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First Approach to Automatic Performance Status Evaluation and Physical Activity Recognition in Cancer Patients

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The evaluation of cancer patients’ recovery is still under the big subjectivity of physicians. Many different systems have been successfully implemented for physical activity evaluation, nonetheless there is still a big leap into Performance Status evaluation with ECOG and Karnofsky’s Performance Status scores. An automatic system for data recovering based on Android smartphone and wearables has been developed. A gamification implementation has been designed for increasing patients’ motivation in their recovery. Furthermore, novel and without-precedent algorithms for Performance Status (PS) and Physical Activity (PA) assessment have been developed to help oncologists in their diagnoses.

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First Approach to Automatic Performance Status Evaluation and Physical Activity Recognition in Cancer Patients

  1. 1. First Approach to Automatic Performance Status Evaluation and Physical Activity Recognition in Cancer Patients Salvador Moreno · Miguel Damas · Hector Pomares Jose A.Moral-Munoz · Oresti Banos Email: smoreno94@correo.ugr.es SUT4Coaching 2016 – Granada, Spain
  2. 2. Index of Contents 1. Motivation 2. State of the Art 3. System Design 4. System Implementation 5. Conclusions Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain. 2
  3. 3. 1. Motivation ● 14 million new cases and 8 million cancer-related deaths in 2012 ● Is projected to increase by 70% in two decades. ● The estimated total annual economic cost of cancer was approximately US$ 1.16 trillion in 2010 ● Between US$ 100 billion and US$ 200 billion could have been saved in 2010 3 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain. [1] World Health Organization, World Cancer Report 2014. Lyon, FRA: International Agency for Research on Cancer, 2014
  4. 4. 1. Motivation ● Cancer treatment relies in several aspects under the subjectivity of the oncologist. – Interviews – Family's Feedback ● Patients are sometimes hard to treat. ● Hard to remember by heart and measure the activity realized. 4 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  5. 5. 1. Motivation Solution Proposed: Automatic Tracking of the Patient's Physical Activity 5 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  6. 6. 2. State of the Art 6 Patient's Condition Performance Status Physical Condition ECOG KPS IPAQ Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  7. 7. 2. State of the Art KPS (Karnofsky's Performance Status) – 1949 Normal, no complaints. No evidence of disease. 100 Able to carry on normal activity. Minor signs of disease. 90 Normal activity with effort. Some signs or symptoms of disease. 80 Cares for self; unable to carry on normal activity or do active work. 70 Ocassional assistance. Able to care for most of personal needs. 60 Considerable assistance. Frequent medical care. 50 Disabled. Requires special care and assistance. 40 Severely disabled. Hospital admission indicated. Death not imminent. 30 Very sick. Hospital admission necesary. 20 Moribund. 10 Exitus. 0 7 [3] Karnofsky DA Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. Evaluation of chemotherapeutic agents., pages 191–205, 1949. New York Columbia. University Press. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  8. 8. 2. State of the Art 8 ECOG (Eastern Cooperative Oncology Gropp) – 1960 Asymptomatic. Normal, no complains. 0 Symptomatic but completely ambulatory. Able to carry work of light or sedentary nature like housework or office work. 1 Symptomatic and able of all self care but unable to carry out work activities. Less than 50% of waking hours in bed or chair. 2 Symptomatic and capable of only limited self-care. Confined to bed or chair 50% or more of waking hours. 3 Bedbound. Completely disabled. Cannot carry any self-care. 4 Exitus 5 [15] C.G Zubrod et al. Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. Journal of Chronic Diseases, 11(1):7–33, 1960. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  9. 9. 2. State of the Art 9 IPAQ: International Physical Activity Questionnaire – IPAQ 3: High Physical Activity – IPAQ 2: Moderate Physical Activity – IPAQ 1: Low Physical Activity Physical activity measured in MET·min [22] IPAQ scoring protocol - International Physical Activity Questionnaire. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  10. 10. 2. State of the Art ● IPAQ ● Category 1: Low – This is the lowest level of physical activity. Those individuals who not meet criteria for categories 2 or 3 are considered low/inactive. ● Category 2: Moderate – 3 or more days of vigorous activity of at least 20 minutes per day OR – 5 or more days of moderate-intensity activity or walking of at least 30 minutes per day OR – 5 or more days of any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 600 MET-min/week. ● Category 3: High – Vigorous-intensity activity on at least 3 days and accumulating at least 1500 MET-minutes/week OR – 7 or more days of any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 3000 MET-minutes/week Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 [22] IPAQ scoring protocol - International Physical Activity Questionnaire. SUT4Coaching – Granada, Spain. 10
  11. 11. 2. State of the Art 11 Physical Activity Measurement Heart Rate Intensity (Karvonen) Daily Step Count (Tudor-Locke) Class Steps/day Sedentary <5000 Low Act. 5000 – 7499 Medium Act. 7500 – 9999 High Act. 10000 – 12499 Very High Act. >12500 [35] Dr Juha Karvonen and Timo Vuorimaa. Heart Rate and Exercise Intensity During Sports Activities. Sports Medicine, 5(5):303–311, November 2012. [39] Catrine Tudor-Locke and David R. Bassett Jr. How many steps/day are enough? Sports medicine, 34(1):1– 8, 2004. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  12. 12. 3. System Design Objectives: ● Automatic tracking of the activity performed. ● Develop algorithm for IPAQ estimation ● Develop algorithm for ECOG and KPS estimation. ● Focus on tendencies rather than the absolute measures. 12 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  13. 13. 3. System Design 13 Google FIT: – Sensors API – Recording API – History API – Sessions API – BLE (Bluetooth Low Energy) API – Config API Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain. Data Recorded – Activity Recognition ● Still, walking, running... ● Sleep tracking – Calories Expended (cal) – Heart Rate (BPM) – Step Count (count)
  14. 14. 3. System Design 14 Wearable selected: Sony Smartband 2 SWR12 Cost <100€ Measures: – Heart Rate (HR) – Step Count – Activity Recognition – Calories Expended Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  15. 15. 3. System Design 15 ● Gamification [31] Kevin Werbach and Dan Hunter. For the Win: How Game Thinking Can Revolutionize Your Business. Wharton Digital Press, October 2012. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  16. 16. 3. System Design 16 Gamification Design: – Interactive interface for the patient. – Highlight achievements done in the recovery. – Engagement and progression loops. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  17. 17. 17 Trabajo de Fin de Grado Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016
  18. 18. 3. System Design 18 Planteamiento del sistema. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  19. 19. 4. System Implementation 19 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  20. 20. 4. System Implementation 20 IPAQ Estimation* 1. SQLite query 2. Sampling Frequency adaptation between data. 3. Daily detection and data bucketting. 4. IPAQ rules application. 5. Weekly approach of the estimation. – *Intensity of the Activity Detected by using Heart Rate and Calories Count. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  21. 21. 4. System Implementation 21 IPAQ Algorithm Validation ● Comparison between IPAQ MET estimation and Google Fit's Calorie Count converted to MET ● Pearson Correlation – 0.8505 with all data – 0.9665 without outliers Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  22. 22. 4. System Implementation ECOG and KPS estimation* 1. SQLite Query 2. Sampling Frequency adaptation between data. 3. Daily detection and data bucketting. 4. ECOG and KPS Table Rules application. 5. Weekly approach of the estimation. – *Activity detected, Intensity of the Act. Detected, Steps Count, Proportion of Active Waking Hours. 22 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  23. 23. Daily proportion of active Waking Hours 23 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain. 4. System Implementation
  24. 24. 4. Implementación del sistema Automatic Performance Status Evaluation. S. Moreno Gutiérrez 24.
  25. 25. 4. System Implementation Week 1 Week 2 IHR ECOG KPS ECOG KPS > 0 % 1 90 2 70 > 1 % 2 70 2 70 > 2 % 2 70 2 70 > 3 % 2 70 2 70 > 4 % 2 70 2 70 > 5 % 2 70 2 70 Preliminary Test Results: 25 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  26. 26. 5. Conclusions ● Extensive review of the State of the Art. ● Needs assessment performed with the help of Oncologists and psychologists from the Hostpital Virgen de las Nieves in Granada. ● Android, SQLite and MATLAB have been used for the system implementation. ● It is the first approach to automatic performance status evaluation in cancer patients. 26 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  27. 27. First Approach to Automatic Performance Status Evaluation and Physical Activity Recognition in Cancer Patients Salvador Moreno · Miguel Damas · Hector Pomares Jose A.Moral-Munoz · Oresti Banos Email: smoreno94@correo.ugr.es SUT4Coaching 2016 – Granada, Spain
  28. 28. 3. System Design ● Wearable market grows 171.6% between 2014 y 2015 and smartphones keep their sales (Source: IDC) 28 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  29. 29. 4. System Implementation Physical Activity time detected 29 Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  30. 30. 4. System Implementation 30 ● Execution time of a nineteen-days-query. Execution Time: ET = (3,4 ± 0,4) s Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016 SUT4Coaching – Granada, Spain.
  31. 31. 2. State of the Art 31 ● Gamification: SUT4Coaching – Granada, Spain. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016
  32. 32. 2. State of the Art 32 Automatic Performance Status Evaluation. S. Moreno Gutiérrez ● IoT & mHealth SUT4Coaching – Granada, Spain. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016
  33. 33. 4. System Implementation 33 SUT4Coaching – Granada, Spain. Automatic Performance Status Evaluation. S. Moreno Gutiérrez 15th December 2016
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