“In surgery, we traditionally rely on outcome measures like readmission rates, 30-day mortality, and disease-free survival, which are all extremely valuable and will always have a place in measuring outcomes. But sometimes those outcomes fail to capture what really matters to a patient,” said lead study author Nikhil Panda, MD, a general surgery resident at Massachusetts General Hospital-Harvard Medical School, and postdoctoral fellow at Ariadne Labs, Boston. “There has been a growing community of patients recovering outside of the monitored setting with very few tools to measure aspects of their life that matter most to them.”
Dr. Panda’s collaborators and co-authors from Ariadne Labs, the Harvard T.H. Chan School of Public Health, and Massachusetts General Hospital developed an app that could capture the accelerometer sensor data from the smartphones of patients undergoing cancer surgery. Patients who enrolled in the study were asked to download the app and were told their activity would be tracked following their operation. The research team did not prescribe any specific level of activity. They told the patients to simply use their phones as they normally would. The research team worked with Harvard for a year to ensure that data in the app is captured, encrypted, and stored securely so that patients could not be reidentified.
Sixty-two patients were followed for a median of 147 days. The researchers noted that there were no significant differences in age, gender, American Society of Anesthesiologists classification, or location of primary cancer in this patient group.
The researchers were primarily interested in activity that is considered exertional, such as walking a city block or climbing a flight of stairs. These factors are also commonly used to subjectively measure a patient’s fitness for surgery. Of the 62 patients in the study, 17 of them experienced a postoperative event, which the research team classified as either a complication, readmission, or reoperation that was not expected based on the type of operation the patient underwent. The average daily activity for all patients before surgery was approximately 100 minutes per week. Patients who experienced a postoperative event had a significantly lower level of daily activity compared with their baseline (for example, 40 minutes less activity per week during the third week after the operation), as well as compared with patients who did not experience a postoperative event.
Although these findings show that capturing postoperative daily activity can describe differences in the trajectory of recovery, Dr. Panda said it’s too early to use these data to tell patients what kind of impact certain postoperative events will have on their physical activity. However, the research team was already able to observe that events they expected might impact a patient’s daily activity did so, and events they didn’t think would impact activity did not. Dr. Panda hopes that as more patients are enrolled in this ongoing study and as more data is collected, understanding the specific relationship between a postoperative event and the activity level of a patient will become clearer.
“Ultimately, we would like to see this research lead to the development of a tool that helps surgeons better counsel patients on the risks of surgery. That way, we will be able to tell them the manifestation of a potential complication on their lives,” Dr. Panda said. “We think this tool will truly help our patients in terms of understanding the impacts of surgery, and aid recovery so they can make decisions that are informed by what matters most to them.”
Dr. Panda said he also sees potential in expanding the use of this app to other areas of medicine. For example, a patient’s smartphone accelerometer data could be used to measure their activity not only after surgery, but also after adjuvant therapy, including chemo-radiation. The data could be used by medical providers to help patients understand the impact of different events on their life and recovery. Additionally, the tool may eventually be able to aid with prehabilitation, providing data on a patient’s fitness for an operation.
“There’s a real opportunity to move things forward on the preoperative side, as well,” Dr. Panda said.
Dr. Panda’s coauthors are Ian Solsky, MD, MPH; Emily J. Huang, PhD; Stuart Lipsitz, ScD; Megan Delisle, MD; Jason C. Pradarelli, MD; James C. Cusack MD, FACS; Michele A. Gadd, MD, FACS; Carrie C. Lubitz, MD, MPH, FACS; John T. Mullen MD, FACS; Motaz Qadan, MD, PhD, FACS; Barbara L. Smith, MD, PhD, FACS; Michelle Specht, MD, FACS; Antonia E. Stephen, MD, FACS; Kenneth K. Tanabe, MD, FACS; Atul A. Gawande, MD, MPH, FACS; JP Onnela, PhD; and Alex B. Haynes, MD, MPH, FACS.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: Using Smartphones to Capture Novel Recovery Metrics After Cancer Surgery. JAMA Surgery. DOI:10.1001/jamasurg.2019.4702. Published online October 28, 2019.
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About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
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