Changes in Physical Activity Across Cancer Diagnosis and Treatment Based on Smartphone Step Count Data Linked to a Japanese Claims Database: Retrospective Cohort Study

Abstract

Background: Although physical activity (PA) is recommended for patients with cancer, changes in PA across cancer diagnosis and treatment have not been objectively evaluated.

Objective: This study aimed to assess the impact of cancer diagnosis and treatment on PA levels.

Methods: This was a retrospective cohort study using a Japanese claims database provided by DeSC Healthcare Inc, in which daily step count data, derived from smartphone pedometers, are linked to the claims data. In this study, we included patients newly diagnosed with cancer, along with those newly diagnosed with diabetes mellitus for reference. We collected data between April 2014 and September 2021 and analyzed them. The observation period spanned from 6 months before diagnosis to 12 months after diagnosis. We applied a generalized additive mixed model with a cubic spline to describe changes in step counts before and after diagnosis.

Results: We analyzed the step count data of 326 patients with malignant solid tumors and 1388 patients with diabetes. Patients with cancer exhibited a 9.6% (95% CI 7.1%-12.1%; P<.001) reduction in step counts from baseline at the start of the diagnosis month, which further deepened to 12.4% (95% CI 9.5%-15.2%; P<.001) at 3 months and persisted at 7.1% (95% CI 4.2%-10.0%; P<.001) at 12 months, all relative to baseline. Conversely, in patients with diabetes, step counts remained relatively stable after diagnosis, with a slight upward trend, resulting in a change of +0.6% (95% CI -0.6% to 1.9%; P=.31) from baseline at 3 months after diagnosis. At 12 months after diagnosis, step counts remained decreased in the nonendoscopic subdiaphragmatic surgery group, with an 18.0% (95% CI 9.1%-26.2%; P<.001) reduction, whereas step counts returned to baseline in the laparoscopic surgery group (+0.3%, 95% CI -6.3% to 7.5%; P=.93).

Conclusions: The analysis of objective pre- and postdiagnostic step count data provided fundamental information crucial for understanding changes in PA among patients with cancer. While cancer diagnosis and treatment reduced PA, the decline may have already started before diagnosis. The study findings may help tailor exercise recommendations based on lifelog data for patients with cancer in the future.

Keywords: Japanese; cancer; database; exercise; lifelog data; mobile app; mobile phone; physical activity; quality of life; smartphone; step count.

Figure 1

Estimated daily step count changes before and after diagnosis. Daily step count changes in (left) patients diagnosed with cancer and (right) patients diagnosed with diabetes mellitus are described. Shading indicates the SE. Month 0 signifies the month of diagnosis. For patients with cancer, the baseline for step count change was defined as the first day of month −1, accounting for the time needed for pathology after biopsy or diagnostic surgery to confirm diagnosis.

Figure 2

Estimated daily step count changes before and after diagnosis by treatment methods: Other treatments include conventional cytotoxic chemotherapy, immunotherapy, molecular targeted therapy, small interventions with chemotherapy or immunotherapy, and chemoradiotherapy. Shading indicates the SE. NAC: neoadjuvant chemotherapy.