A Scoping Review to Assess Adherence to and Clinical Outcomes of Wearable Devices in the Cancer Population
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Search Strategy
2.2. Criteria for the Inclusion of Studies
2.3. Study Selection and Data Extraction
2.4. Adherence Analysis
2.5. Outcomes and Analysis
2.6. Ethical Consideration
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Characteristics of Research Participants
3.4. Measurement Tools
3.5. Major Study Focus
3.6. Intervention Methods
3.7. Interventional Outcomes
3.7.1. Adherence
3.7.2. Clinical Outcomes
4. Discussion
4.1. Summary and Findings
4.2. eHealth Tools for Cancer Care
4.3. Strength and Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Country of Study | Topic (Type of Cancer and Status) | Study Design | Tools Used | Participant (%) Gender | |
---|---|---|---|---|---|
The United States of America [21] | Breast Cancer (n = 57) | Survivors | Feasibility Study | Wearable Device and Questionnaire | 100% Women |
Australia [22] | Breast Cancer (n = 80) | Survivors | RCT | Wearable Device + Text Messages and Personal Interviews + Mobile Application | 100% Women |
The United States of America [23] | Breast Cancer (n = 34) | Survivors | RCT | Wearable Device and Questionnaire (Correlation) | 100% Women |
Australia [24] | Breast Cancer (n = 80) | Survivors | RCT | Wearable Device and Questionnaire (Correlation) | 100% Women |
The United States of America [25] | Breast Cancer (n = 20) | Survivors | RCT | Wearable Device + Group Sessions and Phone Calls | 100% Women |
Canada [26] | Breast Cancer (n = 41) | Survivors | RCT | Wearable Device and Questionnaires (Correlation) | 100% Women |
The Netherlands [27] | Breast Cancer (n = 8) | Survivors | Qualitative Study | Wearable Device and Questionnaires | 100% Women |
United Kingdom [28] | Breast Cancer (n = 39) | Under Treatment | Non-RCT | Wearable Device, Questionnaire, and Behavioral Counseling Session | 100% Women |
India [29] | Breast Cancer (n = 44) | Under Treatment | Non-RCT | Wearable Device + General group session + Questionnaire + Mobile Application | 95.4% Women |
The United States of America [30] | Breast Cancer (n = 32) | Under Treatment | Pilot Study | Wearable Device + Mobile application + Text Messages | 100% Women |
The United States of America [31] | Breast Cancer (n = 10) | Under Treatment | RCT | Wearable Device and Questionnaire | 100% Women |
Germany [32] | Breast Cancer (n = 99) | Under Treatment | Feasibility Study | Wearable Device and Questionnaire | 100% Women |
Central China [33] | Mixed Cancer (n = 112) | Under Treatment | RCT | Wearable Device | 76.2% Women |
The United States of America [34] | Mixed Cancer (n = 38) | Under Treatment | Utility Study/Predictive Study | Wearable Device + Mobile application and Interview | 52% Women |
The United States of America [35] | Mixed Cancer (n = 41) | Under Treatment | Observational Study | Wearable Device + Mobile application + Questionnaire | 56% Women |
The United States of America [36] | Mixed Cancer (n = 33) | Under Treatment | Prospective cohort Study | Wearable Devices and Spirometer | 57.5% Women |
Japan [37] | Mixed Cancer (n = 30) | Under Treatment | Feasibility Study | Wearable Device | 70% Men |
France [38] | Mixed Cancer (n = 31) | Under Treatment | Pilot Study | Wearable Device + Mobile Application + Questionnaire | 55% Men |
Ireland [39] | Mixed Cancer (n = 61) | Survivors | RCT | Wearable Devices + Goal-setting session + Telephone-delivered health-coaching sessions | 50% Men |
The United States of America [40] | Mixed Cancer (n = 32) | Survivors | Feasibility Study | Wearable Device + Two group sessions + support phone call | 51% Men |
Switzerland [41] | Mixed Cancer (n = 30) | Survivors | Feasibility Study | Fitbit + iPad (preloaded apps) + Questionnaires | 70% Men |
The United States of America [42] | Mixed Cancer (n = 59) | Survivors | Pilot Study | Wearable Device and Questionnaire | 59.3% Women |
The United States of America [43] | Mixed Cancer (n = 47) | Survivors | RCT | Wearable Device + Questionnaire + Social Media Intervention (Health Education) | 96% Women |
Australia [44] | Colorectal and Endometrial cancer (n = 29) | Survivors | RCT | Mobile application (in-app chat service) + Wearable device + Questionnaires | 58% Women |
Western Australia [45] | Colorectal Cancer (n = 61) | Survivors | RCT | Wearable Device + mHealth app + Peer-based virtual support group + Qualitative Interviews | 50% Women |
The United States of America [46] | Colorectal Cancer (n = 39) | Survivors | RCT | Wearable Device and Questionnaire-based study | 58% Women |
South Korea [47] | Colorectal Cancer (n = 75) | Under Treatment | Feasibility Study | Wearable device + Questionnaires + e-Patient Diary | 58.7% Men |
The United States of America [48] | Colorectal Cancer (n = 40) | Under Treatment | Pilot Study | Wearable Device and Questionnaire-based study | 56.8% Women |
Taiwan [49] | Lung Cancer (n = 12) | Under Treatment | Observational Study | Wearable Device and Questionnaire-based study | 58.33% Men |
The United States of America [50] | Lung Cancer (n = 30) | Under Treatment | Observational Study | Wearable Device + Questionnaire + Educational handbook + Social support + Email-based coaching | 67% Men |
The United States of America [51] | Lung Cancer (n = 18) | Under Treatment | Observational Study | Wearable Device and Questionnaire (Correlation) | 44% Women |
South Korea [52] | Lung Cancer (n = 555) | Under Treatment | Usability Study | Wearable Devices + Questionnaire+ Educational handbook+ Social support + Email-based coaching | 61% Men |
The United States of America [53] | Gastric cancer (n = 27) | Under Treatment | Cohort Study | Wearable Device + Mobile Application | 62.96% Men |
Taiwan [54] | Gastric Cancer (n = 43) | Under Treatment | Group Study | Wearable Devices + Questionnaires | 51% Men |
South Korea [55] | Liver Cancer (n = 31) | Under Treatment | Usability Study | Wearable Device + Daily text messages+ Questionnaire | 84% Men |
The United States of America [56] | Blood Cancer (n = 11) | Under Treatment | Feasibility Study | Diary + Accelerometer | 66.6% Men |
Japan [57] | Urothelial Carcinoma (n = 21) | Under Treatment | Cohort Study | Wearable Device | 84% Men |
The United States of America [58] | Skin Cancer (n = 60) | Survivor | Observational Study | Wearable Devices + Questionnaire + Interviews | 60% Women |
Country of Study | Total Study Duration (in Weeks) | Intervention Duration (in Weeks) | Patients Recruited | Criteria for Evaluation | Adherence (in Percentage) |
---|---|---|---|---|---|
The United States of America [21] | 24 | 12 | 60 | Percentage of enrolled patients who completed all assessments (10 h per day for 4 days in a week) | 95 |
Australia [22] | 24 | 12 | 83 | Based on the given assessment completion | 94 |
The United States of America [23] | 52 | 24 | 44 | Collection of data (days with less than 1000 steps considered as non-adherent) | 65 |
Australia [24] | 12 | 12 | 83 | Completeness of data collection | 96 |
The United States of America [25] | 10 | 10 | 30 | Completeness of data collection | 67 |
Canada [26] | 24 | 12 | 45 | Completeness of data collection | 88 |
The Netherlands [27] | 12 | 12 | 10 | Based on data collection and total wearing days | 80 |
United Kingdom [28] | 2 | 2 | 56 | Collected data on the different days (39 patients*14 days) | 89 |
India [29] | 7 | 7 | 44 | Users’ tolerance ability to the intensity of the program that was set using the rate of perceived exertion (RPE) | 93 |
The United States of America [30] | 17 | 17 | 32 | Days were considered “valid” if there was any wear time recorded (5 min threshold) | 100 |
The United States of America [31] | 10 | 10 | 10 | Completeness of data collection | 100 |
Germany [32] | 24 | 24 | 112 | Completeness of data collection | 95 |
Central China [33] | 8 | 8 | 143 | Completeness of data collection | 78 |
The United States of America [34] | 8 | 8 | 45 | Completeness of data collection | 84 |
The United States of America [35] | 20 | 8 | 34 | Completeness of data collection | 68 |
The United States of America [36] | 43 | 43 | 44 | Completeness of data collection | 75 |
Japan [37] | 4 | 4 | 30 | Completeness of data collection | 90 |
France [38] | 4 | 4 | 30 | Completeness of data collection | 86 |
Ireland [39] | 24 | 12 | 68 | Completeness of data collection | 89 |
The United States of America [40] | 52 | 12 | 49 | Completeness of data collection | 65 |
Switzerland [41] | 12 | 12 | 30 | Completeness of data collection and qualitative analysis of interviews | 83 |
The United States of America [42] | 10 | 10 | 59 | Completeness of data collection | 100 |
The United States of America [43] | 12 | 12 | 50 | Completeness of data collection | 94 |
Australia [44] | 24 | 12 | 34 | Based on participants who completed the study criterion, which is a minimum of 1000 steps or more denoted per day. | 82 |
Western Australia [45] | 12 | 12 | 68 | Completeness of data collection | 94 |
The United States of America [46] | 12 | 12 | 41 | Completeness of data collection | 81 |
South Korea [47] | 12 | 12 | 102 | Completeness of data collection | 74 |
The United States of America [48] | 12 | 12 | 44 | Completeness of data collection | 88 |
Taiwan [49] | 1 | 1 | 12 | Completeness of data collection | 100 |
The United States of America [50] | 1 | 1 | 39 | Completeness of data collection | 67 |
The United States of America [51] | 3 | 3 | 30 | Completeness of data collection | 60 |
South Korea [52] | 52 | 52 | 555 | Completeness of data collection | 100 |
The United States of America [53] | 3 | 3 | 41 | Based on the rate of data collected during chemotherapy | 63 |
Taiwan [54] | 4 | 4 | 43 | Completeness of data collection | 100 |
South Korea [55] | 12 | 12 | 37 | Equivalent to the completion of the exercise program | 84 |
The United States of America [56] | 2 | 2 | 12 | Completeness of data collection | 92 |
Japan [57] | 12 | 12 | 28 | Completeness of data collection | 75 |
The United States of America [58] | 3 | 3 | 60 | In-person interviews to examine the acceptability of the device and analysis of qualitative data | 100 |
Country of Study | Cancer Type | Purpose | Reported Clinical Outcomes |
---|---|---|---|
The United States of America [21] | Breast Cancer | Behavioral health management (PA/QoL and fatigue) | High engagement among hospitalized patients and increased energy expenditure among cancer survivors. Outcomes depend on numerous factors related to users and their needs. |
Australia [22] | Breast Cancer | Behavioral health management (sleep quality) | Changes in actigraphy (sleep efficiency) and PSQI global and subscales favored the intervention arm. Findings were not significant or clinically meaningful. |
The United States of America [23] | Breast Cancer | Behavioral health management (physical activity/BMI/QoL/fatigue/ fitness/self-regulation and self-efficacy related to PA) | Self-monitoring, goal setting, and self-efficacy were significantly correlated with activity levels. Increased improvement in health was noted with an increase in PA. |
Australia [24] | Breast Cancer | Behavioral health management (MVPA/Sedentary Behavior) | The intervention resulted in increases in MVPA and MVPA accrued in bouts of at least 10 consecutive min while reducing total and prolonged sitting times. A significant difference in MVPA was noted between groups at T2, favoring the intervention arm. |
The United States of America [25] | Breast Cancer | Behavioral health management (PA- MVPA, Sedentary/physiological/ psychosocial/QoL variables) | No significant group differences were observed for changes over time for any variable. Both groups showed increased mean daily MVPA, light PA, energy expenditure, and steps/day. |
Canada [26] | Breast Cancer | Behavioral health management (PA-MVPA, LIPA, Sedentary Behavior/Sleep quality/health-related Fitness Markers) | Increases in moderate-to-vigorous intensity PA and decreases in sedentary time were significantly greater in the lower-intensity PA group versus the control group at 12 weeks. Increases in V˙O2 max at 12 weeks in both intervention groups were significantly greater than the changes in the control group. Changes in PA and V˙O2 max remained at 24 weeks but differences between the intervention and control groups were not significant. |
The Netherlands [27] | Breast Cancer | Behavioral health management (PA-Sedentary behavior) | The activity tracker motivated women to be physically active and increased their awareness of their sedentary lifestyle. Wearing an activity tracker raised lifestyle awareness in patients with breast cancer. |
United Kingdom [28] | Breast Cancer | Behavioral health management (Upper Limb Function) | WAM improved on the surgical side of the upper limb with an increment in PA for the first week and showed a good correlation with DASH (0.0506) |
India [29] | Breast Cancer | Behavioral health management (Fatigue/QoL//Functional Capacity/PA/Body Composition) | At the end of the 7-week intervention, functional capacity, quality of life, and skeletal mass were significantly improved, whereas fatigue and changes in total fat improved nonsignificantly. |
The United States of America [30] | Breast Cancer | Behavioral health management (PA/MVPA/SB/Cognitive functions) | Participants decreased their activity from pre- to post-chemotherapy by 1 h/week in MVPA and 8 h/week in TPA during the decline. This is useful for determining the stage of chemotherapy in which PA starts to decline and patients need extra support for their care. |
The United States of America [31] | Breast Cancer | Behavioral health management (PA/Sleep Metrics) | Overall step count decreased by an average of 54 steps per day from baseline during treatment. Although differences in step count, calories expended, and miles walked throughout the RT were minimal, they were significant because of the substantial number of events |
Germany [32] | Breast Cancer | Behavioral health management (PA) | Coherence between self-reported and device data was strong (r = 0.566). Neither treatment nor week nor their interaction had effects on step counts. Self-reported activity time was lower for patients receiving chemotherapy than for those not receiving chemotherapy and lower in the 18th week than in the 3rd week |
Central China [33] | Mixed Cancer | Behavioral health management (Asleep + QoL) | The baseline measurement was not significantly different among the three groups. However, after the intervention, a significant difference between the experimental and control groups was noted. Sleep quality and PA improved significantly but not the secondary outcomes. |
The United States of America [34] | Mixed Cancer | Behavioral health management (Unplanned Healthcare Encounter/PA) | Kinematic features associated with physical activity showed a positive correlation. Chair-to-table kinematics are good predictors of unexpected hospitalization. Get- up-and-walk kinematics are good predictors of low physical activity |
The United States of America [35] | Mixed Cancer | Behavioral health management (Unplanned Healthcare Encounter/PA) | This study demonstrated the feasibility of an outpatient wearable activity tracker. The results revealed a 50% disagreement with no association of these disagreements with UHEs and no correlation between the UHEs and ECOG scores. A correlation between (1) average METs and UHEs and (2) no sedentary physical activity hours and UHEs was noted |
The United States of America [36] | Mixed Cancer | Behavioral health management (PA/QoL) | Significant improvements across all eight dimensions of HRQOL; most patients (85%) reported that they enjoyed wearing the Fitbit. Most felt that the Fitbit helped them to be more active (79%), whereas a minority (18%) felt their activity level was the same, and none reported becoming less active. |
Japan [37] | Mixed Cancer | Behavioral health management (PA/Symptom Burden Assessment/Sleep/Fatigue) | Use of a wearable activity tracker for collecting PGHD in real time according to the protocol was feasible. With respect to adherence, the result was significant. The correlation between the assessed data was not significant |
France [38] | Mixed Cancer | Behavioral health management (PA/Sleep) | Results provide evidence for both the feasibility and relevance of the combined objective and subjective remote monitoring of sleep and other symptoms in patients with cancer with single-night precision. This dynamic approach can help the development of novel therapeutics whose testing is warranted in patients with cancer |
Ireland [39] | Mixed Cancer | Behavioral health management (MVPA/Cardiovascular risk factors and sedentary behavior) | The estimated difference between groups at 24 weeks supported higher MVPA; no change in MVPA in the intervention group was observed during the 12-week follow-up period, indicating a positive correlation with the improvement in cardiovascular risk factors. |
The United States of America [40] | Mixed Cancer | Behavioral health Management (MVPA/QoL/ Fatigue/Fitness/Sedentary Behavior) | Results of the studies revealed some promising improvements in muscular strength that aligned with the intervention’s focus on strength training. |
Switzerland [41] | Mixed Cancer | Behavioral health management (Symptom Analysis) | Remote monitoring of healthcare status in patients receiving palliative care with a limited life expectancy is feasible, and patients can handle the smartphone and sensor-equipped bracelet. Feedback toward the use of this monitoring system was mostly positive. |
The United States of America [42] | Mixed Cancer | Behavioral health management (PA-SB and MVPA/QoL) | Intervention participants had a lower-than-expected engagement in the Facebook group component, (passive instead of active engagement); MVPA and sedentary time showed no significant difference b/w gaps |
The United States of America [43] | Mixed Cancer | Behavioral health management (PA-MVPA) | Increased physical activity among cancer survivors was noted: the intervention group increased their daily steps. Moderate-to-vigorous-intensity activity performed in 10 min bouts increased, but no significant group-by-time differences for either light- or vigorous-intensity activity were noted |
Australia [44] | Colorectal and endometrial Cancer | Behavioral health management (PA -Steensma) | Fitbit wear time (percentage of valid wear days = adherence) was consistent with a median adherence score of 100%. Comparison and correlation with actigraphy (MVPA) show that both devices are not correlated and do not show any type of association. |
Western Australia [45] | Colorectal Cancer | Behavioral health management (MVPA/Cardiovascular Risk) | Despite a significant increase in MVPA, the change in the proportion of participants meeting the guidelines in relation to MV10 did not significantly differ by group. Reduction in DBP among intervention participants that were hypertensive. Fitbit was promising for low-intensity interventions. |
The United States of America [46] | Colorectal Cancer | Behavioral health management (PA-MVPA/ Adverse events) | Intervention arm increased its MVPA by 13 min per day more than the control arm. Larger studies should be conducted to determine whether the intervention increases physical activity. |
South Korea [47] | Colorectal Cancer | Behavioral health management (PA/QoL/Nutritional Status/Physical Performance) | Lower-extremity strength and cardiorespiratory endurance were significantly improved. Fatigue and nausea/vomiting symptoms were significantly relieved after the program. Most of the functional scales showed improvements, although the changes were not significant. |
The United States of America [48] | Colorectal Cancer | Behavioral health management (PA/) | Pilot data show a nonsignificant decrease in moderate activity accumulated in bouts of at least 10 min in both arms (16–21 min per week). |
Taiwan [49] | Lung Cancer | Behavioral health management (CRF) | The LF to HF ratio is highly correlated with the subjective BFI, particularly when measured during sleep time. Analytical results revealed that this ratio can be used to evaluate cancer fatigue because of a 3% mapping error in the BFI |
The United States of America [50] | Lung Cancer | Behavioral health management (Steps/Day and MVPA/Sedentary Behavior/Cardiorespiratory Fitness) | Participants who received surgery in the spring, summer, autumn, and winter seasons, respectively, had lower PA and CRF than those who received surgery in other seasons. These results were consistent among all study subgroups. |
The United States of America [51] | Lung Cancer | Behavioral health management (PA-Steps/QoL/ Symptoms/Functional Status/Dyspepsia) | Improved PA was associated with the early discharge of patients with GC undergoing gastrectomy. This was because patients with improved PA had resumed physical function, which was the main factor evaluated if patients were qualified to be discharged. |
South Korea [52] | Lung Cancer | Behavioral health management (MVPA/Aerobic Capacity) | Eight (47%) of the seventeen participants demonstrated a clinically significant improvement of 14 m or more. The average improvement in aerobic capacity (13.8 m) was close to the minimum threshold for a clinically meaningful improvement of 14 m |
The United States of America [53] | Gastric cancer | Behavioral health management (PA and Symptom Burden) | This study’s results indicate significant correlations between the number of the step count and two common performance statuses, which is consistent with previous research findings. Questionnaire findings indicated that active patients have a lower burden of symptoms. |
Taiwan [54] | Gastric Cancer | Behavioral health management (PA/Sleep Metrics) | Results provide evidence for both the feasibility and relevance of the combined objective and subjective remote monitoring of sleep and other symptoms in patients with cancer with single-night precision. This dynamic approach can guide the development of novel therapeutic concepts whose testing is warranted in patients with cancer |
South Korea [55] | Liver Cancer | Behavioral health management (Exercise Capacity/PA/QoL/Body Composition and Biochemical) | Compared with baseline, significant improvements were found in physical fitness measures, body composition, self-reported amount of physical activity, and pain. All symptoms improved, as observed in the QoL scales (i.e., EORTC-QLQ C30). |
The United States of America [56] | Blood Cancer | Behavioral health management (PA/Sleep) | This study demonstrates the feasibility of collecting sleep data through actigraphy among hospitalized adults. Actigraphy measures suggested poor sleep. |
Japan [57] | Urothelial Carcinoma | Behavioral health management (PA/QoL/ Adverse Events) | Significant correlations were noted between measurements performed using an oscillometer and a Fitbit during chemotherapy for patients. The measurement of fatigue using Fitbit was effective |
The United States of America [58] | Skin Cancer | Preventive care | No differences in baseline knowledge or attitudes regarding sun exposure or protection were noted between the two groups. |
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Huang, Y.; Upadhyay, U.; Dhar, E.; Kuo, L.-J.; Syed-Abdul, S. A Scoping Review to Assess Adherence to and Clinical Outcomes of Wearable Devices in the Cancer Population. Cancers 2022, 14, 4437. https://doi.org/10.3390/cancers14184437
Huang Y, Upadhyay U, Dhar E, Kuo L-J, Syed-Abdul S. A Scoping Review to Assess Adherence to and Clinical Outcomes of Wearable Devices in the Cancer Population. Cancers. 2022; 14(18):4437. https://doi.org/10.3390/cancers14184437
Chicago/Turabian StyleHuang, Yaoru, Umashankar Upadhyay, Eshita Dhar, Li-Jen Kuo, and Shabbir Syed-Abdul. 2022. "A Scoping Review to Assess Adherence to and Clinical Outcomes of Wearable Devices in the Cancer Population" Cancers 14, no. 18: 4437. https://doi.org/10.3390/cancers14184437