Research suggests that physical activity can decrease hospitalizations for people undergoing cancer treatment. So a team of researchers set out to determine if collecting activity data could help them identify and triage high-risk patients with gastrointestinal cancer who were undergoing concurrent chemoradiation. Their findings were published in JCO Oncology Practice.

As part of their prospective, single-blinded clinical trial, the researchers randomly assigned a series of patients with GI cancer undergoing chemoradiation to an intervention group or an observation group. Both groups were provided with activity monitors (Fitbit Charge 2 HR) to be worn on the wrist. The 18 patients in the observation group also received standard-of-care treatment.

The 22 patients in the intervention group were actively monitored by clinical staff during the entire course of their therapy. A decrease of 20% or more in their daily steps or an increase of 20% or more in their heart rate would trigger a triage visit to provide supportive care, medication changes, or escalation of care, as needed.

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Patients in the intervention group had 3.4 more triage visits than those in the observation group. Twenty-six patients required at least 1 triage visit, with more visits occurring in patients in the intervention group. However, no statistically significant difference was found in emergency department visits or hospitalizations. The primary endpoint, a 20% increase in the number of completed triage visits in the intervention group compared with the usual care group, was met.

Patients in the intervention group were more likely to receive patient education and nonprescription medication management, and sometimes received supportive care such as changes to their prescription medication or intravenous fluid administration. “It is conceivable that these supportive care measures may have prevented severe adverse effects and hospitalizations, considering that the majority of admissions is due to uncontrolled symptoms,” the researchers stated.

They concluded that their findings demonstrate the feasibility of monitoring daily step and heart rate data to trigger and execute triage visits for patients undergoing chemoradiotherapy for gastrointestinal cancer.

The study did have limitations. This was a pilot study with a small sample size, so it wasn’t possible to detect statistically significant decrease in hospitalizations and emergency department visits.

Another factor was the observation group had fewer patients undergoing definitive and postoperative treatment than the intervention group. “Patients undergoing neoadjuvant therapy were less likely to require triage visits, which is concordant because preoperative [radiation therapy] doses are less than definitive doses on average,” they stated. “It is conceivable that this imbalance contributed to patients requiring more support in the intervention arm compared with the observation group.”

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Shah NK, Kim KN, Grewal A, et al. Activity monitoring for toxicity detection and management in patients undergoing chemoradiation for gastrointestinal malignancies. JCO Oncol Pract. Published online February 14, 2022. doi:10.1200/OP.21.00671