Those Set to Receive autoHSCT for Hematologic Malignancies Appear to Have Poor Mobility

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

Patients who are set to undergo autologous hematopoietic stem cell transplant following induction chemotherapy may have poor mobility across several domains vs an age-matched control group.

Wearable inertial sensors identified significantly worse mobility potentially related to nausea and pain in patients with hematologic malignancies scheduled to undergo autologous hematopoietic stem cell transplant (autoHSCT) following induction chemotherapy compared with an age-matched control group, according to findings from a cross-sectional study published in JMIR Cancer.

In a 6-minute walk test, turn duration was 0.28 (standard deviation (SD), 0.54) seconds longer for patients set to undergo transplantation compared with the control arm. The group was also found to have a significantly slower gait speed (mean, –0.32; SD, 0.25 seconds), longer stride time (mean, 0.13; SD 0.13 seconds), higher stride time variability (mean, 1.07%; SD, 1.42%), and a longer double support time (mean, 5.91%; SD, 4.23%).

A significantly shorter stride length (mean, –0.18; SD, 0.19) and distance traveled (mean, –60.01; SD, 93.49) were also reported (P <.001). Additionally, patients in the transplant group demonstrated a significantly larger coronal sway (mean, 0.02; SD, 0.03 m/s2; P <.001), longer coronal range (mean, 0.10; SD 0.16 m/s2; P <.001), and higher coronal velocity (mean, 0.03; SD, 0.10 m/s; P = .02) during standing balance compared with those in the control group.

According to the study authors, the use of wearable inertial sensors to assess patient mobility in the clinic before further treatment could potentially benefit patient rehabilitation or symptom management.

“Detecting dynamic and potentially reversible gait changes during pretransplant appointments may minimize future health care use by directing resources to patients at high risk of treatment-associated disability or falls,” the authors stated.

Investigators of this cross-sectional study assessed the mobility of patients scheduled to receive autoHSCT following induction chemotherapy compared with that of healthy, age-matched adults to determine the impact of chemotherapy-related symptoms on mobility. The study included a total of 78 patients scheduled to receive autoHSCT and 78 healthy adults in the control group.

All patients and healthy adults included in the study completed prescribed performance tests wearing inertial sensors that quantified mobility across several domains including turning, gait, and balance. Additionally, investigators collected data from validated patient-reported questionnaires to determine chemotherapy-related symptoms including chemotherapy-induced peripheral neuropathy, nausea and pain, fatigue, vertigo, and depression.

Patients 21 years and older who were scheduled to receive autoHSCT for a hematopoietic or lymphatic malignancy were eligible for enrollment on the study. Additional inclusion criteria included having no cognitive difficulties precluding the completion of surveys; ability to participate in performance testing; providing informed consent; and having no preexisting medical conditions significantly affecting mobility including severe dystrophy, severe spasticity, and epilepsy.

The average patient age before transplant was 60.3 years (SD, 10.3; range, 31-76), and the average age in the control group was 60.2 years (SD, 10.4). The most common cancer diagnosis was multiple myeloma (68%; n = 53/78). All patients received induction chemotherapy with an average regimen lasting 4.7 months (SD, 3.2).

The majority of patients had stage II (27%) or stage III (27%) disease. Additionally, the average time since diagnosis was 9.9 months (SD, 11). A total of 18% of patients had received radiation therapy, and 17% had a fall within a year before enrollment.

Of 78 patients with mobility data, 88% completed patient-reported chemotherapy-related symptom questionnaires. The mean sample score for chemotherapy-induced peripheral neuropathy was 13.01 (SD, 3.63) out of a maximum of 16. The mean sample scores for nausea, pain, and fatigue, which each had a potential maximum score of 100, were 11.35 (SD, 18.63), 27.05 (SD, 29.02), and 53.00 (SD, 7.84), respectively. The mean sample scores for vertigo and depression, which each had a potential maximum score of 60, were 4.81 (SD, 5.74) and 9.19 (SD, 7.81), respectively.

High nausea had an association with great stride time variability (ß = .023; 95% CI, −0.007 to 0.039) and shallow heel strike angle (ß= −.088; 95% CI, −0.160 to −0.017). Additionally, investigators reported a link between high pain and slow gait speed (ß = −.003; 95% CI, −0.004 to –0.001), short stride length (ß= −.002; 95% CI, −0.003 to −0.001), short distance (ß = –0.786; 95% CI, ­–1.321 to –0.252), and great stride time variability (ß = 0.012; 95% CI, –0.002 to –0.023) for patients.

Reference

Skiba MB, Harker G, Guidarelli C, et al. Using wearable inertial sensors to assess mobility of patients with hematologic cancer and associations with chemotherapy-related symptoms before autologous hematopoietic stem cell transplant: cross-sectional study. JMIR Cancer. 2022;8(4):e39271. doi:10.2196/39271