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de Lima ML, de Oliveira AA, Carneiro MAS, Silva SHA, de Queiroz Freitas AC, de Souza LRMF, Nomelini RS, Souza MVC, de Oliveira Assumpção C, Orsatti FL. Intramuscular adipose tissue, muscle area, and power as predictors of performance in breast cancer survivors. Support Care Cancer 2024; 32:380. [PMID: 38789606 DOI: 10.1007/s00520-024-08595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE The decline in physical performance, assessed by physical tests such as the timed up and go (TUG) test, is a consequence of reduced physiological reserves at higher levels of a hierarchical process. This occurs due to changes in muscle architecture, including atrophy and fat infiltration into the muscles, which in turn lead to changes in muscle function, resulting in reduced muscle strength and power and, consequently, affecting physical performance. This study investigated predictive factors for physical performance in breast cancer survivor (BCS), focusing on intramuscular adipose tissue (IMAT), quadríceps muscle area (QMA), and muscular power. METHODS This observational, analytical, and cross-sectional study included 23 women without a history of cancer (age, 58.5 ± 8.3 years; BMI, 27.2 ± 5.1 kg/m2) and 56 BCS (age, 58.5 ± 8.3 years; BMI, 27.2 ± 5.1 kg/m2). QMA and IMAT were assessed using computed tomography images. Muscular power and physical performance were measured using the 5-repetition sit-to-stand and TUG tests, respectively. RESULTS IMAT (r = 0.4, P < 0.01) and muscular power (r = - 0.4, P < 0.01) were associated with TUG performance in BCS, whereas QMA (r = - 0.22, P = 0.10) showed no significant association. QMA (r = 0.55, P < 0.01) was associated with muscular power, while no significant association was found between IMAT and muscular power (r = - 0.05, P = 0.73). Age explained 19% (P < 0.01) of TUG performance variability. Adding muscular power increased explanatory power by 12% (P < 0.01), and including IMAT further increased it by 7% (P = 0.02) for TUG performance. Collectively, age, muscular power, and IMAT accounted for 38% of the performance variance in the TUG test (age, B = 0.06, P = 0.043; muscular power, B = - 0.01, P = 0.002; IMAT, B = - 0.05, P = 0.020). CONCLUSIONS Our findings suggest that IMAT and muscular power predict the physical performance of BCS, while QMA does not have the same predictive capability.
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Affiliation(s)
- Mariana Luíza de Lima
- Applied Physiology, Nutrition and Exercise Research Group (PhyNER), Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Avenida Tutunas, 490, Uberaba, Minas Gerais, 38061-500, Brazil
| | - Anselmo Alves de Oliveira
- Department of Physical Education, University Center of the Plateau of Araxá, Araxá, Minas Gerais, Brazil
| | - Marcelo A S Carneiro
- Applied Physiology, Nutrition and Exercise Research Group (PhyNER), Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Avenida Tutunas, 490, Uberaba, Minas Gerais, 38061-500, Brazil
| | - Sebastião Henrique Assis Silva
- Applied Physiology, Nutrition and Exercise Research Group (PhyNER), Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Avenida Tutunas, 490, Uberaba, Minas Gerais, 38061-500, Brazil
| | - Augusto Corrêa de Queiroz Freitas
- Applied Physiology, Nutrition and Exercise Research Group (PhyNER), Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Avenida Tutunas, 490, Uberaba, Minas Gerais, 38061-500, Brazil
| | | | - Rosekeila Simões Nomelini
- Department of Ginecology and Obstetrics, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Markus Vinícius Campos Souza
- Applied Physiology, Nutrition and Exercise Research Group (PhyNER), Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Avenida Tutunas, 490, Uberaba, Minas Gerais, 38061-500, Brazil
- Department of Sport Science, Health Science Institute, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Cláudio de Oliveira Assumpção
- Applied Physiology, Nutrition and Exercise Research Group (PhyNER), Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Avenida Tutunas, 490, Uberaba, Minas Gerais, 38061-500, Brazil
- Department of Sport Science, Health Science Institute, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Fábio Lera Orsatti
- Applied Physiology, Nutrition and Exercise Research Group (PhyNER), Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Avenida Tutunas, 490, Uberaba, Minas Gerais, 38061-500, Brazil.
- Department of Sport Science, Health Science Institute, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
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da Silva RC, Chaves GV, Bergmann A, Frajacomo FTT. Assessment of myosteatosis and functionality in pretreatment gynecological cancer patients. Support Care Cancer 2024; 32:339. [PMID: 38733544 DOI: 10.1007/s00520-024-08558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE We aimed to investigate the relationship between pretreatment gynecologic cancer survival and the physical function of patients with myosteatosis. Understanding this relationship prior to treatment would help healthcare providers identify and refer patients with poor muscle quality to an exercise program prior to treatment. METHODS We conducted a cross-sectional analysis of 73 GC patients. Physical function was quantified using handgrip strength and an adapted version of the Senior Fitness Test (aerobic endurance not included). The EORTC QLC-C30 was used to evaluate general health quality. Myosteatosis (values below the median muscle radiodensity), muscle mass, and adipose tissue variables were calculated from the computed tomography (CT) scan at the third lumbar vertebra using specific software. RESULTS Seventy patients (50.9 ± 15.2) were included; 41.5% had stage III or IV disease, and 61.4% had cervical cancer. The myosteatosis group was 11.9 years older and showed reduced functioning compared to the normal-radiodensity group. Age and Timed Up and Go (TUG) test results were shown to be the most reliable predictors of muscle radiodensity in pretreatment gynecological patients according to multivariate regression analysis (R2 = 0.314). CONCLUSION Gynecological healthcare professionals should be aware that prompt exercise programs might be especially beneficial for older patients with reduced TUG performance to preserve muscle function and quality.
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Affiliation(s)
- Regielly Candido da Silva
- Program of Molecular Carcinogenesis, Brazilian National Cancer Institute, Andre Cavalcanti Av. 37, Rio de Janeiro, 20231050, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition and Dietetics, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Anke Bergmann
- Program of Molecular Carcinogenesis, Brazilian National Cancer Institute, Andre Cavalcanti Av. 37, Rio de Janeiro, 20231050, Brazil
| | - Fernando Tadeu Trevisan Frajacomo
- Program of Molecular Carcinogenesis, Brazilian National Cancer Institute, Andre Cavalcanti Av. 37, Rio de Janeiro, 20231050, Brazil.
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Krok-Schoen JL, Chaplow ZL, Chase C, Spees C, Rosko A, Naughton MJ, Smith J, Soufi S, Beck M, Focht BC. E-PROOF: E-intervention for protein intake and resistance training to optimize function: A study protocol. PLoS One 2024; 19:e0302727. [PMID: 38718069 PMCID: PMC11078354 DOI: 10.1371/journal.pone.0302727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Accounting for more than 60% of cancer survivors, older (≥65 years) cancer survivors have a 2- to 5-fold risk of physical function impairment, compared to cancer-free peers. One strategy to improve physical function is dietary and resistance training interventions, which improve muscle strength and mass by stimulating muscle protein synthesis. The E-PROOF (E-intervention for Protein Intake and Resistance Training to Optimize Function) study will examine the feasibility, acceptability, and preliminary efficacy of a 12-week randomized controlled trial of an online, tailored nutritional and resistance training education and counseling intervention to improve physical function and associated health outcomes (muscle strength, health-related quality of life (HRQoL), self-efficacy, and weight management). METHODS In this study, 70 older cancer survivors will be randomized to one of two groups: experimental (receiving remote behavioral counseling and evidence-based education and resources), and control (general survivorship education). We will examine the intervention effects on physical function, muscle strength, HRQoL, self-efficacy, weight, and waist circumference during a 12-week period between the experimental and control groups. Three months following the end of the intervention, we will conduct a follow-up assessment to measure physical function, muscle strength, and HRQoL. SIGNIFICANCE AND IMPACT This study is the first synchronous, online protein-focused diet and resistance training intervention among older cancer survivors. This novel study advances science by promoting independent health behaviors among older cancer survivors to improve health outcomes, and provide foundational knowledge to further address this growing problem on a wider scale through online platforms.
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Affiliation(s)
- Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Zachary L. Chaplow
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
| | - Cara Chase
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Colleen Spees
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Ashley Rosko
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Michelle J. Naughton
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Jade Smith
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Sam Soufi
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
| | - Mike Beck
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
| | - Brian C. Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
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Lee M, Kang D, Um Y, Jo B, Rhue J, Park S, Lee YY, Noh JJ, Lee YG, Koo DH, Park KH, Lee S, Ahn JS, Oh D, Cho J. Evaluating the effect of a mobile-based symptom monitoring system for improving physical function in patients with cancer during chemotherapy: study protocol for a multicentre randomised controlled trial. BMJ Open 2024; 14:e080976. [PMID: 38692724 PMCID: PMC11086447 DOI: 10.1136/bmjopen-2023-080976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/27/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Symptoms due to chemotherapy are common in patients with cancer. Cancer-related symptoms are closely associated with the deterioration of physical function which can be associated with decreased quality of life and increased mortality. Thus, timely symptom identification is critical for improving cancer prognosis and survival. Recently, remote symptom monitoring system using digital technology has demonstrated its effects on symptom control or survival. However, few studies examined whether remote monitoring would contribute to retaining physical function among patients with cancer. Therefore, this study aimed to evaluate the effectiveness of mobile-based symptom monitoring in improving physical function among patients with cancer under chemotherapy. METHODS AND ANALYSIS This study is a multicentre, open-label, parallel-group, randomised controlled trial. We will recruit 372 patients at three tertiary hospitals located in Seoul, South Korea. Study participants will be randomly assigned to either an intervention group receiving the ePRO-CTCAE app and a control group receiving routine clinical practice only. The primary outcome is changes in physical function from commencement to completion of planned chemotherapy. A linear mixed model will be performed under the intention-to-treat principle. The secondary outcomes include physical activity level; changes in pain interference; changes in depressive symptom; unplanned clinical visits; additional medical expenditure for symptom management; completion rate of planned chemotherapy; changes in symptom burden and health-related quality of life; and 1-year overall mortality. ETHICS AND DISSEMINATION The study has been approved by the institutional review board and ethics committee at the three university hospitals involved in this trial. Written informed consent will be obtained from all the participants. The results of the trial will be submitted for publication in peer-reviewed academic journals and disseminated through relevant literatures. TRIAL REGISTRATION NUMBER KCT0007220.
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Affiliation(s)
- Mangyeong Lee
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Danbee Kang
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Yesol Um
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Bokyung Jo
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Jeong Rhue
- Center for Clinical Epidemiology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Sehhoon Park
- Division of Hematology-Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Joseph J Noh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Yun-Gyoo Lee
- Division of Hematology/Oncology, Kangbuk Samsung Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Kangbuk Samsung Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Kyong-Hwa Park
- Division of Oncology/Hematology, Korea University Medical Center, Seongbuk-gu, Seoul, Korea (the Republic of)
| | - Soohyeon Lee
- Division of Oncology/Hematology, Korea University Medical Center, Seongbuk-gu, Seoul, Korea (the Republic of)
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Juhee Cho
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea (the Republic of)
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Robins VR, Gelcich S, Absolom K, Velikova G. The impact of age on physical functioning after treatment for breast cancer, as measured by patient-reported outcome measures: A systematic review. Breast 2024; 76:103734. [PMID: 38691921 PMCID: PMC11070762 DOI: 10.1016/j.breast.2024.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE This systematic review aims to explore the impact of age on physical functioning post-treatment for early-stage, locally advanced, or locally recurrent breast cancer, as measured by patient-reported outcome measures (PROMs), identify PROMs used and variations in physical functioning terms/labels. METHODS MEDLINE, EmBase, PsycINFO, CINAHL and AMED were searched, along with relevant key journals and reference lists. Risk of bias (quality) assessment was conducted using a Critical Appraisal Skills Programme checklist. Data was synthesised through tables and narrative. RESULTS 28,207 titles were extracted from electronic databases, resulting in 44 studies with age sub-groups, and 120 without age sub-groups. Of those with findings on the impact of age, there was variability in the way findings were reported and 21 % found that age did not have a significant impact. However, 66 % of the studies found that with older age, physical functioning declined post-treatment. Comorbidities were associated with physical functioning declines. However, findings from sub-groups (breast cancer stage, treatment type and time post-treatment) lacked concordance. Twenty-eight types of PROM were used: the EORTC QLQ-C30 was most common (50.6 %), followed by the SF-36 (32.3 %). There were 145 terms/labels for physical functioning: 'physical functioning/function' was used most often (82.3 %). CONCLUSIONS Findings point towards an older age and comorbidities being associated with more physical functioning declines. However, it was not possible to determine if stage, treatment type and time since treatment had any influence. More consistent use of the terminology 'physical functioning/function' would aid future comparisons of study results.
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Affiliation(s)
- V R Robins
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - S Gelcich
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - K Absolom
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK.
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Feyzioğlu Ö, Dinçer S, Özdemir AE, Öztürk Ö. Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer. Disabil Rehabil 2024:1-8. [PMID: 38613370 DOI: 10.1080/09638288.2024.2340703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients. METHODS This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated. RESULTS All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38. CONCLUSIONS The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.
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Affiliation(s)
- Özlem Feyzioğlu
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
| | - Selvi Dinçer
- Department of Radiation Oncology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ayşem Ecem Özdemir
- Department of Physiotherapy and Rehabilitation, Gelisim University, Faculty of Health Sciences, Istanbul, Turkey
| | - Özgül Öztürk
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
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Santagnello SB, Martins FM, de Oliveira Junior GN, de Sousa JDFR, Nomelini RS, Murta EFC, Orsatti FL. Resistance Training-Induced Gains in Muscle Strength and Power Mediate the Improvement in Walking Speed in Middle-Aged Women Who Are Breast Cancer Survivors. J Strength Cond Res 2024; 38:773-782. [PMID: 38354372 DOI: 10.1519/jsc.0000000000004020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
ABSTRACT Santagnello, SB, Martins, FM, de Oliveira Junior, GN, de Sousa, JdeFR, Nomelini, RS, Murta, EFC, and Orsatti, FL. Resistance training-induced gains in muscle strength and power mediate the improvement in walking speed in middle-aged women who are breast cancer survivors. J Strength Cond Res 38(4): 773-782, 2024-(a) Ascertain whether lower muscle mass, strength (1 repetition maximum [1RM]), and power (Pmax) in middle-aged women who are breast cancer survivors (BCS), when compared with women of a similar age never diagnosed with cancer (WNC), are related with lower walking speed (WS). (b) Ascertain whether changes in WS are associated with changes in muscle mass, 1RM, and (or) Pmax after resistance training (RT) in middle-aged BCS. A cross-section study was performed. Twenty WNC and 21 BCS were evaluated for lean mass of legs (LLM), 1RM (knee extension), muscle quality index (MQI = 1RM/LLM), Pmax (maximum muscle power-knee extension), and fast WS (10 and 400-meters). Randomized clinical trial was performed. The BCS were randomly divided into the control group ( n = 9) and the RT group ( n = 11). Breast cancer survivors exhibited lower 1RM (24.2%, p ˂ 0.001), Pmax (30.6%, p ˂ 0.001), MQI (22.2%, p = 0.001), and WS (10-m = 17.0%, p ˂ 0.001 and 400-m = 10.5%, p = 0.002) than WNC. Resistance training increased 1RM (31.6%, p = 0.001), MP (29.0%, p = 0.012), MQI (28.5%, p = 0.008), and WS (10-m = 9.4%, p = 0.009 and 400-m = 6.2%, p = 0.006) in BCS. The changes in WS were positively associated with 1RM (10-m = 68%, p = 0.001 and 400-m = 37%, p = 0.036) and Pmax (10-m = 56%, p = 0.005 and 400-m = 40%, p = 0.027) and MQI (10-m = 63%, p = 0.043 and 400-m = 37%, p = 0.035). Resistance training-induced gains in muscle strength and power mediate the improvement in WS in middle-aged BCS. Resistance training is an effective strategy to improve WS in middle-aged BCS.
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Affiliation(s)
- Samarita Beraldo Santagnello
- Exercise Biology Research Group (BioEx, Institute of Health Sciences, Federal University of Tricângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil)
| | - Fernanda Maria Martins
- Exercise Biology Research Group (BioEx, Institute of Health Sciences, Federal University of Tricângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil)
| | - Gersiel Nascimento de Oliveira Junior
- Exercise Biology Research Group (BioEx, Institute of Health Sciences, Federal University of Tricângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil)
| | - Jairo de Freitas Rodrigues de Sousa
- Exercise Biology Research Group (BioEx, Institute of Health Sciences, Federal University of Tricângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil)
| | - Rosekeila Simões Nomelini
- Research Institute of Oncology, Department of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil; and
| | - Eddie Fernando Candido Murta
- Research Institute of Oncology, Department of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil; and
| | - Fábio Lera Orsatti
- Exercise Biology Research Group (BioEx, Institute of Health Sciences, Federal University of Tricângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil)
- Department of Sport Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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Loh KP, Wang Y, Sanapala C, Gilmore N, Netherby-Winslow C, Mendler JH, Liesveld J, Huselton E, Williams AM, Klepin HD, Jensen-Battaglia M, Mustian K, Vertino P, Susiarjo M, Janelsins MC. Exercise and inflammatory cytokine regulation among older adults with myeloid malignancies. Exp Gerontol 2024; 187:112364. [PMID: 38266886 PMCID: PMC10923152 DOI: 10.1016/j.exger.2024.112364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Tumor necrosis factor (TNF)α is a major regulator of inflammation. However, the epigenetic regulation of TNFα in the context of an exercise intervention among older adults with cancer is understudied. In this exploratory analysis, we used data from a single-arm mobile health (mHealth) exercise intervention among older adults with myeloid malignancies to 1) assess changes in TNFα promoter methylation, TNFα mRNA expression, serum TNFα and other related-cytokine levels after intervention; and 2) assess correlations between blood markers and exercise levels. Twenty patients were included. From baseline to post-intervention, there was no statistical changes in TNFα promoter methylation status at seven CpG sites, TNFα mRNA expression, and serum TNFα levels. Effect sizes, however, were moderate to large for several CpG sites (-120, -147, -162, and -164; Cohen's d = 0.44-0.75). Median serum TNFα sR1 levels increased (83.63, IQR 130.58, p = 0.06; Cohen's d = 0.18) but not the other cytokines. Increases in average daily steps were correlated with increases in TNFα promoter methylation at CpG sites -147 (r = 0.48; p = 0.06) and -164 (r = 0.51; p = 0.04). Resistance training minutes were negatively correlated with TNFα promoter methylation at CpG site -120 (r = -0.62; p = 0.02). All effect sizes were moderate to large. In conclusion, after a mHealth exercise intervention, we demonstrated changes with moderate to large effect sizes in several CpG sites in the TNFα promoter region. Exercise levels were correlated with increases in TNFα promoter methylation. Larger exercise trials are needed to better evaluate TNFα regulation to inform interventions to augment TNFα regulation in order to improve outcomes in older adults with cancer.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Colleen Netherby-Winslow
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - AnnaLynn M Williams
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, USA.
| | | | - Karen Mustian
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Paula Vertino
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Michelle C Janelsins
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
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Cristian A, Rubens M, Orada R, DeVries K, Syrkin G, DePiero MT, Estenoz M, Kothakapu S, McGranaghan P, Lindeman PR. Development of a Cancer Rehabilitation Dashboard to Collect Data on Physical Function in Cancer Patients and Survivors. Am J Phys Med Rehabil 2024; 103:S36-S40. [PMID: 38364028 DOI: 10.1097/phm.0000000000002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The aim of the study is to describe the development of a cancer rehabilitation dashboard that collects data on physical function for cancer survivors in a cancer institute. METHODS This project was conducted at the Miami Cancer Institute. The cancer rehabilitation dashboard was developed by a team of physicians, biostatistician, and medical informatics teams to record, report and track the physical function of cancer survivors. A multimodal approach to the measurement of physical function was used and included the Patient-Reported Outcome Measurement Information System-Physical Function short form, Patient-Reported Outcome Measurement Information System-Fatigue short form, Timed Up and Go Test, Sit-to-Stand Test in 30-sec test, four-stage balance test, and grip strength. To develop this system, a Cerner Power Form was developed based on the physical function data. To display the data, a dedicated flowsheet was developed and placed within the Oncology Viewpoint in Cerner Millennium. Thus, from inside any patient record, the flowsheet could easily be accessed by providers without leaving normal clinician workflows. Using native functionality, the data can also be shown in graphical format to facilitate dialog with patients and oncology teams. All patient data from the Cerner Power Form discrete task assays were integrated into an existing Oncology Data Warehouse for all patients. The data elements in the Cerner Power Form were identified in the electronic medical record system, loaded into the Oncology Data Warehouse, and related to the other source systems to develop reports and data visualizations such as the cancer rehabilitation dashboard. The cancer rehabilitation dashboard allows visualization of numerous parameters of physical function in cancer survivors evaluated and treated and their change over time. Rendered in Tableau, the cancer rehabilitation dashboard acts as a centralized, interactive data source to analyze and connect clinicians to near real-time data. RESULTS The cancer rehabilitation dashboard was successfully developed and implemented into a cancer rehabilitation practice in a cancer institute and used to collect and track physical function data for cancer survivors receiving treatment and cancer survivors. This information has been used to direct the treatment plan and educate individual patients about the impact of the cancer and its treatment on physical function as well as oncology teams in a cancer institute. CONCLUSIONS The cancer rehabilitation dashboard provides an insight into the physical function of cancer survivors receiving treatment and cancer survivors using both self-reported and objective metrics. It can be customized to suit the interests of clinicians and researchers wishing to improve the quality of life of this population.
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Affiliation(s)
- Adrian Cristian
- From the Cancer Rehabilitation, Cancer Patient Support Center-Miami Cancer Institute, Miami, Florida (AC); Department of Oncology Research, Miami Cancer Institute, Miami, Florida (MR); Cancer Patient Support Center, Miami Cancer Institute, Miami, Florida (RO); New York Presbyterian Hospital, New York, New York (KD); Weill Cornell Medical College, New York, New York (KD); Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (GS); Informatics Analyst, Department of Oncology Informatics, Miami Cancer Institute, Miami, Florida (MTD, ME, PRIL); Baptist Health South Florida, Miami, Florida (SK, PM); and Department of Oncology Informatics
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Galvin A, Soubeyran P, Brain E, Cheung KL, Hamaker ME, Kanesvaran R, Mauer M, Mohile S, Montroni I, Puts M, Rostoft S, Wildiers H, Mathoulin-Pélissier S, Bellera C. Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. J Geriatr Oncol 2024; 15:101611. [PMID: 37679204 DOI: 10.1016/j.jgo.2023.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, UMR 1312, SIRIC BRIO, France; Department of medical oncology, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/ Zeist/Doorn, Zeist, the Netherlands
| | | | - Murielle Mauer
- Statistics Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Belgium
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France.
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11
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Rothmund M, Pilz MJ, Schlosser L, Arraras JI, Groenvold M, Holzner B, van Leeuwen M, Petersen MA, Schmidt H, Young T, Rose M, Cella D, Giesinger JM. Equipercentile equating of scores from common patient-reported outcome measures of physical function in patients with cancer. J Clin Epidemiol 2024; 165:111203. [PMID: 37918641 DOI: 10.1016/j.jclinepi.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To provide equipercentile equating of physical function (PF) scores from frequently used patient-reported outcome measures (PROMs) in cancer patients to facilitate data pooling and comparisons. STUDY DESIGN AND SETTING Adult cancer patients from five European countries completed the European Organization for Research and Treatment of Cancer (EORTC) computer adaptive test (CAT) Core, EORTC Quality of Life Questionnaire Version 3.0 (QLQ-C30), Functional Assessment of Cancer Therapy - General (FACT-G), 36-item Short Form Health Survey (SF-36), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function 20a short form. The R package "equate" was used to establish conversion tables of PF scores on those measures with a bivariate rank correlation of at least 0.75. RESULTS In total, 953 patients with cancer (mean age 58.9 years, 54.7% men) participated. Bivariate rank correlations between PF scores from the EORTC CAT Core, EORTC QLQ-C30, SF-36, and PROMIS were all above 0.85, but below 0.69 for the FACT-G. Conversion tables were established for all measures but the FACT-G. These tables indicate which score from one PROM best matches the score from another PROM and provide standard errors of converted scores. CONCLUSION Our analysis indicates that linking of PF scores from both EORTC measures (CAT and QLQ-C30) with PROMIS and SF-36 is possible, whereas the physical domain of the FACT-G seems to be different. The established conversion tables may be used for comparing results or pooling data from clinical studies using different PROMs.
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Affiliation(s)
- Maria Rothmund
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic of Psychiatry II, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria; Institute of Psychology, University of Innsbruck, Innrain 52, A-6020 Innsbruck, Austria
| | - Micha J Pilz
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic of Psychiatry II, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Lisa Schlosser
- Data Lab Hell GmbH, Europastraße 2a, A-6170 Zirl, Austria
| | - Juan I Arraras
- Oncology Department, Hospital Universitario de Navarra, C/Irunlarrea 3, ES-31008 Pamplona, Spain
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Bispebjerg bakke 23B, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, DK-1353 Copenhagen, Denmark
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic of Psychiatry I, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Marieke van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Morten Aa Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Bispebjerg bakke 23B, Copenhagen, Denmark
| | - Heike Schmidt
- University Clinic and Outpatient Clinic for Radiotherapy and Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Teresa Young
- Supportive Oncology Research Team, East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, United Kingdom
| | - Matthias Rose
- Center for Patient-Centered Outcomes Research (CPCOR), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Johannes M Giesinger
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic of Psychiatry II, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria.
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12
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Cheng E, Caan BJ, Cawthon PM, Evans WJ, Hellerstein MK, Shankaran M, Campbell KL, Binder AM, Sternfeld B, Meyerhardt JA, Schmitz KH, Cespedes Feliciano EM. D3-creatine dilution, computed tomography and dual-energy X-ray absorptiometry for assessing myopenia and physical function in colon cancer: A cross-sectional study. J Cachexia Sarcopenia Muscle 2023; 14:2768-2778. [PMID: 37899757 PMCID: PMC10751410 DOI: 10.1002/jcsm.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Low skeletal muscle mass (myopenia) is common in cancer populations and is associated with functional decline and mortality, but prior oncology studies did not assess total body skeletal muscle mass. Instead, they measured surrogates such as cross-sectional area (CSA) of skeletal muscle at L3 from computed tomography (CT) or appendicular lean mass (ALM) from dual-energy X-ray absorptiometry (DXA). D3-creatine (D3Cr) dilution is a non-invasive method to assess total body skeletal muscle mass, which has been examined in a variety of populations but not in cancer. To compare the associations of D3Cr muscle mass, CT CSA, and DXA ALM with myopenia and physical function, we conducted a cross-sectional study among 119 patients with colon cancer (2018-2022). METHODS For each technique (D3Cr, CT and DXA), myopenia was defined as the lowest sex-specific quartile of its measurement. Physical function was measured by the short physical performance battery and grip strength. We calculated Pearson correlations (r) among three techniques, computed Cohen's kappa coefficients (κ) to assess the agreement of myopenia, and estimated Pearson correlations (r) of three techniques with physical function. All analyses were sex-specific. RESULTS Sixty-one (51.3%) participants were male, the mean (standard deviation) age was 56.6 (12.9) years, and most (68.9%) had high physical function (short physical performance battery: ≥11 points). Correlations and myopenia agreement among three techniques were greater in men than women; for example, regarding D3Cr muscle mass versus CT CSA, r was 0.73 (P < 0.001) for men versus 0.45 (P < 0.001) for women, and κ was 0.82 (95% CI: 0.65, 0.99) for men versus 0.24 (95% CI: -0.08, 0.52) for women. Among men, higher D3Cr muscle mass was significantly correlated with faster gait speed (r = 0.43, P < 0.01) and stronger grip strength (r = 0.32, P < 0.05); similar correlations were observed for CT CSA and DXA ALM. However, among women, no measure of muscle or lean mass was significantly associated with physical function. CONCLUSIONS This is the first study using D3-creatine dilution method to assess muscle mass in a cancer population. Regardless of the techniques used for muscle or lean mass assessment, we observed stronger correlations, greater myopenia agreement, and more significant associations with physical function in men with colon cancer than women. D3Cr, CT and DXA are not interchangeable methods for assessing myopenia and physical function, especially in women with colon cancer. Future studies should consider relative advantages of these techniques and examine the D3-creatine dilution method in other cancer types.
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Affiliation(s)
- En Cheng
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Peggy M. Cawthon
- San Francisco Coordinating CenterCalifornia Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - William J. Evans
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
- Division of GeriatricsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Marc K. Hellerstein
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Kristin L. Campbell
- Department of Physical Therapy, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Alexandra M. Binder
- Population Sciences in the Pacific ProgramUniversity of Hawaii Cancer CenterHonoluluHawaiiUSA
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Barbara Sternfeld
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | | | - Kathryn H. Schmitz
- Division of Hematology and OncologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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Aryal S, Bachman SL, Lyden K, Clay I. Measuring What Is Meaningful in Cancer Cachexia Clinical Trials: A Path Forward With Digital Measures of Real-World Physical Behavior. JCO Clin Cancer Inform 2023; 7:e2300055. [PMID: 37851933 PMCID: PMC10642875 DOI: 10.1200/cci.23.00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE The burden of cancer cachexia on patients' health-related quality of life, specifically their physical functioning, is well documented, but clinical trials thus far have failed to show meaningful improvement in physical functioning. The purpose of this review is to summarize existing methods of assessing physical function in cancer cachexia, outline a path forward for measuring what is meaningful to patients using digital measures derived from digital health technologies (DHTs), and discuss the current landscape of digital measures from the clinical and regulatory standpoint. DESIGN For this narrative review, peer-reviewed articles were searched on PubMed, clinical trials records were searched on clinicaltrials.gov, and records of digital measures submitted for regulatory qualification were searched on the US Food and Drug Administration's Drug Development Tool Qualification Program database. RESULTS There are gaps in assessing aspects of physical function that matter to patients. Existing assessment methods such as patient-reported outcomes and objective performance outcomes have limitations, including their episodic nature and burden to patients. DHTs such as wearable sensors can capture real-world physical behavior continuously, passively, and remotely, and may provide a more comprehensive picture of patients' everyday functioning. Recent regulatory submissions showcase potential clinical implementation of digital measures in various therapeutic areas. CONCLUSION Digital measures of real-world physical behavior present an opportunity to detect and demonstrate improvements in physical functioning in cancer cachexia, but evidence-based development is critical. For their use in clinical and regulatory decision making, studies demonstrating meaningfulness to patients as well as feasibility and validation are necessary.
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Doyle C, Ko E, Lemus H, Hsu FC, Pierce JP, Wu T. Living Alone, Physical Health, and Mortality in Breast Cancer Survivors: A Prospective Observational Cohort Study. Healthcare (Basel) 2023; 11:2379. [PMID: 37685413 PMCID: PMC10486593 DOI: 10.3390/healthcare11172379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Living alone, particularly for individuals with poor physical health, can increase the likelihood of mortality. This study aimed to explore the individual and joint associations of living alone and physical health with overall mortality among breast cancer survivors in the Women's Healthy Eating and Living (WHEL). We collected baseline, 12-month and 48-month data among 2869 women enrolled in the WHEL cohort. Living alone was assessed as a binary variable (Yes, No), while scores of physical health were measured using the RAND Short Form-36 survey (SF-36), which include four domains (physical function, role limitation, bodily pain, and general health perceptions) and an overall summary score of physical health. Cox proportional hazard models were used to evaluate associations. No significant association between living alone and mortality was observed. However, several physical health measures showed significant associations with mortality (p-values < 0.05). For physical function, the multivariable model showed a hazard ratio (HR) of 2.1 (95% CI = 1.02-4.23). Furthermore, the study examined the joint impact of living alone and physical health measures on overall mortality. Among women with better physical function, those living alone had a 3.6-fold higher risk of death (95% CI = 1.01-12.89) compared to those not living alone. Similar trends were observed for pain. However, regarding role limitation, the pattern differed. Breast cancer survivors living alone with worse role limitations had the highest mortality compared to those not living alone but with better role limitations (HR = 2.6, 95% CI = 1.11-5.95). Similar trends were observed for general health perceptions. Our findings highlight that living alone amplifies the risk of mortality among breast cancer survivors within specific health groups.
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Affiliation(s)
- Cassie Doyle
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.D.); (H.L.)
| | - Eunjeong Ko
- School of Social Work, San Diego State University, San Diego, CA 92182, USA;
| | - Hector Lemus
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.D.); (H.L.)
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA;
| | - John P. Pierce
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92037, USA;
| | - Tianying Wu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.D.); (H.L.)
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92037, USA;
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Loh KP, Sanapala C, Jensen-Battaglia M, Rana A, Sohn MB, Watson E, Gilmore N, Klepin HD, Mendler JH, Liesveld J, Huselton E, LoCastro M, Susiarjo M, Netherby-Winslow C, Williams AM, Mustian K, Vertino P, Janelsins MC. Exercise and epigenetic ages in older adults with myeloid malignancies. Eur J Med Res 2023; 28:180. [PMID: 37254221 PMCID: PMC10227405 DOI: 10.1186/s40001-023-01145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/19/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Older adults with myeloid malignancies are susceptible to treatment-related toxicities. Accelerated DNAm age, or the difference between DNA methylation (DNAm) age and chronological age, may be used as a biomarker of biological age to predict individuals at risk. In addition, cancer treatment can also lead to accelerated DNAm age. Exercise is a promising intervention to reduce or prevent functional, psychological, and cognitive impairments in older patients with myeloid malignancies, yet there is little evidence of the effects of exercise on DNAm age. We explored (1) the associations of accelerated DNAm age with physical, psychological, and cognitive functions at baseline; (2) changes in DNAm age from baseline to post-intervention; and (3) the associations of changes in accelerated DNAm age with changes in functions from baseline to post-intervention. METHODS We enrolled older patients with myeloid malignancies to a single-arm pilot study testing a mobile health (mHealth) exercise intervention that combines an exercise program (EXCAP©®) with a mobile application over 2 cycles of chemotherapy (8-12 weeks). Patients completed measures of physical, psychological, and cognitive functions and provided blood samples for analyses of DNAm age at baseline and post-intervention. Paired t-tests or Wilcoxon signed rank tests assessed changes in DNAm ages, and Spearman's correlation assessed the relationships between accelerated ages and functions. RESULTS We included 20 patients (mean age: 72 years, range 62-80). Accelerated GrimAge, accelerated PhenoAge, and DunedinPACE were stable from baseline to post-intervention. At baseline, DunedinPACE was correlated with worse grip strength (r = -0.41, p = 0.08). From baseline to post-intervention, decreases in accelerated GrimAge (r = -0.50, p = 0.02), accelerated PhenoAge (r = - 0.39, p = 0.09), and DunedinPace (r = - 0.43, p = 0.06) were correlated with increases in distance walked on 6-min walk test. Decreases in accelerated GrimAge (r = - 0.49, p = 0.03), accelerated PhenoAge (r = - 0.40, p = 0.08), and DunedinPace (r = - 0.41, p = 0.07) were correlated with increases in in grip strength. CONCLUSIONS Among older adults with myeloid malignancies receiving chemotherapy, GrimAge and PhenoAge on average are stable after a mHealth exercise intervention. Decreases in accelerated GrimAge, accelerated PhenoAge, and DunedinPACE over 8-12 weeks of exercise were correlated with increased physical performance. Future trials assessing the effects of exercise on treatment-related toxicities should evaluate DNAm age. Trial registration Clinicaltrials.gov identifier: NCT04981821.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | | | | | - Anish Rana
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Michael B. Sohn
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY USA
| | - Erin Watson
- Department of Psychology, Princeton University, Princeton, NJ USA
| | - Nikesha Gilmore
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC USA
| | - Jason H. Mendler
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Eric Huselton
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Marissa LoCastro
- James P. Wilmot Cancer Institute, Rochester, NY USA
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY USA
| | - Colleen Netherby-Winslow
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - AnnaLynn M. Williams
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Karen Mustian
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Paula Vertino
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY USA
| | - Michelle C. Janelsins
- James P. Wilmot Cancer Institute, Rochester, NY USA
- Division of Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY USA
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Sobue Y, Suzuki M, Ohashi Y, Koshima H, Okui N, Funahashi K, Ishikawa H, Inoue H, Asai S, Terabe K, Kishimoto K, Kihira D, Maeda M, Sato R, Imagama S. Relationship between frailty and methotrexate discontinuation due to adverse events in rheumatoid arthritis patients. Clin Rheumatol 2023:10.1007/s10067-023-06639-z. [PMID: 37211570 DOI: 10.1007/s10067-023-06639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Methotrexate (MTX) is an anchor drug in the treatment of rheumatoid arthritis (RA). Frailty is the intermediate condition between being healthy and disabled, and can lead to negative health outcomes. Adverse events (AEs) due to RA drugs are expected to be higher in frail patients. The present study aimed to investigate the relationship between frailty and MTX discontinuation due to AEs in RA patients. METHODS Of 538 RA patients who visited us between June and August 2020 as part of the retrospective T-FLAG study, 323 used MTX. After 2 years of follow-up, we investigated AEs leading to MTX discontinuation. Frailty was defined as a Kihon Checklist (KCL) score ≥ 8. Cox proportional hazards regression analysis was performed to identify factors associated with MTX discontinuation due to AEs. RESULTS Of the 323 RA patients (251 women, 77.7%) who used MTX, 24 (7.4%) discontinued MTX due to AEs during the 2-year follow-up period. Mean ages in the MTX continuation/discontinuation groups were 64.5 ± 13.9/68.5 ± 11.7 years (p = 0.169), Clinical Disease Activity Index was 5.6 ± 7.3/6.2 ± 6.0 (p = 0.695); KCL was 5.9 ± 4.1/9.0 ± 4.9 points (p < 0.001); and the proportion of frailty was 31.8%/58.3% (p = 0.012). MTX discontinuation due to AEs was significantly associated with frailty (hazard ratio 2.34, 95% confidence interval 1.02-5.37) even after adjusting for age and diabetes mellitus. AEs included liver dysfunction (25.0%), pneumonia (20.8%), and renal dysfunction (12.5%). CONCLUSIONS Because frailty is a significant factor contributing to MTX discontinuation due to AEs, the latter should be carefully monitored in frail RA patients who use MTX. Key Points • Of the 323 rheumatoid arthritis (RA) patients (251 women, 77.7%) who used methotrexate (MTX), 24 (7.4%) discontinued MTX due to adverse events (AEs) during the 2-year follow-up period. • MTX discontinuation due to AEs was significantly associated with frailty (hazard ratio 2.34, 95% confidence interval 1.02-5.37) even after adjusting for age and diabetes mellitus, and neither the MTX dose, folic acid supplementation, nor GC co-therapy were factors in MTX discontinuation. • Frailty is a predominant factor in MTX discontinuation among established, long-term pretreated RA patients, and the occurrence of AEs due to MTX should be carefully monitored when frail RA patients use MTX.
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Affiliation(s)
- Yasumori Sobue
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita, Nakamura, Nagoya, Aichi, 453-8511, Japan.
| | - Mochihito Suzuki
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
- Department of Orthopedic Surgery, Japan Community Healthcare Organization Kani Tono Hospital, 1221-5 Dota, Kani, Gifu, 509-0206, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, Mie, 510-8567, Japan
| | - Hiroshi Koshima
- Department of Orthopedic Surgery, Japan Community Healthcare Organization Kani Tono Hospital, 1221-5 Dota, Kani, Gifu, 509-0206, Japan
| | - Nobuyuki Okui
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, Mie, 510-8567, Japan
| | - Koji Funahashi
- Department of Orthopedic Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi, Kariya, Aichi, 448-0852, Japan
| | - Hisato Ishikawa
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita, Nakamura, Nagoya, Aichi, 453-8511, Japan
| | - Hidenori Inoue
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita, Nakamura, Nagoya, Aichi, 453-8511, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kenji Kishimoto
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Daisuke Kihira
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Masataka Maeda
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Ryo Sato
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
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Swartz MC, Robertson MC, Christopherson U, Wells SJ, Lewis ZH, Bai J, Swartz MD, Silva HC, Martinez E, Lyons EJ. Assessing the Suitability of a Virtual 'Pink Warrior' for Older Breast Cancer Survivors during COVID-19: A Pilot Study. Life (Basel) 2023; 13:574. [PMID: 36836931 PMCID: PMC9965453 DOI: 10.3390/life13020574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
The COVID-19 pandemic impacted the conduct of in-person physical activity (PA) interventions among older survivors of BC, who need such interventions to stay active and prevent functional decline. We tested the feasibility of virtually delivering an exergame-based PA intervention to older BC survivors. We enrolled 20 female BC survivors ≥55 years and randomly assigned them to two groups. The intervention group (Pink Warrior 2) received 12 weekly virtual exergame sessions with behavioral coaching, survivorship navigation support, and a Fitbit for self-monitoring. The control group received 12 weekly phone-based survivorship discussion sessions and wore a Mi Band 3. Feasibility was evaluated by rates of recruitment (≥0.92 participants/center/month), retention (≥80%), and group attendance (≥10 sessions), percentage of completed virtual assessments, and number of technology-related issues and adverse events. Intervention acceptability was measured by participants' ratings on a scale of 1 (strongly disagree) to 5 (strongly agree). The recruitment rate was 1.93. The retention and attendance rates were 90% and 88% (≥10 sessions), respectively. Ninety-six percent completed virtual assessments without an adverse event. Acceptability was high (≥4). The intervention met benchmarks for feasibility. Additional research is needed to further understand the impact of virtually delivered PA interventions on older BC survivors.
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Affiliation(s)
- Maria C. Swartz
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael C. Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Ursela Christopherson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Stephanie J. Wells
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zakkoyya H. Lewis
- Department of Kinesiology & Health Promotion, California State Polytechnic University, Pomona, CA 91768, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health, Houston, TX 77030, USA
| | - H. Colleen Silva
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Eloisa Martinez
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Elizabeth J. Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX 77550, USA
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18
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Martins FM, Santagnello SB, de Oliveira Junior GN, de Sousa JDFR, Michelin MA, Nomelini RS, Murta EFC, Orsatti FL. Lower-Body Resistance Training Reduces Interleukin-1β and Transforming Growth Factor-β1 Levels and Fatigue and Increases Physical Performance in Breast Cancer Survivors. J Strength Cond Res 2023; 37:439-451. [PMID: 36696263 DOI: 10.1519/jsc.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ABSTRACT Martins, FM, Santagnello, SB, de Oliveira Junior, GN, de Sousa, JdFR, Michelin, MA, Nomelini, RS, Murta, EFC, and Orsatti, FL. Lower-body resistance training reduces interleukin-1β and transforming growth factor-β1 levels and fatigue and increases physical performance in breast cancer survivors. J Strength Cond Res 37(2): 439-451, 2023-This article ascertains whether resistance training (RT) improves inflammatory markers, fatigue (sensations and fatigability), and physical performance in breast cancer survivors (BCS) and investigates whether the changes in the inflammatory markers, fatigue, and physical performance are associated with each other. Volunteers were randomly divided into 2 groups: control group (n = 11) and RT group (n = 11). Resistance training (3 sets of 8-12 repetitions with 80% 1 repetition maximum (1RM) on 4 exercises-leg extension, leg curl, 45° leg press, and calf raise) was performed 3 times a week for 12 weeks. Self-reported fatigue (SRF), fatigability (critical torque [CT] and W prime [W']), muscle strength, and circulating inflammatory markers were assessed using the Brief Fatigue Inventory, iDXA, 1RM test, protocol of 60 maximal voluntary isometric contractions, and enzyme-linked immunosorbent assay, respectively. Resistance training reduced interleukin (IL)-1β, transforming growth factor (TGF)-β1, and SRF score and increased muscle strength, 6-minute walk test (6MWT), CT, and W'. In the RT group, the changes in SRF were positively associated with the changes in IL-1β. The changes in muscle strength were associated with the changes in CT and W', and the changes in the 6MWT were associated with the changes in CT, W', muscle strength, and SRF. Resistance training improved fatigue and physical performance and reduced IL-1β, and TGF-β1 in BCS. Although improvement in fatigability seems to be dependent on the increase in muscle strength, improvement in the sensation of fatigue seems to be dependent on the reduction in IL-1β after RT. Increase in physical performance seems to be dependent on improvement in muscle strength and fatigue.
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Affiliation(s)
- Fernanda Maria Martins
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Samarita Beraldo Santagnello
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | | - Jairo de Freitas Rodrigues de Sousa
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Márcia Antoniazi Michelin
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics Course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil ; and
| | - Rosekeila Simões Nomelini
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics Course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil ; and
| | - Eddie Fernando Candido Murta
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics Course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil ; and
| | - Fábio Lera Orsatti
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
- Department of Sport Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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Lee K, Nathwani N, Shamunee J, Lindenfeld L, Wong FL, Krishnan A, Armenian S. Telehealth exercise to Improve Physical function and frailty in patients with multiple myeloma treated with autologous hematopoietic Stem cell transplantation (TIPS): protocol of a randomized controlled trial. Trials 2022; 23:921. [PMID: 36329525 PMCID: PMC9633031 DOI: 10.1186/s13063-022-06848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Advances in autologous hematopoietic stem cell transplantation (HSCT) and supportive care have led to marked improvements in survival for patients with multiple myeloma. Despite these improvements, patients with multiple myeloma remain at high risk of physical dysfunction and frailty due to HSCT and its associated exposures. Although traditional supervised exercise programs can improve frailty in cancer patients and survivors, rehabilitation facilities are typically far from a patient's residence, are offered on fixed days/hours, contain uniform activities for everyone, and carry a higher risk of contact cross-infection due to immunosuppression, which can be barriers to exercise participation. Innovative personalized interventions are needed to overcome the limitations of traditional exercise interventions. The purpose of this study is to determine the efficacy and sustainability of a telehealth exercise intervention on physical function and frailty in patients with multiple myeloma treated with HSCT. METHODS This randomized controlled trial will assess the efficacy of an 8-week telehealth exercise intervention in 60 patients with multiple myeloma who underwent autologous HSCT (30-180 days post-transplant) and are pre-frail or frail. There will be 30 intervention participants and 30 delayed controls. We will administer remote baseline assessments (week 0), followed by an 8-week telehealth intervention (week 1-8), post assessment (week 9), and an additional follow-up assessment (week 17). Our primary endpoint will be improved physical function, as assessed by the Short Physical Performance Battery test. Our secondary endpoint will be a decrease in frailty characteristics such as gait speed, strength, and fatigue. We will also evaluate the sustainability of improved physical function and frailty at week 17. Participants randomized to the intervention group will perform at least 90 min of exercise per week throughout the 8 weeks. DISCUSSION This study will help optimize the delivery of safe, low-cost, and scalable telehealth exercise interventions to improve health outcomes in patients with multiple myeloma, an understudied population at high risk for physical dysfunction and frailty. Our study may provide the foundation for sustainable telehealth exercise interventions to improve physical function and frailty for other hematologic cancer patients (e.g., acute leukemia, lymphoma) as well as any other cancer population of interest. TRIAL REGISTRATION ClinicalTrials.gov NCT05142371 . This study was retrospectively registered on December 2nd, 2021, and is currently open to accrual.
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Affiliation(s)
- Kyuwan Lee
- Division of Outcomes Research, Department of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Bldg. 173, Duarte, CA, 91010, USA.
| | - Nitya Nathwani
- Division of Multiple Myeloma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA
| | - Justin Shamunee
- Division of Outcomes Research, Department of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Bldg. 173, Duarte, CA, 91010, USA
| | - Lanie Lindenfeld
- Division of Outcomes Research, Department of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Bldg. 173, Duarte, CA, 91010, USA
| | - F Lennie Wong
- Division of Outcomes Research, Department of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Bldg. 173, Duarte, CA, 91010, USA
| | - Amrita Krishnan
- Division of Multiple Myeloma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA
| | - Saro Armenian
- Division of Outcomes Research, Department of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Bldg. 173, Duarte, CA, 91010, USA
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20
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Silva CDFR, Gonçalves Ohara D, Pena Matos A, Nunes Pinto ACP, Sousa Pegorari M. Short physical performance battery as a predictor of mortality in community-dwelling older adults: a longitudinal study in the Brazilian Amazon region. PeerJ 2022; 10:e13630. [PMID: 35846876 PMCID: PMC9285644 DOI: 10.7717/peerj.13630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 01/17/2023] Open
Abstract
Background The Short Physical Performance Battery (SPPB) is an instrument for assessing physical performance widely used in research among the elderly in multiple settings. We did not find Brazilian longitudinal studies that aimed to analyze the predictive capacity and accuracy of the SPPB among community-dwelling older adults and no systematic reviews were found on the accuracy of the SPPB in predicting mortality in community- dwelling older adults. This study aimed to analyze the capacity and accuracy of the SPPB for predicting mortality in community-dwelling older adults, as well as to determine cut-off points for men and women. Method Longitudinal observational study conducted with 411 (70.1 ± 7.25 years) community-dwelling older adults, between 2017 and 2020 (37.7 ± 6.24 months). Physical performance was evaluated using the SPPB and information on the all-cause mortality rate was also recorded. Multivariate Cox regression analyses and curves were performed using the Kaplan-Meier method. Receiver Operating Characteristic (ROC) curves were constructed, with the parameters of area under the ROC curve (AUC) to determine cutoff points for discriminating mortality, considering a significance level of 5% (p < 0.05) and 95% confidence interval (CI) 95%. Results Older adults with very low and low physical performance in the SPPB, showed higher risks of mortality (HR = 9.67; 95% CI [1.20-77.65]; HR = 4.06; 95% CI [1.09-15.01]), respectively. In the subtest's analysis, older adults with low performance in the balance (HR = 0.54; 95% CI [0.36-0.81]) and gait speed tests (HR = 0.50; 95% CI [0.33-0.76]) showed greater risks of dying. The same was reproduced for categories in each test (participants that scored 2 points in the balance test had an HR = 5.86; 95% CI [1.84-18.61] and 2 points in the gait speed test, HR = 5.07; 95% CI [1.76-14.58]. The cutoff point ≤ 9 in the SPPB set the discriminator criterion for mortality in older people of both sexes. Conclusions The SPPB, as well as the balance and gait speed subtests were predictors of mortality, and the SPPB is accurate in predicting mortality among community-dwelling older adults.
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21
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Brown JC, Brighton E, Campbell N, McCleary NJ, Abrams TA, Cleary JM, Enzinger PC, Ng K, Rubinson D, Wolpin BM, Yurgelun MB, Meyerhardt JA. Physical activity in older adults with metastatic gastrointestinal cancer: a pilot and feasibility study. BMJ Open Sport Exerc Med 2022; 8:e001353. [PMID: 35722047 PMCID: PMC9152931 DOI: 10.1136/bmjsem-2022-001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives This study determined the feasibility of delivering a 12-week structured physical activity programme during chemotherapy to older adults recently diagnosed with metastatic gastrointestinal (GI) cancer. Methods This study used a single-cohort design. Older adults (aged ≥65 years) diagnosed with metastatic oesophageal, gastric, pancreatic or colorectal cancer who planned to initiate chemotherapy were enrolled. The physical activity programme included a combination of aerobic, flexibility, strength and balance modalities delivered by a certified cancer exercise trainer during chemotherapy infusion appointments, then translated and sustained at home by participants. The co-primary endpoints included: (1) accrual of 20 participants in 12 months and (2) physical activity adherence of ≥50%. Results Between March and October 2018, 29 participants were screened, and 20 were enrolled within 12 months (recruitment rate: 69% (90% CI: 55% to 83%); p<0.001), meeting the first co-primary endpoint. The median age of participants was 73.3 years (IQR: 69.3-77.2). At week 12, 67% (90% CI: 48% to 85%) of participants adhered to ≥50% of the prescribed physical activity (p=0.079 (statistically significant)), meeting the second co-primary endpoint. From baseline to week 12, accelerometer-measured light-intensity and moderate-intensity to vigorous-intensity physical activity increased by 307.4 (95% CI: 152.6 to 462.2; p<0.001) and 25.0 min per week (95% CI: 9.9 to 40.1; p=0.001), respectively. There were no serious or unexpected adverse events. The median overall survival was 16.2 months (8.4-22.4). Conclusion These results establish the feasibility of a larger scale randomised controlled trial that enrols older adults with metastatic GI cancer and delivers a structured physical activity programme during chemotherapy. Trial registration number NCT03331406.
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Affiliation(s)
- Justin C Brown
- Cancer Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.,Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Elizabeth Brighton
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy Campbell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas A Abrams
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James M Cleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Peter C Enzinger
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Douglas Rubinson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew B Yurgelun
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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22
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Keats MR, Grandy SA, Blanchard C, Fowles JR, Neyedli HF, Weeks AC, MacNeil MV. The Impact of Resistance Exercise on Muscle Mass in Glioblastoma in Survivors (RESIST): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e37709. [PMID: 35507403 PMCID: PMC9118089 DOI: 10.2196/37709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Glioblastoma is the most common primary brain malignancy in adults, accounting for approximately 48% of all brain tumors. Standard treatment includes radiation and temozolomide chemotherapy. Glioblastomas are highly vascular and can cause vasogenic brain edema and mass effect, which can worsen the neurologic symptoms associated with the disease. The steroid dexamethasone (DEX) is the treatment of choice to reduce vasogenic edema and intracranial pressure associated with glioblastoma. However high-dose DEX or long-term use can result in muscle myopathy in 10%-60% of glioblastoma patients, significantly reducing functional fitness and quality of life (QOL). There is a wealth of evidence to support the use of exercise as an adjuvant therapy to improve functional ability as well as help manage treatment-related symptoms. Specifically, resistance training has been shown to increase muscle mass, strength, and functional fitness in aging adults and several cancer populations. Although studies are limited, research has shown that exercise is safe and feasible in glioblastoma populations. However, it is not clear whether resistance training can be successfully used in glioblastoma to prevent or mitigate steroid-induced muscle myopathy and associated loss of function. Objective The primary purpose of this study is to establish whether an individualized circuit-based program will reduce steroid-induced muscle myopathy, as indicated by maintained or improved functional fitness for patients on active treatment and receiving steroids. Methods This is a 2-armed, randomized controlled trial with repeated measures. We will recruit 38 adult (≥18 years) patients diagnosed with either primary or secondary glioblastoma who are scheduled to receive standard radiation and concurrent and adjuvant temozolomide chemotherapy postsurgical debulking and received any dose of DEX through the neurooncology clinic and the Nova Scotia Health Cancer Center. Patients will be randomly allocated to a standard of care waitlist control group or standard of care + circuit-based resistance training exercise group. The exercise group will receive a 12-week individualized, group and home-based exercise program. The control group will be advised to maintain an active lifestyle. The primary outcome, muscle myopathy (functional fitness), will be assessed using the Short Physical Performance Battery and hand grip strength. Secondary outcome measures will include body composition, cardiorespiratory fitness, physical activity, QOL, fatigue, and cognitive function. All measures will be assessed pre- and postintervention. Participant accrual, exercise adherence, and safety will be assessed throughout the study. Results This study has been funded by the Canadian Cancer Society Atlantic Cancer Research Grant and the J.D. Irving Limited–Excellence in Cancer Research Fund (grant number 707182). The protocol was approved by the Nova Scotia Health and Acadia University’s Research Ethics Boards. Enrollment is anticipated to begin in March 2022. Conclusions This study will inform how individualized circuit-based resistance training may improve functional independence and overall QOL of glioblastoma patients. Trial Registration ClinicalTrails.gov NCT05116137; https://www.clinicaltrials.gov/ct2/show/NCT05116137 International Registered Report Identifier (IRRID) DERR1-10.2196/37709
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Affiliation(s)
- Melanie R Keats
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,Division of Medical Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Scott A Grandy
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,Division of Medical Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Christopher Blanchard
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Heather F Neyedli
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Adrienne C Weeks
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Mary V MacNeil
- Division of Medical Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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23
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Loh KP, Sanapala C, Janelsins M, Klepin HD, Schnall R, Culakova E, Sohn MB, Vertino P, Susiarjo M, Jensen-Battaglia M, Becker MW, Liesveld J, Mendler JH, Huselton E, Lin PJ, Mustian K. Protocol for a pilot randomized controlled trial of a mobile health exercise intervention for older patients with myeloid neoplasms (GO-EXCAP 2). J Geriatr Oncol 2022; 13:545-553. [PMID: 34949540 PMCID: PMC9058183 DOI: 10.1016/j.jgo.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We have shown the Exercise for Cancer Patients (EXCAP©®) exercise program improved physical function and symptoms and reduced inflammatory markers in patients with cancer. However, adherence to exercise was lower in older adults compared to their younger counterparts. We then leveraged a mobile app to deliver EXCAP©® and adapted the intervention [Geriatric-Oncology (GO)-EXCAP] for older patients with myeloid neoplasms. In this pilot randomized trial, the primary goal is to determine effect sizes. We propose to assess the preliminary efficacy of GO-EXCAP compared to a behavioral placebo control on physical function, patient-reported outcomes (fatigue, mood, and quality of life), and inflammatory markers in 100 patients aged ≥60 years with myeloid neoplasms receiving outpatient chemotherapy. METHODS GO-EXCAP consists of the EXCAP©® exercise prescription (daily home-based progressive aerobic walking and resistance exercises with rated perceived exercise of 5-8), EXCAP©® kit (i.e., activity tracker, resistance bands, print manual, bag), a mobile app, and an in-person or virtual session with the exercise physiologist to deliver exercise prescription. The intervention will last for three cycles of chemotherapy (approximately 12 weeks). The primary outcome measure will be physical function (Short Physical Performance Battery). Secondary outcome measures include fatigue (Brief Fatigue Inventory), mood (Center for Epidemiologic Studies Depression Scale), and quality of life (Functional Assessment of Cancer Therapy-Leukemia). Exploratory outcome measures include inflammatory markers. DISCUSSION Older adults with myeloid neoplasms receiving outpatient chemotherapy serve as an ideal model for studying an individually tailored mobile health exercise intervention in vulnerable older patients receiving cancer treatments to prevent physical function decline and improve symptoms.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Michelle Janelsins
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, USA.
| | | | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Michael B Sohn
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA.
| | - Paula Vertino
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Michael W Becker
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Po-Ju Lin
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Karen Mustian
- James P. Wilmot Cancer Institute, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
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Cross-sectional analysis of myosteatosis and physical function in pretreatment head and neck cancer patients. Support Care Cancer 2022; 30:3401-3408. [PMID: 34999952 DOI: 10.1007/s00520-022-06808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Head and neck cancer (HNC) and its treatment are associated with muscle weakness and considerable long-term comorbidity. The goal of this study was to determine whether skeletal muscle density (SMD) as quantified from pretreatment computed tomography (CT) scans will correlate with measures of function and strength prior to treatment in physical function in HNC patients. PATIENTS AND METHODS A cross-sectional analysis was conducted on 90 HNC patients. SMD (myosteatosis vs. normal) was calculated from pretreatment CT scans using SliceOmatic software. Pretreatment physical function was assessed via handgrip strength (HGS), the timed up and go test (TUG), and the short physical performance battery (SPPB). Demographic, cancer, and social characteristics were also collected as confounders. Linear regression models assessed the association between myosteatosis and measures of physical function. RESULTS The 90 patients were predominately White, male, former smokers with an average BMI of 28.7 ± 5.7 kg/m2. Among men, adjusted models indicate, as compared to those with normal muscle density, the total SPPB score of those with myosteatosis was 1.57 points lower (p = 0.0008), HGS was 0.85 kg lower (p = 0.73), and TUG took 1.34 s longer (p = 0.03). There were no differences in women. CONCLUSION Myosteatosis is associated with physical function prior to treatment in HNC patients. Larger studies are needed to examine the importance of exercise programs prior to and during treatment to build lean mass and improve long-term prognosis in HNC.
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Stäuber A, Heydenreich M, Wright PR, Großmann S, Grusdat N, Zermann DH, Schulz H. Bioelectrical Impedance Vector Pattern and Biomarkers of Physical Functioning of Prostate Cancer Survivors in Rehabilitation. Rehabil Process Outcome 2022; 10:11795727211064156. [PMID: 34987305 PMCID: PMC8689438 DOI: 10.1177/11795727211064156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Knowledge of clinically established factors of physical function such as body
composition, bioelectrical phase angle (PhA) and handgrip strength (HGS)
with mortality predictive and health-related relevance is limited in
prostate cancer survivors (PCS). Therefore, the aim of this study was to
characterise and compare body composition data of PCS with extensive
reference data as well as to analyse PhA and HGS and the prevalence of
critical prognostic values at an early stage of cancer survivorship. Methods: One hundred and forty-eight PCS were examined at the start (T1) and end (T2)
of a 3-week hospitalised urooncological rehabilitation, which began median
28 days after acute cancer therapy. Examinations included a bioimpedance
analysis and HGS test. Comparison of body composition between PCS and
reference data was performed using bioimpedance vector analysis (BIVA). Results: BIVA of the whole PCS group showed abnormal physiology with a cachectic state
and a state of overhydration/oedema, without significant changes between T1
and T2. The age- and BMI-stratified subgroup analysis showed that PCS aged
60 years and older had this abnormal pattern compared to the reference
population. HGS (T1: 38.7 ± 8.9 vs T2: 40.8 ± 9.4, kg), but not PhA (T1/T2:
5.2 ± 0.7, °), changed significantly between T1 and T2. Values below a
critical threshold reflecting a potentially higher risk of mortality and
impaired function were found for PhA in 20% (T1) and 22% (T2) of PCS and in
41% (T1) and 29% (T2) for HGS. Conclusions: BIVA pattern and the prevalence of critically low HGS and PhA values
illustrate the necessity for intensive continuation of rehabilitation and
survivorship care especially in these ‘at risk’ cases. The routine
assessment of body composition, PhA and HGS offer the opportunity to conduct
a risk stratification for PCS and could help personalising and optimising
treatment in rehabilitation and ongoing survivorship care.
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Affiliation(s)
- Alexander Stäuber
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Marc Heydenreich
- Division of Sports and Training Science, Vogtland-Klinik Bad Elster, Bad Elster, Germany
| | - Peter R Wright
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Steffen Großmann
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Niklas Grusdat
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Dirk-Henrik Zermann
- Division of Sports and Training Science, Vogtland-Klinik Bad Elster, Bad Elster, Germany.,Department of Urology & Urooncology, Vogtland-Klinik Bad Elster, Bad Elster, Germany
| | - Henry Schulz
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
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Gorzelitz JS, Stoller S, Costanzo E, Gangnon R, Koltyn K, Dietz AT, Spencer RJ, Rash J, Cadmus-Bertram L. Improvements in strength and agility measures of functional fitness following a telehealth-delivered home-based exercise intervention in endometrial cancer survivors. Support Care Cancer 2022; 30:447-455. [PMID: 34304292 PMCID: PMC9362897 DOI: 10.1007/s00520-021-06415-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Endometrial cancer is strongly linked to obesity and inactivity; however, increased physical activity has important benefits even in the absence of weight loss. Resistance (strength) training can deliver these benefits; yet few women participate in resistance exercise. The purpose of this study was to describe both physiological and functional changes following a home-based strength training intervention. METHODS Forty post-treatment endometrial cancer survivors within 5 years of diagnosis were enrolled in a pilot randomized trial, comparing twice-weekly home-based strength exercise to wait list control. Participants conducted the exercises twice per week for 10 supervised weeks with 5 weeks of follow-up. Measures included DXA-measured lean mass, functional fitness assessments, blood biomarkers, and quality of life outcomes. RESULTS On average, participants were 60.9 years old (SD = 8.7) with BMI of 39.9 kg/m2 (SD = 15.2). At baseline, participants had 51.2% (SD = 6.0) body fat, which was not different between groups. Improvements were seen in the 30-s chair sit to stand (d = .99), the 30-s arm curl (d = .91), and the 8-ft up-and-go test (d = .63). No changes were measured for HbA1c or C-reactive protein. No changes were observed for flexibility (chair sit and reach, back scratch tests), 6-min walk test, maximum handgrip test, anxiety, depression, fatigue, or self-efficacy for exercise. CONCLUSIONS Home-based muscle-strengthening exercise led to favorable and clinically relevant improvements in 3 of 7 physical function assessments. Physical function, body composition, blood biomarkers, and patient-reported outcomes were feasible to measure. These fitness improvements were observed over a relatively short time frame of 10 weeks.
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Affiliation(s)
- Jessica S Gorzelitz
- Department of Kinesiology, University of Wisconsin-Madison, 1300 University Ave, Bardeen 253A, Madison, WI, 53706, USA
| | - Stefanie Stoller
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Erin Costanzo
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Ronald Gangnon
- Departments of Biostatistics & Medical Informatics, and Statistics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Kelli Koltyn
- Department of Kinesiology, University of Wisconsin-Madison, 1300 University Ave, Bardeen 253A, Madison, WI, 53706, USA
| | - Amy Trentham Dietz
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan J Spencer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin-Madison, Madison, WI, USA
| | - Joanne Rash
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lisa Cadmus-Bertram
- Department of Kinesiology, University of Wisconsin-Madison, 1300 University Ave, Bardeen 253A, Madison, WI, 53706, USA.
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de Fátima Ribeiro Silva C, Ohara DG, Matos AP, Pinto ACPN, Pegorari MS. Short Physical Performance Battery as a Measure of Physical Performance and Mortality Predictor in Older Adults: A Comprehensive Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010612. [PMID: 34682359 PMCID: PMC8535355 DOI: 10.3390/ijerph182010612] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/04/2023]
Abstract
The association between the Short Physical Performance Battery (SPPB) score and several adverse health outcomes, including mortality, has been reported in the scientific literature. We conducted a comprehensive literature review of studies on the relationship between SPPB and mortality. The current paper synthesizes the characteristics and main findings of longitudinal studies available in the literature that investigated the role of the SPPB in predicting mortality in older adults. The studies (n = 40) are from North America, South America, Europe, and Asia; the majority (n = 16) were conducted with community-dwelling older adults and reported an association between lower SPPB scores and a higher risk of mortality, and between higher SPPB scores and higher survival. Nevertheless, few studies have analyzed the accuracy of the instrument to predict mortality. The only study that established cut-off points was conducted with older adults discharged from an acute care hospital. Although an SPPB score lower than 10 seems to predict all-cause mortality, further studies showing cut-off points in specific settings and loco-regional specificities are still necessary.
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Kiss NK, Denehy L, Edbrooke L, Prado CM, Ball D, Siva S, Abbott G, Ugalde A, Fraser SF, Everitt S, Hardcastle N, Wirth A, Daly RM. Predicting muscle loss during lung cancer treatment (PREDICT): protocol for a mixed methods prospective study. BMJ Open 2021; 11:e051665. [PMID: 34580100 PMCID: PMC8477324 DOI: 10.1136/bmjopen-2021-051665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Low muscle mass and low muscle attenuation (radiodensity), reflecting increased muscle adiposity, are prevalent muscle abnormalities in people with lung cancer receiving curative intent chemoradiation therapy (CRT) or radiation therapy (RT). Currently, there is a limited understanding of the magnitude, determinants and clinical significance of these muscle abnormalities in the lung cancer CRT/RT population. The primary objective of this study is to identify the predictors of muscle abnormalities (low muscle mass and muscle attenuation) and their depletion over time in people with lung cancer receiving CRT/RT. Secondary objectives are to assess the magnitude of change in these parameters and their association with health-related quality of life, treatment completion, toxicities and survival. METHODS AND ANALYSIS Patients diagnosed with lung cancer and planned for treatment with CRT/RT are invited to participate in this prospective observational study, with a target of 120 participants. The impact and predictors of muscle abnormalities (assessed via CT at the third lumbar vertebra) prior to and 2 months post CRT/RT on the severity of treatment toxicities, treatment completion and survival will be assessed by examining the following variables: demographic and clinical factors, weight loss, malnutrition, muscle strength, physical performance, energy and protein intake, physical activity and sedentary time, risk of sarcopenia (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls history (SARC-F) score alone and with calf-circumference) and systemic inflammation. A sample of purposively selected participants with muscle abnormalities will be invited to take part in semistructured interviews to understand their ability to cope with treatment and explore preference for treatment strategies focused on nutrition and exercise. ETHICS AND DISSEMINATION The PREDICT study received ethics approval from the Human Research Ethics Committee at Peter MacCallum Cancer Centre (HREC/53147/PMCC-2019) and Deakin University (2019-320). Findings will be disseminated through peer review publications and conference presentations.
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Affiliation(s)
- Nicole K Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Lara Edbrooke
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Carla M Prado
- Department of Agricultural, Food and Nutrition Science, University of Alberta, Edmonton, Alberta, Canada
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery and Institute of Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Sarah Everitt
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Medical Imaging and Radiation Therapy Services, Monash University, Clayton, Victoria, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Andrew Wirth
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Depression Moderates Physical Functioning Over Time in Survivors of Cancer. REHABILITATION ONCOLOGY 2021; 39:E98-E105. [DOI: 10.1097/01.reo.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Blackwood J, Rybicki K. Physical function measurement in older long-term cancer survivors. J Frailty Sarcopenia Falls 2021; 6:139-146. [PMID: 34557613 PMCID: PMC8419850 DOI: 10.22540/jfsf-06-139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To establish reliability, validity, and minimal detectable change in measures of function in older long-term cancer survivors. METHODS Older cancer survivors were recruited to perform functional measures; 5 Times Sit-to-Stand (5xSTS), 30-second Timed Chair Rise (30sTCR), Short Physical Performance Battery (SPPB), Physical Performance Test-7 (PPT-7). Two testing sessions were completed two weeks apart. Test-retest reliability was examined using the intraclass correlation coefficient (ICC2,1), convergent and discriminant validity using Spearman's rho and Minimal Detectable Change (MDC95) was calculated. RESULTS Forty-seven older long-term cancer survivors participated. Test-retest reliability was good for 5xSTS (ICC2,1=0.86), 30sTCR (ICC2,1=0.89), and SPPB (ICC2,1=0.85) and poor for PPT-7 (ICC2,1=0.48). Both convergent and discriminant validity was established. CONCLUSIONS SPPB, 5xSTS, and 30sTCR are reliable and valid tools to measure function in older long-term cancer survivors. MDC95 values were larger than those reported in geriatrics and should be interpreted with caution. Residual effects of cancer treatment, comorbidity, and physical inactivity may contribute to decreased physical function in older long-term cancer survivors, therefore valid and reliable measures like SPPB and the timed chair rise tests should be used objectively measure function throughout the survivorship spectrum.
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Affiliation(s)
| | - Kateri Rybicki
- Physical Therapy Department, University of Michigan-Flint, USA
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Medina HN, Liu Q, Cao C, Yang L. Balance and vestibular function and survival in US cancer survivors. Cancer 2021; 127:4022-4029. [PMID: 34265083 DOI: 10.1002/cncr.33787] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cancer and its treatment damage the musculoskeletal system and induce neurotoxicity, affecting the key sensory inputs for maintaining balance. The present study describes the pattern of balance impairment and evaluated its association with mortality among US cancer survivors. METHODS Data on a nationally representative sample of cancer survivors from the US National Health and Nutrition Examination Survey from 1999 to 2015 was analyzed. Sensory-specific balance impairment was measured at baseline by the modified Romberg test of standing balance on firm and compliant support surfaces. The linked mortality data were updated through December 31, 2015. RESULTS Among 511 cancer survivors, 282 (48.3%) had a balance impairment, predominantly attributing to vestibular dysfunction (251; 89.0% of 282 and 44.5% of 511). A higher prevalence of balance impairment was observed among cancer survivors with advanced age, lower socioeconomic status or educational attainment, body mass index <25 kg/m2 , and an inactive lifestyle. During up to 16.4 years of follow-up (median, 11.3 years; 5088 person-years), 253 cancer survivors had died. Cancer survivors with a balance impairment had a 63% higher risk of death from all causes (hazard ratio, 1.63; 95% confidence interval [CI], 1.12-2.38) after adjusting for sociodemographic factors, comorbidities, and cancer type. Specifically, those with vestibular dysfunctions had approximately 1.54 (95% CI, 1.05-2.27) times the risk of death compared to those without any balance impairment. These associations were stronger in males than in females. CONCLUSIONS In a US nationally representative sample of cancer survivors, balance impairment and vestibular dysfunctions were prevalent and associated with heightened all-cause mortality.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Qinran Liu
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, Ma SJ, Gu F, Singh AK, Ray AD. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel) 2021; 13:cancers13071638. [PMID: 33915867 PMCID: PMC8037640 DOI: 10.3390/cancers13071638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies. Abstract Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Dietetics, D’Youville College, Buffalo, NY 14203, USA
| | - Wenyan Ji
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Rehabilitation Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-716-845-2381; Fax: +1-716-845-8487
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Nakano J, Fukushima T, Tanaka T, Fu JB, Morishita S. Physical function predicts mortality in patients with cancer: a systematic review and meta-analysis of observational studies. Support Care Cancer 2021; 29:5623-5634. [PMID: 33770257 DOI: 10.1007/s00520-021-06171-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/18/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to determine whether physical function can predict mortality in patients with cancer. METHODS Literature searches were conducted in Web of Science, CINAHL, the Cochrane Library, ProQuest, PEDro, and PubMed for articles published before September 2020. Four review authors retrieved studies using predetermined eligibility criteria and conducted quality assessment and data extraction. RESULTS A total of 1356 titles and abstracts were screened; ultimately, 26 studies were determined to be suitable for meta-analysis. Grip strength was significantly associated with mortality risk in patients with cancer (hazard ratio [HR] = 1.15, P = 0.005). Gait speed was also associated with mortality risk (HR = 1.58, P = 0.0004). In grip strength and gait speed, the subgroup comprised of patients with cancer aged ≥ 80 years had a higher effect size than that of patients aged < 80 years. The short physical performance battery measurement was markedly associated with mortality risk, showing the largest effect size (HR = 2.37, P < 0.00001). The 6-min walking test distance was significantly associated with mortality risk (HR = 1.55, P = 0.001). The timed up and go test was significantly associated with mortality risk with a high effect size (HR = 2.66, P < 0.00001). CONCLUSION This systematic review and meta-analysis demonstrated that physical function predicted mortality in patients with cancer. Furthermore, physical function outcomes in patients aged 80 years and above reflected a higher mortality.
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Affiliation(s)
- Jiro Nakano
- Department of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
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Rosko AE, Wall S, Baiocchi R, Benson DM, Brammer JE, Byrd JC, Efebera YA, Maddocks K, Rogers KA, Jones D, Sucheston-Campbell L, Tang H, Ozer HG, Huang Y, Burd CE, Naughton MJ. Aging Phenotypes and Restoring Functional Deficits in Older Adults With Hematologic Malignancy. J Natl Compr Canc Netw 2021; 19:1027-1036. [PMID: 33770752 DOI: 10.6004/jnccn.2020.7686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gauging fitness remains a challenge among older adults with hematologic malignancies, and interventions to restore function are lacking. We pilot a structured exercise intervention and novel biologic correlates of aging using epigenetic clocks and markers of immunosenescence to evaluate changes in function and clinical outcomes. METHODS Older adults (n=30) with hematologic malignancy actively receiving treatment were screened and enrolled in a 6-month exercise intervention, the Otago Exercise Programme (OEP). The impact of the OEP on geriatric assessment metrics and health-related quality of life were captured. Clinical outcomes of overall survival and hospital utilization (inpatient length of stay and emergency department use) in relationship to geriatric deficits were analyzed. RESULTS Older adults (median age, 75.5 years [range, 62-83 years]) actively receiving treatment were enrolled in the OEP. Instrumental activities of daily living and physical health scores (PHS) increased significantly with the OEP intervention (median PHS: visit 1, 55 [range, 0-100]; visit 2, 70 [range, 30-100]; P<.01). Patient-reported Karnofsky performance status increased significantly, and the improvement was sustained (median [range]: visit 1, 80 [40-100]; visit 3, 90 [50-100]; P=.05). Quality of life (Patient-Reported Outcome Measurement Information System [PROMIS]) improved significantly by the end of the 6-month period (median [range]: visit 1, 32.4 [19.9-47.7]; visit 3, 36.2 [19.9-47.7]; P=.01]. Enhanced measures of gait speed and balance, using the Short Physical Performance Battery scores, were associated with a 20% decrease in risk of death (hazard ratio, 0.80; 95% CI, 0.65-0.97; P=.03) and a shorter hospital length of stay (decrease of 1.29 days; 95% CI, -2.46 to -0.13; P=.03). Peripheral blood immunosenescent markers were analyzed in relationship to clinical frailty and reports of mPhenoAge epigenetic analysis are preliminarily reported. Chronologic age had no relationship to overall survival, length of stay, or emergency department utilization. CONCLUSIONS The OEP was effective in improving quality of life, and geriatric tools predicted survival and hospital utilization among older adults with hematologic malignancies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Christin E Burd
- 4Department of Molecular Genetics, Cancer Biology and Genetics, and
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Salerno EA, Saint-Maurice PF, Willis EA, Moore SC, DiPietro L, Matthews CE. Ambulatory Function and Mortality among Cancer Survivors in the NIH-AARP Diet and Health Study. Cancer Epidemiol Biomarkers Prev 2021; 30:690-698. [PMID: 33664017 DOI: 10.1158/1055-9965.epi-20-1473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/11/2020] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is limited evidence describing associations between cancer and function in diverse cancer types and its relationship with mortality. We investigated the relationship between cancer and poor ambulatory function and associations between ambulatory function and subsequent mortality. METHODS Participants included 233,135 adults (n = 30,403 cancer and n = 202,732 cancer free) in the NIH-American Association of Retired Persons Diet and Health Study (1994-1996) who self-reported ambulatory function (e.g., walking pace and mobility disability: being unable to walk or walking at the slowest pace) in 2004-2006. Participants were followed for mortality from the assessment of ambulatory function through 2011. Multinomial logistic regression quantified the association between cancer and ambulatory function. We then explored the independent effects of walking pace and mobility disability in cancer survivors, and the joint effects of both a cancer diagnosis and poor ambulatory function on mortality using Cox proportional hazards models. Models explored type-specific associations across 15 cancer types. RESULTS Survivors had 42% greater odds of walking at the slowest pace [OR, 1.42 (confidence interval (CI), 1.30-1.54)] and 24% greater odds of mobility disability [OR, 1.24 (CI, 1.17-1.31)], compared with cancer-free participants, adjusting for baseline demographics, health indicators, and cancer type. Survivors reporting the slowest pace were at increased hazards than those who walked the fastest: all-cause mortality [HR, 2.22 (CI, 2.06-2.39)] and cancer mortality [HR, 2.12 (CI, 1.83-2.45)]. Similar trends emerged for mobility disability (HRs > 1.64). All-cause mortality associations were significant for more than nine cancer types. CONCLUSIONS A diagnosis of cancer is associated with poorer ambulatory function, which is subsequently associated with increased mortality. IMPACT Widespread efforts should target ambulatory function during cancer survivorship for survival benefits.
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Affiliation(s)
- Elizabeth A Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri. .,Cancer Prevention Fellowship Program, Division of Cancer Prevention, NCI, Rockville, Maryland.,Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, NCI, Bethesda, Maryland
| | - Pedro F Saint-Maurice
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, NCI, Bethesda, Maryland
| | - Erik A Willis
- Children's Healthy Weight Research Group, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina
| | - Steven C Moore
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, NCI, Bethesda, Maryland
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, D.C
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, NCI, Bethesda, Maryland
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36
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Ezzatvar Y, Ramírez-Vélez R, Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Izquierdo M, García-Hermoso A. Physical Function and All-Cause Mortality in Older Adults Diagnosed With Cancer: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2020; 76:1447-1453. [PMID: 33421059 DOI: 10.1093/gerona/glaa305] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Physical function is an independent predictor of numerous chronic diseases, but its association with all-cause mortality in older adults diagnosed with cancer has received little attention. The aim of this study was to conduct a systematic review and meta-analysis on the prospective association between physical function and all-cause mortality in older adults diagnosed with cancer. METHODS Two authors systematically searched MEDLINE, EMBASE, and SPORTDiscus databases. Prospective studies reporting associations of baseline physical function with all-cause mortality in patients aged 60 years or older diagnosed with any type of cancer were included. Hazard ratios (HR) with associated 95% confidence intervals (CI) were extracted from studies for all-cause mortality, and pooled HRs were then calculated using the random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment. RESULTS Data from 25 studies with 8109 adults diagnosed with cancer aged 60 and older were included in the study. Higher levels of physical function (short physical performance battery, HR = 0.44, 95% CI 0.29-0.67; I2 = 16.0%; timed up and go, HR = 0.40, 95% CI 0.31-0.53; I2 = 61.9%; gait speed, HR = 0.41, 95% CI 0.17-0.96; I2 = 73.3%; handgrip strength: HR = 0.61 95% CI 0.43-0.85, I2 = 85.6%; and overall, HR = 0.45 95% CI 0.35-0.57; I2 = 88.6%) were associated with a lower risk of all-cause mortality compared to lower levels of functionality. Neither age at baseline nor length of follow-up had a significant effect on the HR estimates for lower all-cause mortality risk. CONCLUSION Physical function may exert an independent protective effect on all-cause mortality in older adults diagnosed with cancer.
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Affiliation(s)
- Yasmin Ezzatvar
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, Universitat de València, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Chile
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Bluethmann SM, Flores E, Campbell G, Klepin HD. Mobility Device Use and Mobility Disability in U.S. Medicare Beneficiaries With and Without Cancer History. J Am Geriatr Soc 2020; 68:2872-2880. [PMID: 32971567 PMCID: PMC8347693 DOI: 10.1111/jgs.16789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES To examine the prevalence of mobility device use in U.S. community-dwelling older adults including older adults with cancer history ("survivors") and to estimate mobility disability noting variation by cancer history, cancer site, and other factors to improve early detection of mobility limitations. DESIGN Cross-sectional analysis from the 2011 National Health and Aging Trends Study. SETTING In-person interviews in the homes of study participants. PARTICIPANTS Nationally representative sample of community-dwelling Medicare beneficiaries, aged 65 and older (n = 6,080 including 1,203 survivors). MEASUREMENTS Participants were asked about cancer history, pain that limited activity, mobility device use (eg, canes, walkers, wheelchairs, and scooters), history of falls, and medical conditions plus they were assessed for approximate mobility disability using a 3-m gait speed test. The results were scored on a scale of 0 to 4 (0 = lowest, 4 = highest) using criteria from the National Institute on Aging. RESULTS A total of 19% of older adults and 23% of survivors reported using one or more mobility device, most commonly a single-point cane. Approximately 10% of breast, 6% of prostate, and 3% of colorectal cancer survivors reported using two or more devices in the past month. Survivors had lower mean gait speed scores (2.27) than adults without cancer history (2.39). In regression models, survivors were 18% less likely than adults without cancer history to score high on the gait speed test (odds ratio = .82; P < .05). Prior mobility device use, history of multiple falls, unhealthy weight, Black race, multimorbidity, and pain that limited activity were associated with lower gait speed scores in all participants (all P < .05). CONCLUSION A greater proportion of older survivors used mobility devices than adults without cancer history. Mobility device use varied by cancer site and was highest in survivors of breast, colorectal, and gynecological cancer. Survivors were also more likely to show signs of mobility disability, based on gait speed, compared with adults without cancer history. These indications, although modest, suggest that older survivors may require special attention to functional changes in survivorship.
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Affiliation(s)
- Shirley M. Bluethmann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA
| | - Eileen Flores
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA
| | - Grace Campbell
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Heidi D. Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
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38
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Guida JL, Holt CL, Dallal CM, He X, Gold R, Liu H. Social Relationships and Functional Impairment in Aging Cancer Survivors: A Longitudinal Social Network Study. THE GERONTOLOGIST 2020; 60:607-616. [PMID: 31050729 DOI: 10.1093/geront/gnz051] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/09/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The intersection of cancer, treatment, and aging accelerates functional decline. Social networks, through the provision of social support and resources, may slow the progression of functional deterioration. Socioemotional selectivity theory posits that aging and major life events, like cancer, cause an intentional social network pruning to procure and maintain emotionally fulfilling bonds, while shedding weaker, less supportive relationships. However, it is relatively unknown if such network changes impact functional impairment in cancer survivors. This study examined the relationships between changes in the egocentric social network and functional impairment in older adult cancer survivors and a similarly aged group without cancer (older adults). RESEARCH DESIGN AND METHODS Data were analyzed from 1,481 community dwelling older adults (n = 201 cancer survivors) aged 57-85 years, from Waves 1 and 2 (2005-2006 and 2010-2011) of the National Social Life, Health and Aging Project. Associations were analyzed with multiple logistic regression. RESULTS Cancer survivors and older adults reported similar levels of functional impairment and social network change. Adding 2 new relationships exhibited protective effects against functional impairment, irrespective of cancer status (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.41-0.99). Declines in frequent contact were associated with higher odds of functional impairment among cancer survivors (OR: 1.92, 95% CI: 1.15-3.20). Social network components were not significantly associated with functional impairment in older adults. DISCUSSION AND IMPLICATIONS Adding new relationships may reduce disability in older adults and increasing network contact may help cancer survivors remain independent. Social network interventions may improve quality of life for older adults.
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Affiliation(s)
- Jennifer L Guida
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Populations Sciences, National Cancer Institute, Bethesda, Maryland
| | - Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park
| | - Cher M Dallal
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
| | - Robert Gold
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
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Hong I, Hreha K, Swartz MC, Pappadis MR, Yoo K, Ko M. Differences in physical function across cancer recovery phases: Findings from the 2015 National Health Interview Survey. Br J Occup Ther 2020; 84:135-143. [PMID: 33879954 DOI: 10.1177/0308022620944071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Recent cancer survivors (<2 years post-diagnosis) report poorer general health and physical weakness compared to long-term cancer survivors (≥2 years post-diagnosis), but differences in functional limitations are unknown. It is unclear which daily tasks are more difficult for recent versus long-term survivors. We aimed to examine differences in functional performances across cancer recovery phases as potential targets for functional impairment screening. Method The cohort consisted of adults with a cancer history in the 2015 National Health Interview Survey (n=2372). Multivariate logistic regression models were used to estimate the odds of having difficulty in health-related outcomes across the cancer recovery phases (recent versus long-term). Results Most subjects were long-term survivors (84.9%). Recent survivors were more likely to have difficulty in work, mobility-related daily tasks and social participation compared to long-term survivors. No differences were found in basic activities of daily living, cognition and emotional functioning between the groups. Conclusion While recent cancer survivors were independent in basic daily tasks, they had difficulties in performing daily tasks that required a high level of physical function. Clinicians, especially occupational therapists, should prioritize evaluating physical functioning to guide intervention planning for recent cancer survivors.
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Affiliation(s)
- Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Kimberly Hreha
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria Chang Swartz
- Department of Pediatrics-Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monique R Pappadis
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyungtae Yoo
- Department of Physical Therapy, Namseoul University, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Mansoo Ko
- Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, USA
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40
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Bland KA, Zopf EM, Harrison M, Ely M, Cormie P, Liu E, Dowd A, Martin P. Prognostic Markers of Overall Survival in Cancer Patients Attending a Cachexia Support Service: An Evaluation of Clinically Assessed Physical Function, Malnutrition and Inflammatory Status. Nutr Cancer 2020; 73:1400-1410. [PMID: 32757683 DOI: 10.1080/01635581.2020.1800765] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer cachexia is a muscle-wasting syndrome that results in physical function impairments and decreased survival. While body weight and muscle mass loss predict survival, the prognostic significance of physical function in this population is unclear. Thus, we evaluated the association between physical function, and other routine measures, and overall survival (OS) in cancer patients attending a cachexia support service. METHODS Physical function was clinically-assessed using the 30 s sit-to-stand test and handgrip strength. Six-month weight loss, the Patient-Generated Subjective Global Assessment (PG-SGA) total score, C-reactive protein (CRP), albumin, and quality of life were also evaluated. RESULTS Records from 203 patients (age: 68.6 ± 11.6 years) were included. Handgrip strength did not predict OS. Sit-to-stand repetitions predicted OS in the single variable, but not the multivariable analysis. Multivariable results suggested higher PG-SGA total scores (HR: 1.04, 95% CI: 1.01-1.07), six-month weight loss (HR: 1.02, 95% CI: 1.004-1.04), and elevated CRP (HR: 1.004, 95% CI: 1.0004-1.01) predicted shorter OS. Higher albumin predicted longer OS (HR: 0.93, 95% CI: 0.90-0.97). CONCLUSION Six-month weight loss, the PG-SGA total score, CRP, and albumin independently predicted survival, while physical function did not. Functional impairments remain a hallmark of cancer cachexia and the benefit of their routine assessment warrants further exploration, especially in relation to patient quality of life.
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Affiliation(s)
- Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Meg Harrison
- Palliative Care, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Matthew Ely
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Anna Dowd
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Peter Martin
- Palliative Care, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Melbourne, Victoria, Australia
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Simcock R, Wright J. Beyond Performance Status. Clin Oncol (R Coll Radiol) 2020; 32:553-561. [PMID: 32684503 PMCID: PMC7365102 DOI: 10.1016/j.clon.2020.06.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of oncology. The wide prevalence of the ECOG PS attests to its proven utility and worth to help triage patient treatment. The ECOG PS is problematic. It is a unidimensional functional score. It is mostly physician assessed, subjective and therefore open to bias. It fails to account for multimorbidity, frailty or cognition. Too often the PS is recorded only once in wilful ignorance of a patient's changing physical state. As modern oncology offers an ever-widening array of therapies that are ‘personalised’ to tumour genotype, modern oncologists must strive to better define patient phenotype. Using a wider range of scoring and assessment tools, oncologists can identify deficits that may be reversed or steps taken to mitigate detrimental effects of treatment. These tools can function well to identify those patients who would benefit from comprehensive assessment. This overview identifies the strengths of ECOG PS but highlights the weaknesses and where these are supported by other measures. A strong recommendation is made here to move to routine use of the Clinical Frailty Score to start to triage patients and most appropriately design treatments and rehabilitation interventions.
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Affiliation(s)
- R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
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Schaffer K, Panneerselvam N, Loh KP, Herrmann R, Kleckner IR, Dunne RF, Lin PJ, Heckler CE, Gerbino N, Bruckner LB, Storozynsky E, Ky B, Baran A, Mohile SG, Mustian KM, Fung C. Systematic Review of Randomized Controlled Trials of Exercise Interventions Using Digital Activity Trackers in Patients With Cancer. J Natl Compr Canc Netw 2020; 17:57-63. [PMID: 30659130 DOI: 10.6004/jnccn.2018.7082] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Background: Exercise can ameliorate cancer- and treatment-related toxicities, but poor adherence to exercise regimens is a barrier. Exercise interventions using digital activity trackers (E-DATs) may improve exercise adherence, but data are limited for patients with cancer. We conducted a systematic review examining the feasibility of E-DATs in cancer survivors and effects on activity level, body composition, objective fitness outcomes, health-related quality of life (HRQoL), self-reported symptoms, and biomarkers. Methods: We identified randomized controlled trials (RCTs) of E-DATs in adult cancer survivors published in English between January 1, 2008, and July 27, 2017. Two authors independently reviewed article titles (n=160), removed duplicates (n=50), and reviewed the remaining 110 articles for eligibility. Results: A total of 12 RCTs met eligibility criteria, including 1,450 patients (mean age, 50-70 years) with the following cancers: breast (n=5), colon or breast (n=2), prostate (n=1), acute leukemia (n=1), or others (n=3). Duration of E-DATs ranged from 4 to 24 weeks, and the follow-up period ranged from 4 to 52 weeks, with retention rates of 54% to 95%. The technology component of E-DATs included pedometers (n=8); pedometers with smartphone application (n=1), Wii Fit (n=1), heart rate monitor (n=1); and a wireless sensor with accelerometer, gyroscope, and magnetometer (n=1). Adherence by at least one measure to E-DATs was >70% in 8 of 8 RCTs. Compared with controls, E-DATs significantly improved patients' step count in 3 of 5 RCTs, activity level in 6 of 9 RCTs, and HRQoL in 7 of 9 RCTs (all P≤05), with no significant changes in biomarkers (eg, interleukin 6, tumor necrosis factor α, C-reactive protein, c-peptide, lipid panel) in 3 RCTs. Duration of E-DAT was not significantly correlated with adherence or study retention. Conclusions: This systematic review shows that E-DATs are feasible to implement in cancer survivors. Future research should examine the optimal type, dose, and schedule of E-DATs for cancer survivors.
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“Katz activities of daily living disability in older cancer survivors by age, stage, and cancer type”. J Cancer Surviv 2020; 14:769-778. [DOI: 10.1007/s11764-020-00891-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
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Kneis S, Straub E, Walz ID, von Olshausen P, Wehrle A, Gollhofer A, Bertz H. Gait Analysis of Patients After Allogeneic Hematopoietic Cell Transplantation Reveals Impairments of Functional Performance. Integr Cancer Ther 2020; 19:1534735420915782. [PMID: 32368937 PMCID: PMC7236089 DOI: 10.1177/1534735420915782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: After allogeneic hematopoietic cell transplantation
(alloHCT), patients often report functional impairments like reduced gait speed
and muscle weakness. These impairments can increase the risk of adverse health
events similar to elderly populations. However, they have not been quantified in
patients after alloHCT (PATs). Methods: We compared fear of falling
(Falls Efficacy Scale–International) and temporal gait parameters recorded on a
10-m walkway at preferred and maximum gait speed and under dual-task walking of
16 PATs (aged 31-73 years) with 15 age-matched control participants (CONs) and
17 seniors (SENs, aged >73 years). Results: Groups’ gait
parameters especially differed during the maximum speed condition: PATs walked
slower and required more steps/10 m than CONs. PATs exhibited greater stride,
stance, and swing times than CONs. PATs’ swing time was even longer than SENs’.
The PATs’ ability to accelerate their gait speed from preferred to fast was
smaller compared with CONs’. PATs reported a greater fear of falling than CONs
and SENs. Conclusion: Gait analysis of alloHCT patients has
revealed impairments of functional performance. Patients presented a diminished
ability to accelerate gait and extending steps possibly related to a notable
strength deficit that impairs power-generation abilities from lower extremities.
Furthermore, patients reported a greater fear of falling than control
participants and even seniors. Slowing locomotion could be a risk-preventive
safety strategy. Since functional disadvantages may put alloHCT patients at a
higher risk of frailty, reinforcing appropriate physical exercises already
during and after alloHCT could prevent adverse health events and reduce the risk
of premature functional aging.
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Affiliation(s)
- Sarah Kneis
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
| | - Elisa Straub
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
- Department of Psychology, University of
Freiburg, Freiburg, Germany
| | - Isabelle Daniela Walz
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
| | - Philipp von Olshausen
- Currently at Fraunhofer Institute for
Physical Measurement Techniques IPM, Freiburg, Germany
| | - Anja Wehrle
- Institute for Exercise- and Occupational
Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University
of Freiburg, Freiburg, Germany
- Department of Sport and Sport Science,
University of Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science,
University of Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I, Medical Center
– University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
- Hartmut Bertz, Department of Medicine I,
Medical Centre—University of Freiburg, Hugstetterstr 55, Freiburg 79106,
Germany.
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45
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Santagnello SB, Martins FM, de Oliveira Junior GN, de Freitas Rodrigues de Sousa J, Nomelini RS, Murta EFC, Orsatti FL. Improvements in muscle strength, power, and size and self-reported fatigue as mediators of the effect of resistance exercise on physical performance breast cancer survivor women: a randomized controlled trial. Support Care Cancer 2020; 28:6075-6084. [PMID: 32306100 DOI: 10.1007/s00520-020-05429-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/23/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To gain more knowledge about the mechanism (i.e., mediators) of resistance exercise (RE)-induced improvements in physical performance (PP), we seek to investigate whether improvements in muscle strength (MS), muscle power (MP), and lean body mass (LBM) and (or) self-reported fatigue (SRF) are mediators of the effect of RE on PP in breast cancer survivor women (BCSW). METHODS The volunteers were randomly divided into two groups: control group (CT; n = 9) and resistance exercise (RE; n = 11). The RE protocol consisted of three sets in each exercise (leg extension, leg curl, 45° leg press, and calf raise), between 8 and 12 repetitions per set, with an estimated load of 80% of one-repetition maximum (1RM), and three times a week on non-consecutive days for 12 weeks. The CT group performed only stretching exercises twice a week. SRF, maximal muscle power (Pmax), MP, LBM, and PP were assessed using the Brief Fatigue Inventory Questionnaire; 1RM test; isoinertial dynamometer; DXA; and walking speed, sit-to-stand (STS), and timed up and go (TUG) test, respectively. RESULTS Following 12 weeks, the RE group reduced SRF and increased MP, Pmax, LBM, and performance in all tests (walking speed, STS, and TUG) when compared with the CT group. There were significant associations of the changes in LBM, MS, Pmax, and SRF with changes in physical performance tests only in the RE group. CONCLUSION Our findings suggest that improvements in LBM, MS, MP, and self-reported fatigue mediate the effect of resistance exercise on physical performance in BCSW.
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Affiliation(s)
- Samarita Beraldo Santagnello
- Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
| | - Fernanda Maria Martins
- Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | | | | - Rosekeila Simões Nomelini
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Eddie Fernando Candido Murta
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Fábio Lera Orsatti
- Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.,Department of Sport Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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46
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Effects of a Multicomponent Exercise Program in Older Adults with Non-Small-Cell Lung Cancer during Adjuvant/Palliative Treatment: An Intervention Study. J Clin Med 2020; 9:jcm9030862. [PMID: 32245169 PMCID: PMC7141539 DOI: 10.3390/jcm9030862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical intervention studies support the efficacy and safety of exercise programs as a treatment modality for non-small-cell lung cancer (NSCLC) during adjuvant/palliative treatment, but the effectiveness of real-world oncogeriatric services is yet to be established. We aimed to examine the effects of a 10-week structured and individualized multicomponent exercise program on physical/cognitive functioning and mental wellness in elderly patients with NSCLC under adjuvant therapy or palliative treatment. A non-randomized, opportunistic control, longitudinal-design trial was conducted on 26 patients with NSCLC stage I-IV. Of 34 eligible participants, 21 were allocated into two groups: (i) control group (n = 7) received usual medical care; and (ii) intervention group (n =19) received multicomponent program sessions, including endurance, strength, balance, coordination and stretching exercises. Tests included the Short Physical Performance Battery (SPPB), 5-m habitual Gait Velocity Test (GVT), Timed Up & Go Test (TUG), 6-Min Walk Test (6MWT), independence of activities in daily living (IADL), muscular performance, cognitive function, and quality of life, which were measured at baseline and after 10 weeks of the program. Results revealed a significant group×time interaction for SPPB (p = 0.004), 5-m GVT (p = 0.036), TUG (p = 0.007), and muscular performance (chest and leg power; p < 0.001). Similarly, significant changes were observed between groups for cognitive functioning (p = 0.021) and quality of life for EUROQoL 5D (p = 0.006). Our findings confirm that a multicomponent exercise program improves measures of physical/cognitive functioning and quality of life in the elderly with NSCLC under adjuvant therapy or palliative treatment. This is an interesting and important study that adds to our current body of knowledge on the safety of exercise interventions, especially in the elderly with solid tumors.
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Harrington SE, Stout NL, Hile E, Fisher MI, Eden M, Marchese V, Pfalzer LA. Cancer Rehabilitation Publications (2008-2018) With a Focus on Physical Function: A Scoping Review. Phys Ther 2020; 100:363-415. [PMID: 32043151 PMCID: PMC8204886 DOI: 10.1093/ptj/pzz184] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. PURPOSE This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. DATA SOURCES PubMed and CINAHL were searched up to September 2018. STUDY SELECTION Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. DATA EXTRACTION Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. DATA SYNTHESIS Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). LIMITATIONS Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. CONCLUSIONS This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.
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Affiliation(s)
- Shana E Harrington
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Blatt PE Center, 101G, Columbia, SC 29208 (USA)
| | - Nicole L Stout
- Office of Strategic Research, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland; Cancer Prevention and Control, Department of Hematology/Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Elizabeth Hile
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mary Insana Fisher
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, Ohio
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Lucinda A Pfalzer
- Physical Therapy Department, University of Michigan–Flint, Flint, Michigan
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48
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Lucas AR, Bitting RL, Fanning J, Isom S, Rejeski WJ, Klepin HD, Kritchevsky SB. Trajectories in muscular strength and physical function among men with and without prostate cancer in the health aging and body composition study. PLoS One 2020; 15:e0228773. [PMID: 32053654 PMCID: PMC7017990 DOI: 10.1371/journal.pone.0228773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/22/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives To examine and compare changes in strength and physical function from pre- to post-diagnosis among men with prostate cancer (PC, [cases]) and matched non-cancer controls identified from the Health, Aging and Body Composition (Health ABC) study. Materials and methods We conducted a longitudinal analysis of 2 strength and 3 physical function-based measures among both cases and controls, identified from a large cohort of community living older adults enrolled in the Health ABC study. We plotted trajectories for each measure and compared cases vs. controls from the point of diagnosis onwards using mixed-effects regression models. For cases only, we examined predictors of poor strength or physical function. Results We identified 117 PC cases and 453 matched non-cancer controls (50% African Americans). At baseline, there were no differences between cases and controls in demographic factors, comorbidities or self-reported physical function; however, cases had slightly better grip strength (44.6 kg vs. 41.0 kg, p<0.01), quadriceps strength (360.5 Nm vs. 338.7 Nm, p = 0.02) and Health ABC physical performance battery scores (2.4 vs. 2.3, p = 0.01). All men experienced similar declines in strength and physical function over an equivalent amount of time. The loss of quad strength was most notable, with losses of nearly two-thirds of baseline strength over approximately 7 years of follow up. Conclusions Among both cases and controls, strength and physical function decline with increasing age. The largest declines were seen in lower body strength. Regular assessments should guide lifestyle interventions that can offset age- and treatment-related declines among men with PC.
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Affiliation(s)
- Alexander R. Lucas
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Richmond, Virginia, United States of America
- * E-mail:
| | - Rhonda L. Bitting
- Department of Internal Medicine, Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
| | - Jason Fanning
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - W. Jack Rejeski
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Heidi D. Klepin
- Department of Internal Medicine, Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America
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Sheehan P, Denieffe S, Murphy NM, Harrison M. Exercise is more effective than health education in reducing fatigue in fatigued cancer survivors. Support Care Cancer 2020; 28:4953-4962. [PMID: 32020356 DOI: 10.1007/s00520-020-05328-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Cancer-related fatigue is a most debilitating side effect reported by survivors, often lasting years following treatment. PURPOSE To determine the effects of a 10-week exercise intervention compared with a health education intervention on fatigue, quality of life outcomes and functional fitness in cancer survivors with documented fatigue. METHODS This quasi-experimental study allocated 37 post-treatment fatigued cancer survivors (33 female, 30 breast cancer, aged 55 ± 2 years, time since treatment 2.3 ± 0.3 years; mean ± SEM) to an exercise group (EX, n = 19) or health education comparison group (HE, n = 18). The EX intervention emphasised brisk walking with progressive increments, stretching, exercise education and self-efficacy enhancement. The HE intervention emphasised sleep management, nutrition and cognitive behavioural therapy. All participants were evaluated at pre- and post-intervention with EX followed up at 26 W. RESULTS The intervention effect on fatigue (FACT-F) in EX was greater (p < 0.05) than that in HE, the difference being 4 times the recognised clinically important difference. The intervention also increased (p < 0.05) cognitive function, global quality of life and functional fitness scores. It reduced (p < 0.05) insomnia and fear of physical activity. All intervention effects were maintained to 26 W. The intervention effect on fatigue in EX was largely achieved by week 4. There was 100% retention rate at 10 W and no adverse events reported. CONCLUSIONS There is a reduction of considerable magnitude in cancer fatigue from group-based exercise training, that is sustainable and attributable to exercise per se. IMPLICATIONS FOR CANCER SURVIVORS Exercise training is feasible for fatigued cancer survivors and should form part of tailored rehabilitation programmes.
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Affiliation(s)
- Patricia Sheehan
- Department of Sport and Exercise Science, Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | - Suzanne Denieffe
- School of Humanities, Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | - Niamh M Murphy
- Department of Sport and Exercise Science, Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | - Michael Harrison
- Department of Sport and Exercise Science, Waterford Institute of Technology, Cork Road, Waterford, Ireland.
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50
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Pahl A, Wehrle A, Kneis S, Gollhofer A, Bertz H. Whole body vibration training during allogeneic hematopoietic cell transplantation-the effects on patients' physical capacity. Ann Hematol 2020; 99:635-648. [PMID: 31970448 PMCID: PMC7060160 DOI: 10.1007/s00277-020-03921-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
Abstract
Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) experience a considerable decline in physical and psycho-social capacity. Since whole body vibration (WBV) is known to efficiently stimulate the neuromuscular system and enhance cardiorespiratory fitness and muscle strength in frail individuals, we hypothesized that WBV would maintain various physical and psychological capacities in patients during alloHCT. Seventy-one patients were randomly allocated to either an intervention group (IG) doing WBV or an active control group (CG) doing mobilization exercises five times per week. We determined peak oxygen consumption (VO2peak) and maximum power, maximum strength, functional performance, body composition, quality of life (QoL), and fatigue. Tests were carried out before conditioning therapy, at hospital discharge and at day ± 180 (follow-up). As 18 patients did not participate in post-intervention assessment and follow-up data from 9 patients was not collectible, per-protocol (PP) analysis of 44 patients is presented. During hospitalization, WBV maintained maximum strength, height, and power output during jumping, as well as reported QoL, physical functioning, and fatigue level compared with mobilization. At follow-up, relative VO2peak (p = 0.035) and maximum power (p = 0.011), time and power performing chair-rising test (p = 0.022; p = 0.009), and reported physical functioning (p = 0.035) significantly increased in the IG, while fatigue decreased (p = 0.005). CG’s body cell mass and phase angle had significantly decreased at follow-up (p = 0.002; p = 0.004). Thus, WBV might maintain maximum strength, functional performance, QoL, and fatigue during alloHCT, while cardiorespiratory fitness might benefit from accelerated recovery afterwards.
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Affiliation(s)
- Antonia Pahl
- Department of Medicine I, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Anja Wehrle
- Institute for Exercise and Occupational Medicine, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Sarah Kneis
- Department of Medicine I, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117, Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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