2020 & 2022 Grantee: Gillian Gresham, PhD
Cedars-Sinai Medical Center
Research Project: Evaluating Objective Measures of Physical Function in Pancreatic Cancer
Award: 2020 Pancreatic Cancer Action Network Career Development Award in memory of Skip Viragh
Award Period: July 1, 2020 – June 30, 2022
Award Extension: 2022 Pancreatic Cancer Action Network Career Development Award Extension funded by the George & June Block Family Foundation
Award Period: July 1, 2022 – June 30, 2023
Dr. Gresham is an assistant professor of hematology/oncology in the Department of Medicine at Cedars-Sinai Medical Center. After obtaining a PhD in epidemiology at Johns Hopkins University, Dr. Gresham pursued a postdoctoral fellowship in oncology trials and joined the Pancreatic Cancer Research Team at Cedars-Sinai Cancer.
Her research interests lie at the intersection of cancer outcomes research, emerging technologies in healthcare and patient-reported outcomes. Dr. Gresham has dedicated the majority of her academic career to understanding and improving treatment tolerability, quality of life and survival outcomes in pancreatic cancer patients.
Physical function is a key measure of cancer treatment tolerability, and a decrease in physical function is known to be associated with diminished quality of life and higher risk for death. There are currently no validated methods to systematically evaluate and monitor physical function decline in pancreatic cancer outside of the clinic setting.
Patients diagnosed with advanced pancreatic cancer are in particular need for physical function assessment because of the significant physiological and psychological effects associated with the disease and its treatment. Although objective measures of physical function such as hand grip strength and gait (walking) speed are known predictors of morbidity and mortality (how a patient feels and how long they live), their assessment is limited to clinic settings, and they are not always feasible to obtain. Furthermore, measurements taken in the clinic do not capture the dynamic changes in physical function that patients can experience over the course of their treatment experience.
Thus, there is a critical need for access to real-time objective measures of physical function to inform treatment decisions and provide timely delivery of supportive care. Recent advances in wearable technology present a fresh opportunity to address this need. Wearable activity monitors allow for the measurement of continuous biometric data, including physical activity (e.g., steps, stairs, distance), sleep and heart rate. To date, their role as tools to predict functional outcomes in cancer patients is relatively unexplored. Dr. Gresham and her team will build upon their previous work, which established feasibility of the use of wearable activity monitors in advanced cancer patients, to conduct a six-month study focused on patients with advanced pancreatic cancer.
Dr. Gresham’s proposed study will examine associations between novel measures of physical function, remotely assessed with the Fitbit Charge HR, and current objective measures including gait speed and hand grip strength as assessed in the clinic. The investigators will also explore the prospective (forward-looking) relationship between remotely assessed biometric data and patient-reported physical function decline. They plan to develop a model that combines remotely assessed biometric data with patient characteristics to predict survival outcomes, including toxicity, hospitalization and death.
Findings from this research can lead to the use of novel technology for the early detection of physical function decline and lead to the development of individualized care plans that will ultimately improve functional independence and quality of life in pancreatic cancer patients.
Project Overview: 2022 Extension
Because advanced pancreatic cancer and its treatment are associated with significant physiological effects, patients with this disease may benefit from wearable activity monitors that measure physical well-being. This type of technology presents an opportunity for researchers to monitor real-time, objective measures of patients’ physical function, which in turn could inform treatment decisions and allow for the delivery of timely supportive care.
Through her 2020 PanCAN Career Development Award, funded in memory of Skip Viragh, Dr. Gresham and her team worked to develop a model that combines remotely accessed biometric data with patient characteristics to predict survival outcomes, including toxicity, hospitalization, and death.
Dr. Gresham has been awarded a one-year extension of her project to allow time for the completion of follow-up assessments for patients recruited in 2022, and to enable the team to pursue new exploratory aims to inform future research endeavors. The team will also use this additional time to collect, manage and analyze data generated from the study.
In addition to their original research objectives, the Gresham lab will investigate three new exploratory aims:
- Measure associations between objective measures of physical function (physical activity and sleep via wearable activity monitor, hand grip strength, gait speed), patient-reported functional outcomes and inflammatory markers measured from patients’ blood samples.
- Evaluate relationships between activity metrics, patient-reported outcomes and body composition, including lean body mass, estimated from CT scans. Cachexia (loss of body weight and muscle mass) is common among patients with advanced pancreatic cancer and is associated with poor outcomes and survival. Understanding how cachexia impacts patient daily activity, patient-reported outcomes, clinical outcomes, and identifying characteristics associated with body composition could help inform the development of tailored interventions. The Gresham lab is currently working with a surgical oncology fellow with expertise in this area who can assist with the calculation of lean body mass and validate it against DEXA – a special type of X-ray that measures bone density – in patients who undergo both CT scans and DEXA scans. Through this innovative approach, the team will examine the role these two technologies might play in the remote assessment of patient function.
- Assess the feasibility and acceptability of a mobile health application to collect patient-reported outcomes from pancreatic cancer patients. RePROsent is a mobile health app that tracks a cancer patient’s daily symptoms and uses these data to produce reports for their oncologist. With the help of a RePROsent oncology nurse, a symptom rubric is developed for each patient and provided to their care team to help patients navigate routine visits; communicate with their care team; and improve their treatment planning and health outcomes.
The additional funding dedicated to this project will advance the research, further develop Dr. Gresham and her trainees’ focus and expertise on pancreatic cancer and serve as the basis for subsequent federal funding to support the work.