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Wearable health trackers: a revolution in cancer care

Activity trackers, wearable electronics that collect data passively and can be worn on the body, infiltrated the world’s fitness market in the last decade. Those devices allowed consumers to track steps and heart rate. Next, wearable devices overtook the chronic illness market, giving patients the power to track health behavior and adherence to medication, which could be easily reported back to doctors. In the past year wearable trackers have stepped into what may be their most important passive monitoring role yet: cancer care.

Last summer, at the Memorial Sloan Kettering Cancer Center in New York, 40 multiple myeloma patients joined a small trial using wearable devices to track activity and sleep, assessing those patients’ quality of life. At Cedars–Sinai Medical Center in Los Angeles, oncologists recently launched a similar study during which cancer patients will be given Fitbits, allowing oncologists to assess whether patients are active enough for chemotherapy. At the Dana–Farber Cancer Institute in Boston, researchers are using Fitbits to study how weight loss affects breast cancer recurrence. The list of other cancer centers launching studies of wearable devices goes on and on. Bloomberg reported that more than 300 clinical trials had incorporated the trackers into their design as of December 2015.

Wearable health trackers infiltrated the fitness market in 2009, the year Fitbit launched its first wristband. Initially, those devices were simple. Most came in wristband form, and they allowed consumers to track simple fitness behaviors, such as steps taken, floors climbed, and distance. Today, fitness trackers have advanced markedly, both in capability and in quantity. They now monitor, for example, steps, distance traveled, floors climbed, calories burned, minutes of activity, sleep time and quality, heart rate, and workout pace. Many other companies have since introduced other activity trackers. There are several popular brands. In December 2016, annual sales for wearable devices in the United States were expected to top $38 million, according to the Consumer Technology Association.

Fitbit Flex and accompanying wristband by MorePix. CC BY-SA 3.0 via Wikimedia Commons.

Clinical-grade wearable trackers are becoming more widespread, too. Most of those devices focus on chronic illnesses such as congestive heart failure, diabetes, hypertension, and chronic obstructive pulmonary disease. The devices measure advanced behaviors beyond fitness, such as drug adherence, fertility, sun exposure, and health behaviors, continuously measuring people’s health status as they follow their daily routine.

Arvind Shinde, MD, a faculty physician at Cedars–Sinai, just launched a clinical trial to help his oncology patients live longer and better lives. Shinde and care providers like him are bringing wearable devices into more specialized areas of care, such as oncology, because they offer an enticing solution to a major problem. Right now, most cancer treatments involve expensive drug regimens meant to reduce the risk of relapse and extend patients’ lives. But growing evidence indicates that quality cancer treatment might be about more than just drugs; lifestyle choices matter, too. In a meta-analysis of 82 peer-reviewed studies about lifestyle interventions for cancer patients, physical activity had a small-to-moderate positive effect on cancer patients during treatment, including overall activity level, aerobic fitness, muscular strength, functional quality of life, anxiety, and self-esteem.

Shinde’s clinical trial at Cedars–Sinai, now in its final stages, used Fitbit Charge devices to assess whether 30 cancer patients were active enough to respond to chemotherapy. Shinde’s team asked patients to wear their Fitbits consistently for two weeks. The patients also completed questionnaires at two oncologist visits during the trial and will do so again at a six-month follow-up appointment. Using data from the trackers, Shinde plans to analyze his patients’ behaviors, including steps, stairs, heart rate, and sleep, as well as moments of peak activity and duration of sleep. He said that he hopes to use that information to tailor cancer treatments for each patient.

At Dana–Farber, medical oncologist Jennifer Ligibel, MD, runs a similar trial. Using Fitbits, Ligibel’s team will monitor 3,200 overweight and obese women with early-stage breast cancer for two years. Recruitment for the trial is just beginning, but all patients will participate remotely and be given a health coach to encourage them.

“We’ve known for a while that women who are heavier when they are diagnosed with breast cancer have a higher rate of breast cancer recurrence and mortality than thinner women. But we don’t know if reducing weight changes this,” Ligibel said. She said that she hopes her study can provide context for what oncologists already know about breast cancer treatments.

At Memorial Sloan Kettering, Neha Korde, MD, an assistant professor, focuses on multiple myeloma, a blood cancer in the bone marrow with no known cure. Korde oversees a forthcoming clinical trial that will monitor 40 recently diagnosed multiple myeloma patients for nine months, using Medidata activity trackers to gather data on sleep, activity, and self-reported quality of life. Steroids are a common treatment to reduce pain for myeloma, but Korde said that many of her patients find themselves unable to sleep once they take steroids. That loss of sleep can severely affect the body’s ability function and fight disease. By measuring sleep and activity data through wearable trackers, she could assess which patients respond best to certain treatment and course quickly for those who might be struggling.

“A personalized approach matters,” Korde said. “And we should be able to manage side effects and adverse events, taking a more tailored approach if a patient needs it.”

Most consumer-grade wearable trackers, like the Fitbit, are not yet validated for medical use. That is one reason why all those providers approach their trials with some skepticism. They aren’t sure what kind of data will turn up, and they’re hopeful, but not convinced, that patients will keep their trackers on for the duration of the studies.

However, those cancer trials Memorial Sloan Kettering, Cedars–Sinai, and Dana–Farber, and others like them, will potentially yield important data about how providers and scientists can best use wearable technology to collect important data. Shinde’s data look promising so far, he said, with strong insights emerging from the tracker data.

“People are really interested in this work,” Korde said. “Coming up with a cocktail of targeted drug agents is great. But if a patient falls apart, that alone isn’t going to work, so clinicians are interested in looking at what else is out there. Remote monitoring should be one of our most fundamental next reaches: If there is no cure, we must understand all the different aspects of helping a patient improve quality of life.”

A version of this article originally appeared in the Journal of the Nation Cancer Institute.

Featured image credit: Heart rate monitoring device by pearlsband. CC0 public domain via Pixabay.

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