Adopting the "Exercise as a Vital Sign" metric to assess physical activity in GI oncology patients.
Authors: Williams Silva Karly , Shen Hanjie , Rillamas-Sun Eileen , Lin Cindy , Harlow Lexi M. , Siman Jonathan , Veleber Susan , Cobos Sofia , Greenlee Heather , Cohen Stacey 
Published: January 2022

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Background: Regular moderate to vigorous physical activity (MVPA) in patients with gastrointestinal (GI) cancers is associated with improved health outcomes, including greater quality of life and reduced fatigue and comorbidity. PA guidelines for cancer survivors recommend ≥150 minutes of MVPA per week for optimal health. Identifying GI oncology patients with low MVPA is important to tailor interventions aimed at increasing MVPA levels in this population. The “Exercise as a Vital Sign” (EVS) tool is a validated, two question assessment tool to quantify minutes per week (min/wk) of MVPA that was incorporated in the clinical rooming process at an academic GI oncology clinic. Here, we report characteristics of patients by amount of MVPA by EVS. Methods: Patient information was entered in the electronic medical record at a large, academic oncology clinic. Data from the first clinic visit where min/wk of MVPA EVS was collected were extracted and included demographics (e.g. age, sex, marital status, race), health status (body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, comorbidities), cancer characteristics (primary tumor site, localized/metastatic, current treatment), and reason for the clinic visit. MVPA was divided into two groups based on the recommended guidelines: 0-149 min/wk (“low”) and ≥150 min/wk (“high”). Chi-square and t-tests were used to examine statistically significant differences. Results: Among 265 patients abstracted, EVS data were reported from 156 (59%) patients. Mean (standard deviation (SD)) age was 61 (13) years (range: 25-82). The primary cancer site was 35% colorectal, 23% pancreatic, 17% gastroesophageal, 10% neuroendocrine, and 15% other GI cancers. While gastroesophageal cancer patients reported high amounts of MVPA (mean (SD) = 268 (309) min/wk), comparisons with other cancer sites were not statistically different. Of the 156 with EVS data, 84 (54%) had low MVPA (mean (SD): 55 (49) min/wk) and 72 (46%) had high MVPA (mean (SD): 357 (244) min/wk). Demographic and cancer characteristics were similar across the two groups. Patients with high MVPA were more likely to have BMI 18.5-24.9 kg/m2 (56% vs. 31%) and less likely to have BMI ≥25 kg/m2 (40% vs.61%) compared to patients with low MVPA (p = 0.02). Patients with high vs. low MVPA were also more likely to have excellent performance status (ECOG 0; 47% vs. 24%, p < 0.001). Conclusions: In this study, GI oncology patients not meeting PA guidelines for cancer survivors were more likely to be overweight/obese and have worse performance status. The EVS tool was an inexpensive and accessible measure of MVPA that can be used to identify patients with low MVPA for interventions targeted to improve health outcomes. A lack of statistical significance may be due to low power. At the conference, more data will be presented (̃1000 patient visits), including longitudinal data and MVPA by active chemotherapy regimen.