title: Measuring the impact of ambulatory red blood cell transfusion on home functional status: study protocol for a pilot randomized controlled trial.
abstract: Red blood cell (RBC) transfusion is frequently employed in both ambulatory and hospital environments with the aim of improving patient functional status. In the ambulatory setting, this practice is particularly common in patients with malignancy due to anemia associated with their cancer therapy. Increasingly, the efficacy of this US$10.5 billion per year practice has been called into question. While it is often standard of care for patients with chemotherapy-induced anemia to receive ambulatory RBC transfusions, it is unclear to what extent such transfusions affect home functional status. It is also unclear whether or not changes in functional status in this population can be objectively quantified using wearable activity monitors. We propose to directly measure the impact of outpatient RBC transfusions on at-home functional status by recording several physiological parameters and quantifiable physical activity metrics, e.g., daily energy expenditure and daily total step count, using the ActiGraph wGT3X-BT. This device is an accelerometer-based wearable activity monitor similar in size to a small watch and is worn at the waist. Study participants will wear the device during the course of their daily activities giving us quantifiable insight into activity levels in the home environment.
  
  
  
  This will be a randomized crossover pilot clinical trial with a participant study duration of 28 days. The crossover nature allows each patient to serve as their own control. Briefly, patients presenting at a tertiary medical center's Ambulatory Infusion Center (AIC) will be randomized to either: (1) receive an RBC transfusion as scheduled (transfusion) or (2) abstain from the scheduled transfusion (no transfusion). After an appropriate washout period, participants will crossover from the transfusion arm to the no-transfusion arm or vice versa. Activity levels will be recorded continuously throughout the study using an accelerometry monitor. In addition to device data, functional status and health outcomes will be collected via a weekly telephone interview. The primary outcome measure will be daily energy expenditure. Performance metrics, such as step count changes, will also be evaluated. Additional secondary outcome measures will include daily sedentary time and Patient-reported Outcomes Measurement Information System (PROMIS) Global 10 Survey scores.
  
  
  
  This trial will provide important information on the feasibility and utility of using accelerometry monitors to directly assess the impact of RBC transfusion on patients' functional status. The results of the study will inform the merit and methods of a more definitive future trial evaluating the impact of ambulatory RBC transfusions in the target population.
  
  
  
  ClinicalTrials.gov, identifier: NCT02835937 . Registered on 15 July 2016.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. murphree.dennis@mayo.edu.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Murphree
authors.affiliation: Department of Pathology and Laboratory Medicine, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA.
authors.forename: Theresa N
authors.initials: TN
authors.lastname: Kinard
authors.affiliation: Department of Hematology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Curtis B
authors.initials: CB
authors.lastname: Storlie
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Che
authors.initials: C
authors.lastname: Ngufor
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Upadhyaya
authors.affiliation: Division of Health Informatics, Weill Cornell Medical College, 425 East 61 Street, New York, NY, 10065, USA.
authors.forename: Jyotishman
authors.initials: J
authors.lastname: Pathak
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Fortune
authors.affiliation: Division of Hematology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Eapen K
authors.initials: EK
authors.lastname: Jacob
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Poterack
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
mesh_terms: D056044:Actigraphy / Q000295:instrumentation; D000203:Activities of Daily Living; D000553:Ambulatory Care / Q000379:methods*; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D002985:Clinical Protocols; D018592:Cross-Over Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D000072936:Fitness Trackers; D006304:Health Status; D006801:Humans; D008297:Male; D000071066:Patient Reported Outcome Measures; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clinical trial; Functional status; Outpatient; Transfusion