Accelerometry reflects QoL in malignant pleural effusion

Accelerometry appears to be an accurate measure of quality of life (QoL) in patients with malignant pleural effusion (MPE), as shown in a study. It is also a useful tool for examining subtle differences in patients following various treatment regimens, particularly drainage protocols in MPE.

In this multicentre clinical trial, the researchers randomized MPE patients treated with an indwelling pleural catheter to daily (DD) or symptom-guided draining (SGD) for 60 days. After randomization, participants completed an accelerometry assessment, which was repeated monthly for 5 months.

The researchers calculated activity behaviour outcomes as percent of daily waking-wear time and compared these between groups. They also examined the associations between activity behaviour outcomes and QoL.

Of the patients with MPE, 41 (91 percent) had at least one valid accelerometry assessment (DD: n=20; SGD: n=21). Participants were sedentary most of their waking hours (72 percent to 74 percent across timepoints) and spent very little time doing moderate-to-vigorous physical activities (<1 percent across timepoints). [Respirology 2023;28:561-570]

Patients in the DD group had a more favourable sedentary-to-light ratio than those in the SGD group in the week after randomization (2.4 vs 3.2; p=0.047) and at 60 days (2.0 vs 2.9; p=0.016). Notably, sedentary-to-light ratio was associated with several QoL domains at multiple timepoints.

“Patients with MPE are largely sedentary,” the researchers said. “Preliminary results suggest that even modest differences in activity behaviours favouring the DD group could be meaningful for this clinical population.”

Additionally, accelerometry outcomes in MPE correlated with important QoL aspects. Previous studies have reported the association between device-assessed physical activity and QoL in cancer patients. [Cancer Caus Cont 2016;27:1093-1103; J Pain Symptom Manage 2014;48:322-332]

“Similar to findings in lung cancer, we found sedentary and light activity time were associated with multiple domains of QoL, particularly mobility, over 120 days,” the researchers said. “Light activity participation has been previously identified as an important predictor of mobility disability. [Palliat Support Care 2019;17:574-578; Lung Cancer 2018;119:78-84; JAMA Netw Open 2021;4:e210005]

These findings suggested that interventions allowing for more light activity had a positive effect on QoL in patients with MPE, according to the researchers.

Accelerometry measures

Furthermore, identifying suitable outcome measures that are patient-oriented and clinically relevant remains a challenge in MPE research.

“Accelerometry reflected QoL and could be a useful tool to provide additional information about how treatment regimens impact daily living of patients,” the researchers said. “Measuring activity behaviours in intensities and metrics such as sedentary-to-light ratio, prolonged bouts of sedentary time, or short bouts of light activity could be particularly relevant for this population.”

The current study demonstrated the feasibility and value of repeated accelerometry measures in this palliative population. Notably, the median survival for patients with MPE was 9 to 12 months.

“Attrition due to patient decline and death, as we saw here, is well documented in supportive care intervention studies in palliative populations,” the researchers noted. [Cancer 2013;119:1098-1105]

“Further work is necessary to improve feasibility by optimizing wear time and continuing to test the utility of accelerometry as an outcome measure in MPE populations,” they said.