at home,” said Shinde, who is the principal investigator on the study. “Our thought was, ‘This is an assessment based on how functional a person is and how active, how mobile they are.’ We thought that with these inexpensive activity trackers and wearable biosensors, there may be a way to see how active a patient actually is, and see how they’ve been doing over the past week, perhaps as a better assessment tool for how functional they are and therefore whether they will or will not tolerate chemotherapy well.”

Correction: An earlier version of this article incorrectly quoted Shinde as describing the devices as "expensive" instead of "inexpensive".

In addition, Shinde wants to see whether the combination of the Fitbit and patient-reported-outcome questionnaires can help physicians screen patients for things like fatigue, distress, pain, and trouble sleeping, which patients can underreport.

The study is seeking to enroll 30 patients in advanced stages of cancer who are ambulatory, over 18, and have access to an internet-connected smartphone. The trial will mainly be a feasibility study, seeing how effective the Fitbit — as well as questionnaires — are at monitoring this population.

All 30 patients will be given Fitbit Charge HR devices and asked to wear them at all times, other than in the bath and other times the tracker would be submerged, for two weeks. They will fill out questionnaires at two oncologist visits during the trial period, and again at a six month follow-up. Researchers will also review mortality and hospitalization for the subjects, as well as whether they wore the device as directed.

The two-week trial is something of a dry run to get the kinks of data collection ironed out, Shinde says, though he hopes the data will still be interesting and actionable.

“A 30-patient study is not enough to give us all the data we need,” Shinde said. “The next step will be to do a larger study across multiple tumor types and follow people longitudinally for a much longer period of time. We can see how they do as they progress through their treatments, follow their ups and downs. We’ll be able to get changes over baseline and create a better algorithm for this assessment.”

Interestingly, Fitbit’s decision to not connect to Apple’s HealthKit may have caused something of a hiccup. Shinde said that Cedars-Sinai, which uses the Epic EHR -- one of the EHRs HealthKit integrates with -- found the lack of connection between Fitbit and HealthKit to be a “big issue” for the team. Ultimately, though, they went with another vendor for the data pipes.

Shinde hopes to have the data collected in a few weeks and ready to share in a few months.

This isn’t the first time a Fitbit has been used in a clinical context. Back in 2013, Mayo Clinic published a study, completed in 2012, on using a Fitbit activity tracker to monitor recovery in cardiac surgery patients. They found that step tracking with the Fitbit was easy and cost-effective to implement, and preliminary data suggests that collecting step data could help hospitals determine the appropriate length of stay for a patient recovering from surgery.