1
|
Thanarajasingam G, Kluetz P, Bhatnagar V, Brown A, Cathcart-Rake E, Diamond M, Faust L, Fiero MH, Huntington S, Jeffery MM, Jones L, Noble B, Paludo J, Powers B, Ross JS, Ritchie JD, Ruddy K, Schellhorn S, Tarver M, Dueck AC, Gross C. Integrating 4 methods to evaluate physical function in patients with cancer (In4M): protocol for a prospective cohort study. BMJ Open 2024; 14:e074030. [PMID: 38199641 PMCID: PMC10806877 DOI: 10.1136/bmjopen-2023-074030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Accurate, patient-centred evaluation of physical function in patients with cancer can provide important information on the functional impacts experienced by patients both from the disease and its treatment. Increasingly, digital health technology is facilitating and providing new ways to measure symptoms and function. There is a need to characterise the longitudinal measurement characteristics of physical function assessments, including clinician-reported outcome, patient-reported ported outcome (PRO), performance outcome tests and wearable data, to inform regulatory and clinical decision-making in cancer clinical trials and oncology practice. METHODS AND ANALYSIS In this prospective study, we are enrolling 200 English-speaking and/or Spanish-speaking patients with breast cancer or lymphoma seen at Mayo Clinic or Yale University who will receive intravenous cytotoxic chemotherapy. Physical function assessments will be obtained longitudinally using multiple assessment modalities. Participants will be followed for 9 months using a patient-centred health data aggregating platform that consolidates study questionnaires, electronic health record data, and activity and sleep data from a wearable sensor. Data analysis will focus on understanding variability, sensitivity and meaningful changes across the included physical function assessments and evaluating their relationship to key clinical outcomes. Additionally, the feasibility of multimodal physical function data collection in real-world patients with breast cancer or lymphoma will be assessed, as will patient impressions of the usability and acceptability of the wearable sensor, data aggregation platform and PROs. ETHICS AND DISSEMINATION This study has received approval from IRBs at Mayo Clinic, Yale University and the US Food and Drug Administration. Results will be made available to participants, funders, the research community and the public. TRIAL REGISTRATION NUMBER NCT05214144; Pre-results.
Collapse
Affiliation(s)
| | - Paul Kluetz
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Abbie Brown
- Health Education and Content Services, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew Diamond
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Louis Faust
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Scott Huntington
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale's Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Molly Moore Jeffery
- Division of Health Care Delivery Research and Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lee Jones
- Patient Advocate, Arlington, Virginia, USA
| | - Brie Noble
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brad Powers
- CancerHacker Lab, Boston, Massachusetts, USA
| | - Joseph S Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jessica D Ritchie
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathryn Ruddy
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah Schellhorn
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale's Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michelle Tarver
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Amylou C Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Cary Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale's Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
2
|
Thanarajasingam G, Kluetz PG, Bhatnagar V, Brown A, Cathcart-Rake E, Diamond M, Faust L, Fiero MH, Huntington SF, Jeffery MM, Jones L, Noble BN, Paludo J, Powers B, Ross JS, Ritchie JD, Ruddy KJ, Schellhorn SE, Tarver ME, Dueck AC, Gross CP. Integrating 4 Measures to Evaluate Physical Function in Patients with Cancer (In4M): Protocol for a prospective study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.08.23286924. [PMID: 36945495 PMCID: PMC10029056 DOI: 10.1101/2023.03.08.23286924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Introduction Accurate, patient-centered evaluation of physical function in patients with cancer can provide important information on the functional impacts experienced by patients both from the disease and its treatment. Increasingly, digital health technology is facilitating and providing new ways to measure symptoms and function. There is a need to characterize the longitudinal measurement characteristics of physical function assessments, including clinician-reported physical function (ClinRo), patient-reported physical function (PRO), performance outcome tests (PerfO) and wearable data, to inform regulatory and clinical decision-making in cancer clinical trials and oncology practice. Methods and analysis In this prospective study, we are enrolling 200 English- and/or Spanish-speaking patients with breast cancer or lymphoma seen at Mayo Clinic or Yale University who will receive standard of care intravenous cytotoxic chemotherapy. Physical function assessments will be obtained longitudinally using multiple assessment modalities. Participants will be followed for 9 months using a patient-centered health data aggregating platform that consolidates study questionnaires, electronic health record data, and activity and sleep data from a wearable sensor. Data analysis will focus on understanding variability, sensitivity, and meaningful changes across the included physical function assessments and evaluating their relationship to key clinical outcomes. Additionally, the feasibility of multi-modal physical function data collection in real-world patients with cancer will be assessed, as will patient impressions of the usability and acceptability of the wearable sensor, data aggregation platform, and PROs. Ethics and dissemination This study has received approval from IRBs at Mayo Clinic, Yale University, and the U.S. Food & Drug Administration. Results will be made available to participants, funders, the research community, and the public. Registration Details The trial registration number for this study is NCT05214144. Strengths & Limitations This study addresses an important unmet need by characterizing the performance characteristics of multiple patient-centered physical function measures in patients with cancerPhysical function is an important and undermeasured clinical outcome. Scientifically rigorous capture and measurement of physical function constitutes a key component of cancer treatment tolerability assessment both from a regulatory and clinical perspective.This study will include patients with lymphoma or breast cancer receiving a broad range of cytotoxic chemotherapy regimens. While recruitment will occur at two academic sites, patients who ultimately receive treatment at local community sites will be included.A patient-centered health data aggregating platform facilitates the delivery of patient-reported outcome measures and collection of wearable data to researchers, while reducing patient burden compared to traditional patient-generated data collection and aggregation methodsHeterogeneity in patient willingness or comfort engaging with mobile products including smartphones and wearables, enrollment primarily at large academic centers, and the modest sample size are potential limitations to the external validity of the study.
Collapse
Affiliation(s)
| | - Paul G. Kluetz
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Abbie Brown
- Health Education and Content Services, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew Diamond
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Louis Faust
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Scott F. Huntington
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale’s Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Molly Moore Jeffery
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lee Jones
- Patient advocate, Arlington, Virginia, USA
| | - Brie N. Noble
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brad Powers
- CancerHacker Lab, Boston, Massachusetts, USA
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jessica D. Ritchie
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA
| | - Kathryn J. Ruddy
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah E. Schellhorn
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale’s Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Cary P. Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale’s Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|