OS10.5.A BrainWear: Longitudinal, objective assessment of physical activity in 42 HGG patients

Abstract

BACKGROUND In patients with High Grade Glioma (HGG), QoL and physical function decline with progressive disease (PD). Objective assessment of physical functioning is challenging as patients spend most of their time away from the hospital. Wearable technology allows measurement of objective, continuous activity data in a non-obtrusive manner. BrainWear is a phase II feasibility study, collecting longitudinal physical activity (PA) data from patients with primary and secondary brain tumours. MATERIAL AND METHODS All agreed to wear an Axivity AX3 triaxial accelerometer and completed the EORTC QLQ C30 and BN20, the Montreal Cognitive Assessment (MoCA) and Multidimensional fatigue inventory (MFI) questionnaires. Accelerometers were changed at 14-day intervals, and PRO questionnaires completed at pre-specified study intervals. Age-sex matched controls were identified from the UK Biobank 7-day accelerometer study. Raw accelerometer data was processed using UK Biobank accelerometer software and inclusion of high-quality wear time selected as ≥72 hours of data in a 7-day data collection and data in each 1-hour period of a 24-hour cycle over multiple days. We analysed variation in activity by patient demographics and treatment days. The wilcoxin-signed rank test was used to compare participant activity between radiotherapy treatment days and non-treatment days, mixed effects models were used to evaluate longitudinal changes in activity and we used k-means clustering to characterise clusters of PA behaviours. RESULTS We have collected 3458 days of accelerometer data from 42 HGG patients with a median age of 59, 80% of which has been classified as high quality. Patients >60 years spend more time doing moderate activity compared to those <60 years (52 vs 33 minutes/day, p=0.012), and there are significant differences in mean vector magnitude (17.12 vs 16.85 mg, p=0.013) and walking (91 vs 72 minutes/day) between radiotherapy and non-radiotherapy days. In patients having a 6-week RT course, time spent in daily moderate activity falls 4-fold between week 1 and the second week after RT completion (70 minutes to 16 minutes/day). Comparing HGG patients to healthy controls shows a significant difference in time spent across all activities (p<0.05). K-means clustering analysis shows three distinct clusters, with 87% of HGG patients falling into the very inactive or moderately active groups. CONCLUSION Digital remote health monitoring is feasible and acceptable with 80% of data classified as high-quality wear-time suggesting good patient adherence. Triaxial accelerometer data collection captures objective evidence of a significant reduction in moderate daily activity at the time of expected peak RT side-effects and patients walk almost 30% less on non-RT treatment days. HGG patients show significantly lower levels of activity compared to matched healthy controls.