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Derivation and External Validation of Objective Performance Status Among Patients With Metastatic Cancer.
Eva Ruiz1, Christopher R Manz2, Anthony Girard3
1Medical Oncology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
JCO Oncology Practice
|July 25, 2025
Summary
Objective performance status (OPS) using wearable accelerometers accurately predicts survival in metastatic cancer patients. This novel approach offers a reliable alternative to traditional performance status assessments in clinical trials.
Area of Science:
- Oncology
- Biomedical Engineering
- Clinical Trials
Background:
- Traditional performance status (PS) assessment in cancer patients can be subjective and inaccurate.
- Objective assessment of physical activity via wearable accelerometers may serve as a reliable proxy for PS.
Purpose of the Study:
- To derive and externally validate an objective performance status (OPS) using daily physical activity data from wearable accelerometers.
- To assess the association between objective performance status and overall survival in patients with metastatic cancer.
Main Methods:
- Prospective measurement of daily physical activity using accelerometers in two cohorts of metastatic cancer patients.
- Derivation of an OPS cutoff based on mean daily distance walked, using survival analysis and Youden's index.
- External validation of OPS using a multivariable Cox model to assess 180-day mortality.
Main Results:
- An OPS cutoff was defined at 1,200 meters walked per day.
- Poor OPS was significantly associated with higher 180-day mortality in both derivation (81.6% vs 38.4%) and validation (36% vs 8%) cohorts.
- Adjusted hazard ratios for poor OPS were 6.82 (P < .001) and 7.07 (P = .02) in derivation and validation cohorts, respectively.
Conclusions:
- Objective performance status (OPS) derived from physical activity is an independent and externally validated prognostic indicator.
- OPS can serve as an objective surrogate for traditional PS assessment in cancer clinical trials.
- OPS may aid in treatment decisions for patients with metastatic cancer.
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