Objective Measure for Physical Symptoms in Terminal Phase: Activity Scores from Nonwearable Devices

Abstract

Background:

Continuous monitoring of patients with terminal cancer using nonwearable devices may offer advantages.

Objectives:

This study aimed to determine the association between nighttime activity scores, measured using Nemuri SCAN (NSCAN), and physical symptom intensity, measured using the Integrated Palliative Care Outcome Scale staff version items, in the final days of life.

Design:

Prospective observational study.

Setting/Subjects:

This study included 1111 patients with advanced cancer admitted to a 27-bed palliative care unit in Japan.

Measurements:

Nighttime activity scores measured using NSCAN and symptom intensity (pain, nausea, fatigue, shortness of breath, and the most severe of these) were recorded. The associations between symptom intensity and activity scores in the final days of life (one to three days) were analyzed using the Jonckheere–Terpstra test. The associations in the final weeks of life (14, 21, and 28 days before death) were also examined.

Results:

Activity scores increased with worsening of the most severe symptom over the final days and weeks of life (p < 0.001). They were significantly associated with the intensity of pain, nausea, fatigue, and shortness of breath one day before death (p < 0.005). Three days and in the final weeks before death, activity scores were significantly associated with the intensity of all symptoms, except for shortness of breath (p < 0.05).

Conclusion:

The association between symptom intensity and activity scores suggests that NSCAN activity scores could serve as a potential supplementary assessment tool to flag increases in symptom-related distress, prompting further clinical assessment in the final days of life.