Factors Influencing Life Space Mobility in Cancer Survivors Following Hematopoietic Stem Cell Transplantation - Physical Function, Depression, Fatigue, Neighborhood Walkability, and Employment Status

BACKGROUND/OBJECTIVE

The level of physical activity in the daily lives of cancer survivors following hematopoietic stem cell transplantation (HSCT) is crucial for maintaining their physical and mental health. Considering that life space mobility (LSM) may limit physical activity, maintaining and expanding LSM is particularly essential for post-HSCT survivors. This study aimed to identify factors influencing LSM in post-HSCT survivors.

METHODS

Thirty cancer survivors after HSCT (14 women, mean age 52.0 ± 12.3 years, 196-3017 days post-HSCT) were included in this cross-sectional study. The assessment encompassed patient characteristics, employment status, life space (Life Space Assessment; LSA), physical function (handgrip strength, isometric knee extension strength, 5 chair standing test, walking speed), depression (Self-rating Depression Scale; SDS), fatigue (Cancer Fatigue Scale), and neighborhood walkability (Walk Score®). The association between LSA and each factor was compared by correlation analysis. Subsequently, multiple regression analysis was conducted, with LSA as the dependent variable and independent variables being outcome measures exhibiting a significant correlation with LSA.

RESULTS

Variables significantly correlated with LSA included SDS (r =-0.65, p < .01), employment status (r=-0.60, p < .01), handgrip strength (r = 0.43, p = .02), and isometric knee extension strength (r = 0.40, p = .03). Results of multiple regression analysis show that SDS (β = -0.53, p < .01), employment status (β = 0.48, p < .01), and isometric knee extension strength (β = 0.27, p = .02) were significantly associated with LSA (R2 = 0.74).

CONCLUSION

Depression, employment status, and isometric knee extension strength were identified as factors related to LSM in post-HSCT survivors.

Activity of Daily Living and Walking Ability of Patients with Severe COVID-19 at Discharge from an Acute Care Hospital

Objectives

The effectiveness of acute rehabilitation treatment for severe coronavirus disease 2019 (COVID-19) has not yet been established. This study examined the efficacy of treatment provided to patients with severe COVID-19 in an acute care facility.

Methods

A total of 98 patients with severe COVID-19 requiring inpatient management in our intensive care unit (ICU) were included between December 2020 and October 2021. They were divided into two groups: those who received physiotherapy (PT group; n=44) and those who did not receive physiotherapy (non-PT group; n=54). Their backgrounds, clinical characteristics, and activities of daily life (ADL) at discharge were compared to examine factors that influenced the need for physiotherapy (PT). We also evaluated the effect of PT on ADL by comparing the Barthel Index (BI) before PT and at discharge.

Results

The PT group patients were significantly older, had longer hospital and ICU stays, and used invasive mechanical ventilators (IMV) more frequently than those in the non-PT group. More patients in the non-PT group were able to walk at discharge than in the PT group. The PT group patients showed significant improvement in BI and ADL at discharge when compared with BI at the start of PT, regardless of whether an IMV was used.

Conclusions

Older patients with severe COVID-19 with prolonged hospitalization or ICU stay or on an IMV are prone to a decline in ADL and may need to be considered for early PT.

Predictors of Activities of Daily Living in Intensive Care Unit Survivors: A Propensity Score Matching Analysis

Objectives

Increased long-term impairment is common among intensive care unit (ICU) survivors. However, predictors of activities of daily living (ADL) in ICU survivors are poorly understood. We aimed to focus on the trajectory of physical function and explore the clinical variables that affect ADL at hospital discharge.

Methods

We enrolled 411 patients admitted to the ICU from April 2018 to October 2020. Physical function was evaluated at ICU admission, ICU discharge, and hospital discharge. We assessed physical function (grip strength, arm and calf circumference, quadriceps thickness, and Barthel index). Patients were assigned to the high or low ADL group based on their Barthel index at discharge. Propensity score matching analysis was performed to minimize selection biases and differences in clinical characteristics.

Results

After matching propensity scores, 114 of the 411 patients (aged 65±15 years) were evaluated. The high ADL group showed better physical function at ICU discharge and hospital discharge than the low ADL group. An overall decreasing trend in muscle mass was observed over time; the rates of decline were lower in the high ADL group than in the low ADL group. The cutoff values for relative changes in calf circumference and quadriceps thickness to predict high ADL were -7.89% (sensitivity: 77.8%, specificity: 55.6%) and -28.1% (sensitivity: 81.0%, specificity: 58.8%), respectively.

Conclusions

The relative decreases in calf circumference and quadriceps thickness during hospitalization were lower in patients who maintained their ADL. Assessment of the trajectory of physical function can predict ADL status at hospital discharge among ICU survivors.

Actual Sarcopenia Reflects Poor Prognosis in Patients with Esophageal Cancer

BACKGROUND

Minimally invasive esophagectomy (MIE) for esophageal cancer patients with sarcopenia is associated with a high risk of perioperative complications; however, the relationship between sarcopenia and the survival of esophageal cancer patients remains controversial. In this study, we aimed to develop a stratifying marker for sarcopenia to precisely predict patients' prognosis.

METHODS

We retrospectively studied 135 patients who underwent thoracoscopic esophagectomy at Kobe University Hospital from 2011 to 2015 and who were preoperatively diagnosed with or without sarcopenia based on the Asian Working Group for Sarcopenia index. Creatinine levels and albumin as measures of skeletal muscle volume and nutritional status, respectively, were used to develop a marker to be used for stratifying sarcopenic patients based on prognosis.

RESULTS

Of the 135 patients, 35 were diagnosed with sarcopenia and 100 were not. We combined the creatinine and albumin levels (Cr × Alb) as a stratifying marker for sarcopenia, and extracted sarcopenic patients with values below the Cr × Alb cut-off as the actual sarcopenic group. The 5-year overall survival (OS) rates of the actual and non-actual sarcopenic groups were 28.9% and 58.9%, respectively (p = 0.0005), and the 5-year disease-free survival rate of the actual sarcopenic group was 34.1%, and 62.8% (p = 0.0106) for the non-actual sarcopenic group. This stratified sarcopenia model was an independent prognostic factor and was superior to sarcopenia alone for OS.

CONCLUSIONS

In patients undergoing MIE, preoperative measurement of Cr × Alb may be a prognostic stratification marker for patients with sarcopenia.

The effect of home-based preoperative pulmonary rehabilitation before lung resection: A retrospective cohort study

OBJECTIVES

This study aimed to assess the effect of home-based preoperative pulmonary rehabilitation (HBPPR) on the incidence of postoperative complications, length of stay (LOS), and duration of intercostal catheterization in non-small cell lung cancer (NSCLC) patients who underwent lung resection.

MATERIALS AND METHODS

In this retrospective cohort study, 144 patients who underwent lung resection were recruited, 51 of whom received HBPPR, comprising respiratory muscle training and was supervised (for patients undergoing it for the first time). Patients continued these programs for 2-4 weeks during the preoperative waiting period, in their homes. Data on postoperative complications graded according to the Clavien-Dindo classification, LOS, and intercostal catheterization duration were collected from medical records. These outcomes were compared between the HBPPR and non-HBPPR groups using Fisher's exact test and Wilcoxon rank sum test, after 1:1 propensity score matching to avoid selection bias.

RESULTS

Forty-nine matched pairs were extracted using propensity score matching. HBPPR reduced the onset of postoperative complications (p = 0.04), with the relative ratio (RR) for Clavien-Dindo Class I postoperative complications showing a significant difference (RR 0.55, 95% CI 0.30-1.02; p = 0.05), whereas RRs for the other Clavien-Dindo classes were not statistically significant. There was no significant difference in LOS or the duration of intercostal catheterization.

CONCLUSION

HBPPR reduced the incidence of Clavien-Dindo Class I postoperative complications after lung resection. Implementing HBPPR practices in a clinical setting would benefit patients unable to receive supervised preoperative pulmonary rehabilitation due to access barriers, time, and financial constraints.

Impact of Preoperative Social Frailty on Overall Survival and Cancer-Specific Survival among Older Patients with Gastrointestinal Cancer

OBJECTIVES

Frailty is a multidimensional syndrome. However, typical frailty scales used in oncology clinics assess physical impairment and/or malnutrition but do not consider the social domain. Our study aimed to clarify the relationship between preoperative social frailty and overall survival (OS) and cancer-specific survival (CSS) among older patients with gastrointestinal cancer.

DESIGN

This was a prospective cohort study.

SETTING AND PARTICIPANTS

This single-center study recruited 195 patients with gastrointestinal cancer scheduled for curative surgery and aged >60 years.

METHODS

The outcomes considered were the OS and CSS of surgery. Primary associated factors included frailty defined as a Geriatric 8 score ≤14; social frailty defined as 2 or more of the following-going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone daily, and combinations therein [no frailty without social frailty (-/-), frailty without social frailty (+/-), no frailty with social frailty (-/+), and frailty with social frailty (+/+)]. We used the Cox proportional hazards model and the Fine and Gray proportional subdistribution hazard model adjusting for confounding factors.

RESULTS

Of the 195 patients, 181 (mean age, 72.0 years) were included for analysis. The median follow-up time was 994 days. Social frailty (hazard ratio 3.10) and their combinations [6.35; frailty with social frailty (+/+) vs no frailty without social frailty (-/-)] were significant predictors of OS. Social frailty (subdistribution hazard ratio 3.23) and their combinations (7.57) were significant predictors of CSS.

CONCLUSIONS AND IMPLICATIONS

Preoperative social frailty is a predictor of OS and CSS in older patients with gastrointestinal cancer. Screening for social frailty, frailty, and their combinations in older patients with cancer is important.

Comparison between quantitative and subjective assessments of chemotherapy-induced peripheral neuropathy in cancer patients: A prospective cohort study

OBJECTIVE

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event experienced by cancer patients. In general, CIPN is evaluated subjectively based on patient self-assessment or clinician-reported scales; evidence supporting the utility and validity of quantitative sensory tests (QST) is lacking in this patient population. The aim of this study was to objectively assess CIPN of lower extremities by QSTs, and to evaluate the concordance between QSTs and subjective assessments.

METHODS

In this prospective cohort study, outpatients with cancer receiving chemotherapy were recruited at a single university hospital. We assessed CIPN at the lower extremities at baseline and three months after baseline. The QSTs were performed by applying a monofilament and a tuning fork to determine touch and vibration thresholds, respectively, at the affected site. Subjective assessments were performed based on the visual analog scale (VAS) and the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) toxicity grade. Kappa coefficients were calculated to evaluate the concordance between QSTs and subjective assessments.

RESULTS

After exclusion and drop-outs during follow-up, nineteen patients were included in the analysis. The prevalence of patients with abnormal sensation was 37% based on QSTs, 32% based on the VAS, and 14% based on CTCAE grading, respectively. Kappa coefficients were 0.32 between QSTs and VAS, and 0.28 between QSTs and CTCAE.

CONCLUSIONS

The concordance rates between quantitative and subjective assessments were low. CIPN should be assessed using both quantitative and subjective assessments.

Association between preoperative sleep disturbance and low muscle mass in patients with gastrointestinal cancer

[Purpose] Low muscle mass and sleep disturbance are common among geriatric patients with cancer. In patients with gastrointestinal cancer, low muscle mass is considered an indicator of poor prognosis. In the recent years, sleep disturbance has attracted much attention as a factor for low muscle mass among community-dwelling elderly individuals; however, such associations are unclear in patients with cancer. The present study investigated the relationship between preoperative sleep disturbance and low muscle mass in patients with gastrointestinal cancer. [Participants and Methods] This cross-sectional survey enrolled 86 elderly patients (aged more than 60 years) with gastrointestinal cancer who were scheduled for curative surgery. Low preoperative muscle mass was defined according to Asian Working Group for Sarcopenia criteria. Sleep disturbance was assessed using the Japanese version of the Pittsburgh Sleep Quality Index, including the subscales. [Results] Twenty-seven patients (31%) were classified as having low muscle mass. After adjusting for confounding factors, bad sleep quality, determined by the subscales, was significantly associated with low muscle mass. [Conclusion] Our results suggest that the evaluation of sleep quality is imperative for addressing low preoperative muscle mass in patients with gastrointestinal cancer.

Anemia Is a Novel Predictive Factor for the Onset of Severe Chemotherapy-Induced Peripheral Neuropathy in Lymphoma Patients Receiving Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone Therapy

Chemotherapy-induced peripheral neuropathy (CIPN) frequently occurs in lymphoma patients receiving R-CHOP, a drug combination therapy. Although severe CIPN may lead to reduction and/or discontinuation of the medication, predictive factors of CIPN have not been investigated sufficiently to date. We performed a retrospective exploratory research to determine associations between prevalence of severe CIPN and sociodemographic data, health characteristics, and medical conditions such as anemia at initial diagnosis. Forty patients (indolent lymphoma, n = 9; diffuse large B-cell lymphoma; n = 31) received R-CHOP therapy from September 2009 to July 2014. The median age of patients was 58 years (range = 27–76 years). Statistical analyses were applied to the patients, who were divided into two groups: mild CIPN (no symptoms or grade 1 according to the CTCAE version 3.0 program) and severe CIPN patients (grade 2 or higher). Forward stepwise logistic regression analyses were performed using the following variables: sex, BMI, BSA, hyperglycemia, malnutrition, and anemia. Severe CIPN occurred in seven patients (17.5%). Gender and anemia remained following the stepwise procedure, and anemia predicted severe CIPN significantly (OR = 19.45, 95% confidence interval = 1.52–171.12). Our study suggests that anemia at initial diagnosis could be a predictive factor of R-CHOP-induced CIPN.

Impact of Sarcopenia on Unplanned Readmission and Survival After Esophagectomy in Patients with Esophageal Cancer

BACKGROUND

Although sarcopenia increases postoperative complications following esophagectomy, its effects on prognosis remain unclear. This study was performed to identify the effect of sarcopenia on 90-day unplanned readmission and overall survival (OS) after esophagectomy.

METHODS

Ninety-eight patients with esophageal cancer who underwent esophagectomy were enrolled in this study. Unplanned readmission was defined as any emergent hospitalization within 90 days after discharge. Sarcopenia, defined as low muscle mass plus low muscle strength and/or low physical performance according to the Asian consensus definition, was assessed prior to esophagectomy. Multivariate logistic regression analysis was performed to identify factors that contributed to 90-day unplanned readmission. OS was estimated using the Kaplan-Meier method, and a Cox proportional hazards model was used to assess the relationship between sarcopenia and OS.

RESULTS

Thirty-one patients (31.6%) were diagnosed with sarcopenia. The 90-day unplanned readmission rate was significantly higher in patients with sarcopenia than those without (42.9% vs. 16.4%, respectively; p = 0.01). Multivariable logistic regression analysis showed that sarcopenia was an independent predictor of 90-day unplanned readmission [odds ratio 3.71, 95% confidence interval (CI) 1.29-11.05; p = 0.02], and the log-rank test showed that sarcopenia was associated with OS (p = 0.01). Moreover, sarcopenia was a significant predictor of OS after adjustment for age, sex, and pathological stage (hazard ratio 2.35, 95% CI 1.21-4.54; p = 0.01).

CONCLUSIONS

Sarcopenia is a risk factor for 90-day unplanned readmission and OS following esophagectomy. Assessment of sarcopenia could help to identify patients at higher risk of a poor prognosis after esophagectomy.

Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer

Postoperative pulmonary complications (PPCs) after esophagectomy have been reported to occur in 15.9-30% of patients and lead to increased postoperative morbidity and mortality, prolonged duration of hospital stay, and additional medical costs. The purpose of this retrospective cohort study was to investigate the possible prevention of PPCs by intensive preoperative respiratory rehabilitation in esophageal cancer patients who underwent esophagectomy. The subjects included 100 patients (87 males and 13 females with mean age 66.5 ± 8.6 years) who underwent esophagectomy. They were divided into two groups: 63 patients (53 males and 10 females with mean age 67.4 ± 9.0 years) in the preoperative rehabilitation (PR) group and 37 patients (34 males and 3 females with mean age 65.0 ± 7.8 years) in the non-PR (NPR) group. The PR group received sufficient preoperative respiratory rehabilitation for >7 days, and the NPR group insufficiently received preoperative respiratory rehabilitation or none at all. The results of the logistic regression analysis and multivariate analysis to correct for all considerable confounding factors revealed the rates of PPCs of 6.4% and 24.3% in the PR group and NPR group, respectively. The PR group demonstrated a significantly less incidence rate of PPCs than the NPR group (odds ratio: 0.14, 95% confidential interval: 0.02~0.64). [Correction added after online publication 25 June 2012: confidence interval has been changed from -1.86~ -0.22] This study showed that the intensive preoperative respiratory rehabilitation reduced PPCs in esophageal cancer patients who underwent esophagectomy.

Daily performance status-based target physical activity of early rehabilitation for hematologic malignancy patients after allogeneic hematopoietic stem cell transplantation

e17020

Background: For hematologic malignancy patients receiving allogeneic hematopoietic stem cell transplantation (allo-SCT), the maintenance and/or increase of physical activity (PA) after allo-SCT possibly lead to favorable outcomes. However, it remains to be clarified how much intensity of daily rehabilitation should be prescribed. The aim of this study was to evaluate target PA according to daily performance status (PS) in these patients. Methods: Twenty-seven allo-SCT patients were enrolled in this study (13 males, 14 females, the median age; 47 years). Written informed consent was obtained from all patients. Donor types were bone marrow (n = 12), peripheral blood stem cell (n = 6), and single-unit cord blood (n = 9). All patients received our established exercise program supervised by physical therapists just after neutrophil engraftment in a bioclean room. As an alternative value of PA, daily steps (DS) were measured by using a uniaxial pedometer (Lifecorder EX, Suzuken Co. Ltd., Nagoya, Japan), and Eastern Cooperative Oncology Group PS after allo-SCT were also assessed daily for each individual. The data were statistically analyzed by using ANOVA and Scheff 's tests. Results: A correlation between DS and PS was observed. After the early physical intervention, the mean DS of patients with PS 1, 2, or 3 in a bioclean room were 2,411 ± 1,068, 1,205 ± 572, and 597 ± 216 steps/day, respectively. DS significantly declined by about 50% according to one grade deterioration of PS. Conclusions: As the target PA correlated with PS seems to be existence, we should plan daily activity in a bioclean room to keep more than above-mentioned mean DS according to daily PS for allo-SCT patients.

The effects of shoe fit on gait in community-dwelling older adults

Shoes have a beneficial function in physical performance, particularly for gait. The purpose of this study was to investigate the association of shoe fit with gait parameters in community-dwelling older people. The fit of habitual shoes (HS) was evaluated in healthy older subjects and subjects were classified into well-fit (n=48) and poorly-fit (n=37) groups. The sizes of their feet were measured using an optical laser scanning system to provide newly-fitted shoes (NFS). Gait experiments were performed while wearing HS and NFS, separately. Trunk linear accelerations were measured along the vertical, anteroposterior and mediolateral axes using a tri-axial accelerometer attached to the L3 spinous process. Measurements were sampled at 200-Hz during a 20-m gait task at a self-selected speed. After signal processing, the gait velocity, stride duration, stride length and gait regularity (Reg) were obtained. Among the poorly-fit group, 86% wore shoes that were too loose. Subjects wearing ill-fitting shoes had a tendency to walk slower, had shorter stride lengths and lower Reg in the vertical direction than those wearing well-fitting shoes. Whereas NFS increased the gait velocity, the stride length and the Reg in the vertical direction, the increases in subjects that previously wore ill-fitting HS was significantly greater than in subjects that originally wore well-fitting HS. In conclusion, our study indicates that a significant proportion of older adults wear ill-fitting shoes and that well-fitting shoes are important to improve gait performance.