The SMILE scale: A pilot study among patients with cancer

e24036 Background: In the US, it is projected that more than 22 million people will be living with cancer by 2030. As survivorship increases, there is a need for simple, convenient tools to quantify patient quality of life and encourage healthy behaviors. To fill this gap, a new psychometric tool named the SMILE Scale was created. The SMILE Scale is a brief self-administered questionnaire assessing the frequency of behaviors intended to improve wellness in five domains: Sleep, physical activity (Move), stress management (Inhale and Exhale), social interactions (Love and connect), and nutrition (Eat to nourish). In this study, we aimed to determine the feasibility of collecting daily self-reported SMILE Scale data and weekly quality of life data, via electronic surveys in patients with cancer. We also aimed to measure the association between SMILE Scale responses and validated health-related quality of life (HRQOL) tools (PROMIS-29+2 and SymTrak-8) as a pilot test of the hypothesis that increased wellness behaviors may impact quality of life. Methods: We surveyed 100 patients with cancer at the IU Simon Comprehensive Cancer Center. Participants were asked to complete daily SMILE Scale assessments over a two-week period, as well as weekly PROMIS-29+2 and SymTrak-8 surveys. The primary endpoint was the SMILE Scale completion rate. Secondary endpoints in this single-arm pilot study included correlations between SMILE Scale results and the other HRQOL tools. Results: Daily completion rate of the SMILE Scale ranged from 57% to 65% of participants over a 14-day period. Among the 61% of participants who completed SMILE on day 1, 87% completed SMILE on 10 of 14 days. Further, 77% completed SMILE at least 1 of the 14 days. By end of study, participants who self-reported more wellness behaviors (i.e., higher daily SMILE scores) demonstrated significantly higher PROMIS physical health (p = .003), higher PROMIS mental health (p = .008), and lower (better) SymTrak total symptom burden (p = .006). Further, among those who completed at least 1 of 14 daily SMILE assessments, quality of life significantly improved over the two-week period for PROMIS mental health (p = .018) and SymTrak total symptom burden (p = .014). Conclusions: The SMILE Scale completion rate on any given day did not satisfy our pre-planned ≥70% threshold for feasibility; however, the rate for completing SMILE at least once during the 14 days (77%) met this threshold. There is growing recognition that interventions with modest uptake may benefit interested patients. The SMILE completion rate across 14 days among those who completed at least one day indicates benefit for providing a daily or on-demand option for those interested. Further, significant correlative results between SMILE scores and secondary QOL endpoints suggest a potential benefit for delivering SMILE in clinical practice and warrants testing the SMILE Scale’s causal impact in a future randomized trial.