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Wildes TM, Depp B, Colditz G, Stark S. Fall-risk prediction in older adults with cancer: an unmet need. Support Care Cancer 2016; 24:3681-4. [PMID: 27341803 PMCID: PMC4967373 DOI: 10.1007/s00520-016-3312-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
Falls in older adults with cancer are more common than in noncancer controls, yet no fall-risk screening tool has been validated in this population. We undertook a cross-sectional pilot study of the Falls Risk Questionnaire (FRQ) in 21 adults aged ≥65 receiving systemic cancer therapy. Participants completed the FRQ, geriatric assessment measures, and a measure of fear-of-falling. The recruitment rate was 87.5 %, with 95.2 % completion of the FRQ and additional geriatric assessment and quality of life measures. The FRQ correlated significantly with the Timed Up and Go test (Pearson r 0.479, p = 0.028). In addition, the FRQ score correlated directly with fear-of-falling and inversely with QOL, particularly physical health and neurotoxicity subscales. In conclusion, the FRQ was feasible in older adults receiving cancer therapy and correlates with measures of physical performance, functional status, and fear-of-falling. The FRQ may prove to be a valuable fall-risk screening tool to implement fall-prevention interventions in this vulnerable population of older adults with cancer.
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Affiliation(s)
- Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St. Louis, MO, 63110, USA.
| | - Brittany Depp
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | - Graham Colditz
- Division of Population Health Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
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102
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Bao T, Basal C, Seluzicki C, Li SQ, Seidman AD, Mao JJ. Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk. Breast Cancer Res Treat 2016; 159:327-33. [PMID: 27510185 PMCID: PMC5509538 DOI: 10.1007/s10549-016-3939-0] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/06/2016] [Indexed: 12/25/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with chemotherapy, but researchers rarely study its risk factors, fall risk, and prevalence in long-term breast cancer survivors. We aimed to determine CIPN prevalence, risk factors, and association with psychological distress and falls among long-term breast cancer survivors. We conducted Cross-sectional analyses among postmenopausal women with a history of stage I-III breast cancer who received taxane-based chemotherapy. Participants reported neuropathic symptoms of tingling/numbness in hands and/or feet on a 0-10 numerical rating scale. We conducted multivariate logistic regression analyses to evaluate risk factors associated with the presence of CIPN and the relationship between CIPN and anxiety, depression, insomnia, and patient-reported falls. Among 296 participants, 173 (58.4 %) reported CIPN symptoms, 91 (30.7 %) rated their symptoms as mild, and 82 (27.7 %) rated them moderate to severe. Compared with women of normal weight, being obese was associated with increased risk of CIPN (adjusted OR 1.94, 95 % CI: 1.03-3.65). Patients with CIPN reported greater insomnia severity, anxiety, and depression than those without (all p < 0.05). Severity of CIPN was associated with higher rates of falls, with 23.8, 31.9, and 41.5 % in the "no CIPN," "mild," and "moderate-to-severe" groups, respectively, experiencing falls (p = 0.028). The majority of long-term breast cancer survivors who received taxane-based chemotherapy reported CIPN symptoms; obesity was a significant risk factor. Those with CIPN also reported increased psychological distress and falls. Interventions need to target CIPN and comorbid psychological symptoms, and incorporate fall prevention strategies for aging breast cancer survivors.
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Affiliation(s)
- Ting Bao
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
| | - Coby Basal
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Christina Seluzicki
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Susan Q Li
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Andrew D Seidman
- Memorial Sloan Kettering Cancer Center, 300 66th Street, New York, NY, 10065, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
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103
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Koll T, Pergolotti M, Holmes HM, Pieters HC, van Londen GJ, Marcum ZA, MacKenzie AR, Steer CB. Supportive Care in Older Adults with Cancer: Across the Continuum. Curr Oncol Rep 2016; 18:51. [PMID: 27342609 PMCID: PMC5504916 DOI: 10.1007/s11912-016-0535-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anticancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent.
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Affiliation(s)
- Thuy Koll
- Internal Medicine Division of Geriatric Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, 68198-6155, NE, USA
| | - Mackenzi Pergolotti
- Cancer Outcomes Research Group, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, UTHealth, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin, MSB 5.116, Houston, 77030, TX, USA
| | | | - G J van Londen
- University of Pittsburgh, S. 140 Cooper Pavilion, 5115 Centre Ave., Pittsburgh, 15232, PA, USA
| | - Zachary A Marcum
- University of Washington, 1959 NE Pacific Ave, H375G, Box 357630, Seattle, 98195, WA, USA
| | - Amy R MacKenzie
- Department of Medical Oncology, Division of Regional Cancer Care, Thomas Jefferson University, 925 Chestnut St., 4th floor, Philadelphia, 9107, PA, USA
| | - Christopher B Steer
- Border Medical Oncology, Suite 1, 69 Nordsvan Drive, Wodonga, 3690, VIC, Australia.
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104
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Vincent JA, Wieczerzak KB, Gabriel HM, Nardelli P, Rich MM, Cope TC. A novel path to chronic proprioceptive disability with oxaliplatin: Distortion of sensory encoding. Neurobiol Dis 2016; 95:54-65. [PMID: 27397106 DOI: 10.1016/j.nbd.2016.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/06/2016] [Accepted: 07/03/2016] [Indexed: 02/08/2023] Open
Abstract
Persistent neurotoxic side effects of oxaliplatin (OX) chemotherapy, including sensory ataxia, limit the efficacy of treatment and significantly diminish patient quality of life. The common explanation for neurotoxicity is neuropathy, however the degree of neuropathy varies greatly among patients and appears insufficient in some cases to fully account for disability. We recently identified an additional mechanism that might contribute to sensory ataxia following OX treatment. In the present study, we tested whether that mechanism, selective modification of sensory signaling by muscle proprioceptors might result in behavioral deficits in rats. OX was administered once per week for seven weeks (cumulative dose i.p. 70mg/kg) to adult female Wistar rats. Throughout and for three weeks following treatment, behavioral analysis was performed daily on OX and sham control rats. Compared to controls, OX rats demonstrated errors in placing their hind feet securely and/or correctly during a horizontal ladder rung task. These behavioral deficits occurred together with modification of proprioceptor signaling that eliminated sensory encoding of static muscle position while having little effect on encoding of dynamic changes in muscle length. Selective inability to sustain repetitive firing in response to static muscle stretch led us to hypothesize that OX treatment impairs specific ionic currents, possibly the persistent inward Na currents (NaPIC) that are known to support repetitive firing during static stimulation in several neuron types, including the class of large diameter dorsal root ganglion cells that includes muscle proprioceptors. We tested this hypothesis by determining whether the chronic effects of OX on the firing behavior of muscle proprioceptors in vivo were mimicked by acute injection of NaPIC antagonists. Both riluzole and phenytoin, each having multiple drug actions but having only antagonist action on NaPIC in common, reproduced selective modification of proprioceptor signaling observed in OX rats. Taken together, these findings lead us to propose that OX chemotherapy contributes to movement disability by modifying sensory encoding, possibly via a chronic neurotoxic effect on NaPIC in the sensory terminals of muscle proprioceptors.
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Affiliation(s)
- Jacob A Vincent
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH 45435, United States
| | - Krystyna B Wieczerzak
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH 45435, United States
| | - Hanna M Gabriel
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH 45435, United States
| | - Paul Nardelli
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH 45435, United States; School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30318, United States
| | - Mark M Rich
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH 45435, United States
| | - Timothy C Cope
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH 45435, United States; School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30318, United States.
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105
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Monfort SM, Pan X, Patrick R, Singaravelu J, Loprinzi CL, Lustberg MB, Chaudhari AMW. Natural history of postural instability in breast cancer patients treated with taxane-based chemotherapy: A pilot study. Gait Posture 2016; 48:237-242. [PMID: 27341530 PMCID: PMC4969166 DOI: 10.1016/j.gaitpost.2016.06.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 02/02/2023]
Abstract
Over 230,000 new cases of breast cancer are expected to be diagnosed in the United States in 2015. Taxane-based chemotherapy is often an effective treatment, but can also cause adverse symptoms in patients due to neurotoxicity. These side effects can impair postural control in patients; however, this instability has scarcely been quantified. The purpose of this pilot study was to gain insight into the natural history of postural instability in breast cancer patients being treated with taxane-based chemotherapy. Thirty-two breast cancer patients (31 female/1 male; 47.6±11.2 year; 16 stage II/16 stage III) completed eyes open and eyes closed quiet standing trials in the oncology clinic where they were being treated. These trials were collected at five timepoints throughout their chemotherapy treatment: (1) before initiating chemotherapy to provide a baseline, (2-4) before starting subsequent chemotherapy cycles, and (5) 1-3 months after receiving their last taxane infusion. After the first chemotherapy cycle, patients demonstrated increases in 95% confidence ellipse area of center of pressure (CoP) [45.2%, p=0.01] and root mean squared CoP excursion [18%, p=0.006] compared to baseline values for the eyes closed condition. These balance deficiencies progressed with cumulative taxane exposure. Postural instability persisted 1-3 months after completing chemotherapy with increases in 95% CoP ellipse area [86.8%, p=0.002], root mean squared CoP excursion [32.6%, p=0.001], and mean CoP velocity [30.4%, p=0.024]. The balance impairments demonstrated by patients in this study appear to be clinically relevant when compared to balance impairments previously reported in other patient populations.
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Affiliation(s)
- Scott M Monfort
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, USA.
| | - Xueliang Pan
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Robyn Patrick
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Maryam B Lustberg
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, The Ohio State University, Columbus, Ohio, USA
| | - Ajit M W Chaudhari
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, USA; School of Health & Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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106
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Huang MH, Miller K, Smith K, Fredrickson K, Shilling T. Reliability, Validity, and Minimal Detectable Change of Balance Evaluation Systems Test and Its Short Versions in Older Cancer Survivors. J Geriatr Phys Ther 2016; 39:58-63. [DOI: 10.1519/jpt.0000000000000047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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107
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Self-reported Balance Confidence Relates to Perceived Mobility Limitations in Older Cancer Survivors. REHABILITATION ONCOLOGY 2016. [DOI: 10.1097/01.reo.0000000000000017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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108
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Bird ML, Cheney M, Williams A. Accidental Fall Rates in Community-Dwelling Adults Compared to Cancer Survivors During and Post-Treatment: A Systematic Review With Meta-Analysis. Oncol Nurs Forum 2016; 43:E64-72. [DOI: 10.1188/16.onf.e64-e72] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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109
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Almstedt HC, Grote S, Perez SE, Shoepe TC, Strand SL, Tarleton HP. Training-related improvements in musculoskeletal health and balance: a 13-week pilot study of female cancer survivors. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26777589 DOI: 10.1111/ecc.12442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
Abstract
Cancer survivors often experience poor post-treatment musculoskeletal health. This study examined the feasibility of combined aerobic and resistant training (CART) for improving strength, skeletal health and balance. Cancer survivors (n = 24) were identified by convenience sampling in Los Angeles County with 11 survivors consenting to 13 weeks of CART. Pre- and post-intervention assessments of bone mineral density (BMD), strength, flexibility and biomarker analysis were performed. Paired t-test analysis suggested increases in lower and upper body strength. The average T-score for BMD at the femoral neck improved from -1.46 to -1.36 and whole body BMD improved from -1.65 to -1.55. From baseline to follow-up, participants also displayed decreases in sway velocity on the eyes open (7%) and eyes closed (27%) conditions. Improvement in lower body strength was associated with increases in lean body mass (LBM) (r = 0.721) and an inverse association was observed between sway velocity and LBM (r = 0.838). Age and time since last treatment were related with biomarkers of anabolic growth (IGF-1, IGFbp-3) and bone (DPD, BAP). In summary, observed physiological changes were consistent with functional improvements, suggesting that isometric and dynamic exercise prescription may reduce the risk for falls and fall-related fractures among survivors.
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Affiliation(s)
- H C Almstedt
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - S Grote
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA.,Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - S E Perez
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - T C Shoepe
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - S L Strand
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - H P Tarleton
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
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110
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Schwenk M, Grewal GS, Holloway D, Muchna A, Garland L, Najafi B. Interactive Sensor-Based Balance Training in Older Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Controlled Trial. Gerontology 2015; 62:553-63. [PMID: 26678611 DOI: 10.1159/000442253] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cancer patients with chemotherapy-induced peripheral neuropathy (CIPN) have deficits in sensory and motor skills leading to inappropriate proprioceptive feedback, impaired postural control, and fall risk. Balance training programs specifically developed for CIPN patients are lacking. OBJECTIVE This pilot study investigated the effect of an interactive motor adaptation balance training program based on wearable sensors for improving balance in older cancer patients with CIPN. METHODS Twenty-two patients (age: 70.3 ± 8.7 years) with objectively confirmed CIPN [vibration perception threshold (VPT) >25 V] were randomized to either an intervention (IG) or a control (CG) group. The IG received interactive game-based balance training including repetitive weight shifting and virtual obstacle crossing tasks. Wearable sensors provided real-time visual/auditory feedback from the lower limb trajectory and allowed the perception of motor errors during each motor action. The CG received no exercise intervention and continued their normal activity. Outcome measures were changes in sway of ankle, hip, and center of mass (CoM) in both mediolateral and anteroposterior (AP) directions during 30-second balance tests with increasing task difficulty [i.e. standing in feet-closed position with eyes open (EO) and eyes closed (EC), and in semi-tandem position with EO] at baseline and after the intervention. Additionally, gait performance (speed, variability) and fear of falling [Falls Efficacy Scale-International (FES-I)] were measured. RESULTS Training was safe despite the participants' impaired health status, great severity of CIPN (VPT 49.6 ± 26.7 V), and great fear of falling (FES-I score 31.37 ± 11.20). After the intervention, sway of hip, ankle, and CoM was significantly reduced in the IG compared to the CG while standing in feet-closed position with EO (p = 0.010-0.022, except AP CoM sway) and in semi-tandem position (p = 0.008-0.035, except ankle sway). No significant effects were found for balance with EC, gait speed, and FES-I score (p > 0.05). CONCLUSIONS This proof-of-concept study demonstrates that older cancer patients with CIPN can significantly improve their postural balance with specifically tailored, sensor-based exercise training. The training approach has potential as a therapy for improving CIPN-related postural control deficits. However, future studies comparing the proposed technology-based training with traditional balance training are required to evaluate the benefit of the interactive joint movement feedback.
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Affiliation(s)
- Michael Schwenk
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, Arizona Center on Aging, University of Arizona, Tucson, Ariz., USA
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111
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Ungar A, Rafanelli M. My older patient with cancer reports falls: What should I do? J Geriatr Oncol 2015; 6:419-23. [PMID: 26480856 DOI: 10.1016/j.jgo.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/18/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
Abstract
Falling is one of the major geriatric syndromes, with a multi-factorial pathogenesis due to age-related changes, pathological conditions and environmental hazards. Such a multi-factorial syndrome needs a standardized approach aimed at identifying risk factors. A comprehensive loco-motor, gait and standing balance, cardiovascular and neurological assessment, as well as a drugs regimens review, should be part of the routinely approach. Modification of environmental hazards, exercise training, behavioral and pharmacological treatment of specific diseases which can be the leading cause of falls, should all be part of an individualized intervention. Particular attention should be paid in the evaluation of unexplained falls, which can mask hypotensive or arrhythmic syncope.
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Affiliation(s)
- Andrea Ungar
- Division of Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Martina Rafanelli
- Division of Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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112
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Hile ES. Imbalance and Falls in Older Cancer Survivors. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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113
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Gewandter JS, Dale W, Magnuson A, Pandya C, Heckler CE, Lemelman T, Roussel B, Ifthikhar R, Dolan J, Noyes K, Mohile SG. Associations between a patient-reported outcome (PRO) measure of sarcopenia and falls, functional status, and physical performance in older patients with cancer. J Geriatr Oncol 2015; 6:433-41. [PMID: 26365897 DOI: 10.1016/j.jgo.2015.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/13/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In older patients with cancer, we aimed to investigate associations between a patient-reported outcome measure for sarcopenia (SarcoPRO) and the Short Physical Performance Battery (SPPB), self-reported falls, and limitations in instrumental activities of daily living (IADLs). MATERIALS AND METHODS Assessments were conducted as part of the initial evaluation of older, often frail, patients with cancer seen in the Specialized Oncology Care and Research in the Elderly (SOCARE) clinic. Univariate associations were evaluated using Spearman's correlation and Wilcoxon sign ranked tests. Logistic regressions were used to identify associations of clinical factors and SarcoPRO scores or SPPB scores with falls and IADL limitations. RESULTS In total, 174 older patients with cancer were evaluated. A moderate correlation was found between the SarcoPRO and the SPPB (ρ=0.62). After adjusting for multiple clinical factors, neither the SarcoPRO nor the SPPB were associated with falls. In contrast, both higher SarcoPRO (i.e., worse) and lower SPPB (i.e., worse) scores were associated with limitations in IADLs (odds ratio for one unit change in predictor: SarcoPRO: 1.06, p<0.0001; SPPB: 0.71, p=0.003, respectively). Models using the SarcoPRO and SPPB explained similar amounts of variability in association with IADL limitations (AUC: 0.88 vs. 0.87, respectively). CONCLUSIONS The SarcoPRO was moderately associated with the SPPB, an objective measure of physical performance, and was associated with limitations in IADLs. Thus, older patients with cancer who present with IADL limitations should be screened for sarcopenia. The SarcoPRO shows promise as a measure for screening as well as outcome assessment for research on sarcopenia.
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Affiliation(s)
- Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester, Box 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - William Dale
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Allison Magnuson
- James Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
| | - Chintan Pandya
- Department of Public Health Sciences, University of Rochester, Rochester, NY 14642, USA
| | - Charles E Heckler
- Department of Surgery, University of Rochester, Rochester, NY 14642, USA
| | - Tatyana Lemelman
- James Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
| | - Breton Roussel
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
| | | | - James Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY 14642, USA
| | - Katia Noyes
- Departments Surgery and of Public Health Sciences, University of Rochester, Rochester, NY 14642, USA
| | - Supriya G Mohile
- James Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
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Balance function in patients who had undergone allogeneic hematopoietic stem cell transplantation. Gait Posture 2015; 42:406-8. [PMID: 26233580 DOI: 10.1016/j.gaitpost.2015.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/21/2015] [Accepted: 07/13/2015] [Indexed: 02/02/2023]
Abstract
A previous study reported a 45% incidence of falling among allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients during hospitalisation. We investigated balance and physical function in allo-HSCT patients. Thirty patients (18 men and 12 women) who underwent allo-HSCT between February 2013 and September 2014 were included in this study. Patients were evaluated for up to 3 weeks before and 7 weeks after transplantation. Balance was evaluated using the Timed Up and Go test (TUG) and length of centre of pressure (CoP). Physical function was assessed using hand-grip strength, knee-extensor strength tests, and the 6 min walk test (6MWT). TUG and length of CoP were significantly increased following HSCT (P<0.01). Hand-grip strength, knee-extensor strength, and the 6MWT score decreased significantly after allo-HSCT (P<0.01). TUG and length of CoP were negatively correlated with hand grip and knee-extensor strength (P≤0.05). The allo-HSCT patients in this study had worsened dynamic and static movements of the CoP after transplantation as well as decline of physical function. Rehabilitation staff, nurses, and physicians should recognize the decreased balance function of patients who have undergone allo-HSCT.
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115
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Abstract
INTRODUCTION The purpose was to determine the effect of peripheral neuropathy (PN) on motor output variability for ankle muscles of older adults, and the relation between ankle motor variability and postural stability in PN patients. METHODS Older adults with (O-PN) and without PN (O), and young adults (Y) underwent assessment of standing postural stability and ankle muscle force steadiness. RESULTS O-PN displayed impaired ankle muscle force control and postural stability compared with O and Y groups. For O-PN, the amplitude of plantarflexor force fluctuations was moderately correlated with postural stability under no-vision conditions (r = .54, p = .01). DISCUSSION The correlation of variations in ankle force with postural stability in PN suggests a contribution of ankle muscle dyscontrol to the postural instability that impacts physical function for older adults with PN.
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116
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Kneis S, Wehrle A, Freyler K, Lehmann K, Rudolphi B, Hildenbrand B, Bartsch HH, Bertz H, Gollhofer A, Ritzmann R. Balance impairments and neuromuscular changes in breast cancer patients with chemotherapy-induced peripheral neuropathy. Clin Neurophysiol 2015; 127:1481-1490. [PMID: 26350407 DOI: 10.1016/j.clinph.2015.07.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/14/2015] [Accepted: 07/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. Resulting sensory and motor dysfunctions often lead to functional impairments like gait or balance disorders. As the underlying neuromuscular mechanisms are not fully understood, we compared balance performance of CIPN patients with healthy controls (CON) to specify differences responsible for postural instability. METHODS 20 breast cancer patients with CIPN (PAT) and 16 matched CONs were monitored regarding centre of pressure displacement (COP) and electromyographic activity of M. soleus, gastrocnemius, tibialis anterior, rectus femoris and biceps femoris. We calculated antagonistic co-contraction indices (CCI) and elicited soleus H-reflexes to evaluate changes in the elicitability and sensitivity of spinal reflex circuitry. RESULTS PAT's COP displacement was greater than CON's (p=.013) and correlated significantly with the level of CCIs and self-reported CIPN symptoms. PAT revealed prolonged H-wave latency (p=.021), decreased H-reflex elicitability (p=.001), and increased H-reflex sensitivity from bi- to monopedal stance (p=.004). CONCLUSIONS We summarise that CIPN causes balance impairments and leads to changes in elicitability and sensitivity of spinal reflex circuitry associated with postural instability. We assume that increased simultaneous antagonistic muscle activation may be used as a safety strategy for joint stiffness to compensate for neuromuscular degradation. SIGNIFICANCE Sensorimotor training has the potential to influence neuromuscular mechanisms in order to improve balance performance. Therefore, this training modality should be evaluated as a possible treatment strategy for CIPN.
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Affiliation(s)
- Sarah Kneis
- Department Medicine I, Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117 Freiburg, Germany.
| | - Anja Wehrle
- Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117 Freiburg, Germany; Institute for Exercise- and Occupational Medicine, Department of Internal Medicine, University Medical Centre Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Kathrin Freyler
- Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117 Freiburg, Germany
| | - Katrin Lehmann
- Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117 Freiburg, Germany
| | - Britta Rudolphi
- Tumour Biology Centre Freiburg, Breisacher Str. 117, 79106 Freiburg, Germany
| | - Bernd Hildenbrand
- Tumour Biology Centre Freiburg, Breisacher Str. 117, 79106 Freiburg, Germany
| | - Hans Helge Bartsch
- Tumour Biology Centre Freiburg, Breisacher Str. 117, 79106 Freiburg, Germany
| | - Hartmut Bertz
- Department Medicine I, Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Albert Gollhofer
- Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117 Freiburg, Germany
| | - Ramona Ritzmann
- Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117 Freiburg, Germany
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Vincent JA, Nardelli P, Gabriel HM, Deardorff AS, Cope TC. Complex impairment of IA muscle proprioceptors following traumatic or neurotoxic injury. J Anat 2015; 227:221-30. [PMID: 26047324 DOI: 10.1111/joa.12312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 01/09/2023] Open
Abstract
The health of primary sensory afferents supplying muscle has to be a first consideration in assessing deficits in proprioception and related motor functions. Here we discuss the role of a particular proprioceptor, the IA muscle spindle proprioceptor in causing movement disorders in response to either regeneration of a sectioned peripheral nerve or damage from neurotoxic chemotherapy. For each condition, there is a single preferred and widely repeated explanation for disability of movements associated with proprioceptive function. We present a mix of published and preliminary findings from our laboratory, largely from in vivo electrophysiological study of treated rats to demonstrate newly discovered IA afferent defects that seem likely to make important contributions to movement disorders. First, we argue that reconnection of regenerated IA afferents with inappropriate targets, although often repeated as the reason for lost stretch-reflex contraction, is not a complete explanation. We present evidence that despite successful recovery of stretch-evoked sensory signaling, peripherally regenerated IA afferents retract synapses made with motoneurons in the spinal cord. Second, we point to evidence that movement disability suffered by human subjects months after discontinuation of oxaliplatin (OX) chemotherapy for some is not accompanied by peripheral neuropathy, which is the acknowledged primary cause of disability. Our studies of OX-treated rats suggest a novel additional explanation in showing the loss of sustained repetitive firing of IA afferents during static muscle stretch. Newly extended investigation reproduces this effect in normal rats with drugs that block Na(+) channels apparently involved in encoding static IA afferent firing. Overall, these findings highlight multiplicity in IA afferent deficits that must be taken into account in understanding proprioceptive disability, and that present new avenues and possible advantages for developing effective treatment. Extending the study of IA afferent deficits yielded the additional benefit of elucidating normal processes in IA afferent mechanosensory function.
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Affiliation(s)
- Jacob A Vincent
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH, USA
| | - Paul Nardelli
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH, USA
| | - Hanna M Gabriel
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH, USA
| | - Adam S Deardorff
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH, USA
| | - Timothy C Cope
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH, USA
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Valentine-Davis B, Altshuler LH. Acupuncture for Oxaliplatin Chemotherapy–Induced Peripheral Neuropathy in Colon Cancer: A Retrospective Case Series. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brandy Valentine-Davis
- Cancer Treatment Centers of America, Southwestern Regional Medical Center, Inc., Tulsa, OK
| | - Laurence H. Altshuler
- Cancer Treatment Centers of America, Southwestern Regional Medical Center, Inc., Tulsa, OK
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Verhulst AL, Savelberg HH, Vreugdenhil G, Mischi M, Schep G. Whole-Body Vibration as a Modality for the Rehabilitation of Peripheral Neuropathies: Implications for Cancer Survivors Suffering from Chemotherapy-Induced Peripheral Neuropathy. Oncol Rev 2015; 9:263. [PMID: 26779309 PMCID: PMC4698591 DOI: 10.4081/oncol.2015.263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/12/2014] [Accepted: 12/17/2014] [Indexed: 01/08/2023] Open
Abstract
The objective was to study the effect of whole-body vibration (WBV) on strength, balance and pain in patients with peripheral neuropathies and to consider its significance for the rehabilitation of patients suffering from chemotherapy-induced peripheral neuropathy (CIPN). Using a broad search strategy, PubMed was searched for clinical trials on WBV interventions aimed at improving strength, balance or pain in patients with peripheral neuropathies, which were published in English until 5(th) June 2014. The search was performed by the first author and generated a total of 505 results, which yielded 5 articles that met the inclusion criteria, being studies: i) published in English; ii) involving adult human subjects' peripheral neuropathies; iii) evaluating the effect of WBV as a therapeutic intervention; and iv) reporting findings for at least one of the following outcomes: strength, balance or pain. Methodological quality of included studies was assessed independently by first and second author, using the physiotherapy evidence database scale. The overall methodological quality of included studies was low. Two studies found a beneficial effect of WBV on neuropathic pain, but another study failed to find the same effect. One study found significant improvements in both muscle strength and balance, while another study found improvements only in some, but not all, of the applied tests to measure muscle strength and balance. The results of this literature search suggest insufficient evidence to assess the effectiveness for the effects of WBV on neuropathic pain, muscle strength and balance in patients with peripheral neuropathies. More high-quality trials are needed to guide the optimization of rehabilitation programs for cancer survivors with CIPN in particular.
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Affiliation(s)
- Anna L.J. Verhulst
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Hans H.C.M. Savelberg
- Department of Human Movement Sciences, Maastricht UniversityMaastricht, The Netherlands
| | - Gerard Vreugdenhil
- Department of Medical Oncology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Goof Schep
- Department of Sports Medicine Máxima Medical Centre, Veldhoven, The Netherlands
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Wildes TM, Dua P, Fowler SA, Miller JP, Carpenter CR, Avidan MS, Stark S. Systematic review of falls in older adults with cancer. J Geriatr Oncol 2015; 6:70-83. [PMID: 25454770 PMCID: PMC4297689 DOI: 10.1016/j.jgo.2014.10.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/26/2014] [Accepted: 10/07/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Older adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors. MATERIALS AND METHODS We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome. RESULTS We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases. CONCLUSIONS Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population.
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Affiliation(s)
- Tanya M Wildes
- Washington University School of Medicine, Division of Medical Oncology, St Louis, MO, USA.
| | - Priya Dua
- Barnes-Jewish Hospital, Siteman Cancer Center, St Louis, MO, USA
| | - Susan A Fowler
- Washington University School of Medicine, Bernard Becker Medical Library, St Louis, MO, USA
| | - J Philip Miller
- Washington University School of Medicine, Division of Biostatistics, St Louis, MO, USA
| | - Christopher R Carpenter
- Washington University School of Medicine, Department of Emergency Medicine, St Louis, MO, USA
| | - Michael S Avidan
- Washington University School of Medicine, Department of Anesthesiology, St Louis, MO, USA
| | - Susan Stark
- Washington University School of Medicine, Department of Occupational Therapy, St Louis, MO, USA
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Oncology Section Task Force on Breast Cancer Outcomes: Clinical Measures of Chemotherapy-induced Peripheral Neuropathy—A Systematic Review. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533030-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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122
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Packel LB, Prehn AW, Anderson CL, Fisher PL. Factors influencing physical activity behaviors in colorectal cancer survivors. Am J Health Promot 2014; 30:85-92. [PMID: 25372238 DOI: 10.4278/ajhp.140103-quan-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To elucidate factors that impact intention (INT) to be active as well as actual physical activity (PA) behavior in colorectal cancer survivors (CRC-S) using the theory of planned behavior (TpB). Planning for PA was explored as a mediator of the INT-behavior relationship. Chemotherapy-induced neuropathy and fatigue were also explored. DESIGN A cross-sectional quantitative mailed survey was used. SETTING The study was conducted among community-dwelling adults living in Pennsylvania when diagnosed with colorectal cancer (CRC). SUBJECTS Subjects comprised 843 CRC-S diagnosed with CRC in Pennsylvania in 2009. MEASURES The survey included questions about planning for PA, TpB constructs, medical and social variables, and PA as measured by a modified Godin Leisure Time Questionnaire. ANALYSIS Descriptive statistics were used to characterize the sample. A mediation analysis was used to determine if planning mediated the relationship between INT and actual PA behavior. A stepwise regression was used to determine predictors of INT and PA. RESULTS Ninety-six CRC-S responded, with 25% meeting PA recommendations for health promotion, suggesting that CRC-S are insufficiently active. Perceived behavioral control (PBC) and social norm (SN) accounted for 43% of the variance in INT, whereas 30% of the variance in PA was explained by PBC and age. Neuropathy negatively impacted PA behavior (p = .008). Both action and coping planning partially mediated the INT-behavior relationship (β = 20.08, p = .007; β = 22.85, p = .001, respectively). CONCLUSION Survivors at risk for inactivity are those with low PBC, low SN, and neuropathy, and those who are older.
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Immediate Influence of Carbon Composite Ankle-Foot Orthoses on Balance and Gait in Individuals with Peripheral Neuropathy. ACTA ACUST UNITED AC 2014. [DOI: 10.1097/jpo.0000000000000040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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124
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Colon Cancer in Older Adults: A Primer for Geriatricians. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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125
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Bhatnagar B, Gilmore S, Goloubeva O, Pelser C, Medeiros M, Chumsri S, Tkaczuk K, Edelman M, Bao T. Chemotherapy dose reduction due to chemotherapy induced peripheral neuropathy in breast cancer patients receiving chemotherapy in the neoadjuvant or adjuvant settings: a single-center experience. SPRINGERPLUS 2014; 3:366. [PMID: 25089251 PMCID: PMC4117856 DOI: 10.1186/2193-1801-3-366] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/02/2014] [Indexed: 12/20/2022]
Abstract
Purpose Taxanes are a cornerstone treatment in early and advanced stage breast cancer and in other common solid tumor malignancies; however, the development of chemotherapy induced peripheral neuropathy (CIPN) often necessitates dose-reduction, which may hamper the effectiveness of the drug and compromise survival outcomes especially when used in the adjuvant setting. Limited literature is available on the prevalence and severity of dose reduction due to CIPN. We sought to determine the frequency and severity of CIPN-induced dose reduction in early stage breast cancer patients who received taxane-based chemotherapy in the neoadjuvant or adjuvant settings. Methods We conducted a retrospective single-institution breast cancer clinic chart review of 123 newly diagnosed breast cancer patients and treated with taxane-based neoadjuvant/adjuvant chemotherapy at the University of Maryland Greenebaum Cancer Center between January 2008 and December 2011. Results Forty-nine of 123 (40%; 95% CI: 31-49%) patients required dose reduction. Twenty-one (17%; 95% CI: 11-25%) of these patients were dose-reduced specifically due to CIPN that developed during treatment. The median relative dose intensity (received dose/planned dose) for the 21 CIPN-induced dose reduction patients was 73.4% (range, 68.0-94.0%). Patients with diabetes appeared to have a higher risk of taxane-induced dose reduction (p-value=0.01). African-American patients and those treated with paclitaxel (rather than docetaxel) experienced a higher-risk of CIPN-induced dose reduction (p-values are <0.001 and 0.001, respectively). Conclusions The incidence of CIPN-associated dose reduction in our patient population was 17%. African-American patients, diabetics and subjects treated with paclitaxel had a higher risk for CIPN-associated dose reduction in our study.
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Affiliation(s)
- Bhavana Bhatnagar
- Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA
| | - Steven Gilmore
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, USA
| | - Olga Goloubeva
- Department of Epidemiology and Biostatistics, University of Maryland School of Medicine, Baltimore, USA
| | - Colleen Pelser
- Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA
| | - Michelle Medeiros
- Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA
| | - Saranya Chumsri
- Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA
| | - Katherine Tkaczuk
- Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA
| | - Martin Edelman
- Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA
| | - Ting Bao
- Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA
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126
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Muss HB. Adjuvant Chemotherapy in Older Women With Breast Cancer: Who and What? J Clin Oncol 2014; 32:1996-2000. [DOI: 10.1200/jco.2013.54.8586] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Huang MH, Lytle T, Miller KA, Smith K, Fredrickson K. History of falls, balance performance, and quality of life in older cancer survivors. Gait Posture 2014; 40:451-6. [PMID: 24931110 DOI: 10.1016/j.gaitpost.2014.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/01/2014] [Accepted: 05/26/2014] [Indexed: 02/02/2023]
Abstract
Older cancer survivors may be predisposed to falls because of the sequalae associated with cancer and its treatments. This study examined the association between the fall history, balance performance, and health-related quality of life (QoL) in older, community-dwelling cancer survivors who had completed primary cancer treatments. Forty-one cancer survivors (age = 67.9 ± 8.8 years) participated in the study. Balance performance was examined using the Activities-specific Balance Confidence Scale (ABC) and the Balance Evaluation Systems Test (BESTest). Scores from the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36v2 were obtained to assess the QoL. The demographics and health status were comparable between the fallers and non-fallers. While 54% of the participants had experienced at least one fall in the past 12 months, 30% had experienced two or more falls. Spearman's correlation analysis revealed a significant relationship between the outcomes from the ABC and the PCS (p < 0.001), and between the BESTest and the PCS (p < 0.001). Only the PCS significantly differentiated fallers from non-fallers (p < 0.01). Logistic regression analysis estimated that a one-unit increase in the PCS score significantly reduced the odds of falling by 13% (p < 0.01). The results demonstrate that in older cancer survivors, falls are a significant problem and balance control is a determinant of perceived physical function and well-being. Older cancer survivors reporting a poor QoL in the physical health domain may have higher risks of falling. Future studies are needed to examine the risk factor profiles of falls and the interventions to prevent falls in older cancer survivors.
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Affiliation(s)
- Min H Huang
- Physical Therapy Department, School of Health Professions and Studies, University of Michigan-Flint, Michigan, United States.
| | - Tracy Lytle
- Physical Therapy Department, School of Health Professions and Studies, University of Michigan-Flint, Michigan, United States
| | - Kara A Miller
- Physical Therapy Department, School of Health Professions and Studies, University of Michigan-Flint, Michigan, United States
| | - Kristin Smith
- Physical Therapy Department, School of Health Professions and Studies, University of Michigan-Flint, Michigan, United States
| | - Kayle Fredrickson
- Physical Therapy Department, School of Health Professions and Studies, University of Michigan-Flint, Michigan, United States
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128
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What about Alice? Peripheral neuropathy from taxane-containing treatment for advanced nonsmall cell lung cancer. Support Care Cancer 2014; 22:2581-92. [DOI: 10.1007/s00520-014-2317-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/08/2014] [Indexed: 01/05/2023]
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130
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Pachman DR, Watson JC, Lustberg MB, Wagner-Johnston ND, Chan A, Broadfield L, Cheung YT, Steer C, Storey DJ, Chandwani KD, Paice J, Jean-Pierre P, Oh J, Kamath J, Fallon M, Strik H, Koeppen S, Loprinzi CL. Management options for established chemotherapy-induced peripheral neuropathy. Support Care Cancer 2014; 22:2281-95. [PMID: 24879391 DOI: 10.1007/s00520-014-2289-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/12/2014] [Indexed: 12/16/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating condition associated with a variety of chemotherapeutic agents. Clinicians are cognizant of the negative impact of CIPN on cancer treatment outcomes and patients' psychosocial functioning and quality of life. In an attempt to alleviate this problem, clinicians and patients try various therapeutic interventions, despite limited evidence to support efficacy of these treatments. The rationale for such use is mostly based on the evidence for the treatment options in non-CIPN peripheral neuropathy syndromes, as this area is more robustly studied than is CIPN treatment. In this manuscript, we examine the existing evidence for both CIPN and non-CIPN treatments and develop a summary of the best available evidence with the aim of developing a practical approach to the treatment of CIPN, based on available literature and clinical practice experience.
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Affiliation(s)
- Deirdre R Pachman
- Division of Medical Oncology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA,
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131
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Argyriou AA, Kyritsis AP, Makatsoris T, Kalofonos HP. Chemotherapy-induced peripheral neuropathy in adults: a comprehensive update of the literature. Cancer Manag Res 2014; 6:135-47. [PMID: 24672257 PMCID: PMC3964029 DOI: 10.2147/cmar.s44261] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Commonly used chemotherapeutic agents in oncology/hematology practice, causing toxic peripheral neuropathy, include taxanes, platinum compounds, vinca alkaloids, proteasome inhibitors, and antiangiogenic/immunomodulatory agents. This review paper intends to put together and discuss the spectrum of chemotherapy-induced peripheral neuropathy (CIPN) characteristics so as to highlight areas of future research to pursue on the topic. Current knowledge shows that the pathogenesis of CIPN still remains elusive, mostly because there are several sites of involvement in the peripheral nervous system. In any case, it is acknowledged that the dorsal root ganglia of the primary sensory neurons are the most common neural targets of CIPN. Both the incidence and severity of CIPN are clinically under- and misreported, and it has been demonstrated that scoring CIPN with common toxicity scales is associated with significant inter-observer variability. Only a proportion of chemotherapy-treated patients develop treatment-emergent and persistent CIPN, and to date it has been impossible to predict high-and low-risk subjects even within groups who receive the same drug regimen. This issue has recently been investigated in the context of pharmacogenetic analyses, but these studies have not implemented a proper methodological approach and their results are inconsistent and not really clinically relevant. As such, a stringent approach has to be implemented to validate that information. Another open issue is that, at present, there is insufficient evidence to support the use of any of the already tested chemoprotective agents to prevent or limit CIPN. The results of comprehensive interventions, including clinical, neurophysiological, and pharmacogenetic approaches, are expected to produce a consistent advantage for both doctors and patients and thus allow the registration and analysis of reliable data on the true characteristics of CIPN, eventually leading to potential preventive and therapeutic interventions.
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Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" General Hospital of Patras, Greece ; Department of Medicine-Division of Oncology, University of Patras Medical School, Rion-Patras, Greece
| | | | - Thomas Makatsoris
- Department of Medicine-Division of Oncology, University of Patras Medical School, Rion-Patras, Greece
| | - Haralabos P Kalofonos
- Department of Medicine-Division of Oncology, University of Patras Medical School, Rion-Patras, Greece
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Winters-Stone K. Tai Ji Quan for the aging cancer survivor: Mitigating the accelerated development of disability, falls, and cardiovascular disease from cancer treatment. JOURNAL OF SPORT AND HEALTH SCIENCE 2014; 3:52-57. [PMID: 25285233 PMCID: PMC4180213 DOI: 10.1016/j.jshs.2013.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Currently there are more than 13.7 million cancer survivors living in the U.S., and that figure is projected to increase by 31% in the next decade, adding another 4 million cancer survivors into the healthcare system. Cancer is largely a disease of aging, and the aging of the population will sharply raise the proportion of older cancer survivors, many of whom will be long-term survivors (5+ years post diagnosis). This review will address the potential utility of exercise to address three health problems that are of particular concern for the aging cancer survivor and the healthcare system, i.e., disability, falls, and cardiovascular disease, because the development of these age-related problems may be accelerated by cancer treatment. While there are many different modes of exercise that each produce specific adaptations, Tai Ji Quan may be a particularly suitable strategy to mitigate the development of age- and cancer-treatment-related problems. Based on studies in older adults without cancer, Tai Ji Quan produces musculoskeletal and cardiometabolic adaptations and is more easily performed by older adults due to its low energy cost and slower movement patterns. Since cancer survivors are mostly older, inactive, and often physically limited by the lingering side effects of treatment, they need to engage in safe, practical, and effective modes of exercise. The dearth of published controlled trials examining the efficacy of Tai Ji Quan to mitigate cancer-treatment-related musculoskeletal and cardiovascular side effects points to ample research opportunities to explore the application of this non-Western exercise modality to improve long-term outcomes for aging cancer survivors.
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Affiliation(s)
- Kerri Winters-Stone
- School of Nursing and Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
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Relationship between Quality of Life and Nurse-led Bedside Symptom Evaluations in Patients with Chemotherapy-induced Peripheral Neuropathy. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:36-41. [DOI: 10.1016/j.anr.2013.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/23/2013] [Accepted: 10/28/2013] [Indexed: 11/18/2022] Open
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134
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Niederer D, Schmidt K, Vogt L, Egen J, Klingler J, Hübscher M, Thiel C, Bernhörster M, Banzer W. Functional capacity and fear of falling in cancer patients undergoing chemotherapy. Gait Posture 2014; 39:865-9. [PMID: 24360638 DOI: 10.1016/j.gaitpost.2013.11.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 08/23/2013] [Accepted: 11/25/2013] [Indexed: 02/02/2023]
Abstract
Cancer patients, particularly during chemotherapy, often encounter functional status limitations. This study examines fear of falling, balance, gait and lower limb strength in cancer patients during ongoing or recently completed (≤12 months) chemotherapeutic treatment in comparison to age-matched and senior controls (≥65 years). Data were obtained from 69 subjects; 21 cancer patients (51±7 years) with histological confirmed diagnosis and two control groups (2×n=24): one age-matched (53±7 years) and one senior group (70±3 years). Fear of falling (FoF) was evaluated using the Falls Efficacy Scale-International Version. Motor function measurement included postural sway (centre of pressure) in upright stance with eyes covered, gait speed (comfortable fluid walking) and maximum voluntary isometric quadriceps strength (MIVF). One-way ANOVA followed by corrected post hoc paired-sample t-test revealed inferior values in cancer patients than in age-matched healthy regarding all parameters. Gait speed and MIVF of cancer patients were higher than in the senior control group (p<.05), whereas their FoF and postural sway were comparable (p>.05). Physical performance parameters of cancer patients were found to be lower in comparison to healthy age-matched subjects. Cancer patients show physical impairments which may limit independence and may increase fall risk. The present findings call for routine screening of physical function in cancer patients, and further stress the relevance of exercise interventions during and after chemotherapy.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Katharina Schmidt
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Lutz Vogt
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Janis Egen
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Julia Klingler
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Markus Hübscher
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany; Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, Sydney, NSW 2141, Australia.
| | - Christian Thiel
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Marcus Bernhörster
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Winfried Banzer
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
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135
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Streckmann F, Kneis S, Leifert J, Baumann F, Kleber M, Ihorst G, Herich L, Grüssinger V, Gollhofer A, Bertz H. Exercise program improves therapy-related side-effects and quality of life in lymphoma patients undergoing therapy. Ann Oncol 2014; 25:493-9. [DOI: 10.1093/annonc/mdt568] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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136
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Smith EML. Current methods for the assessment and management of taxane-related neuropathy. Clin J Oncol Nurs 2013; 17 Suppl:22-34. [PMID: 23360700 DOI: 10.1188/13.cjon.s1.22-34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Taxane-induced peripheral neuropathy (TIPN) affects a number of patients with breast cancer. To properly manage these patients, nurses must be able to identify and assess TIPN, as well as educate patients on TIPN as a side effect of taxane therapy. This article provides practical suggestions regarding how nurses can incorporate clinically feasible measurement approaches into practice and includes examples of grading TIPN that illustrate the limitations of the current tools and techniques for assessment. For example, a shortened and revised version of the Total Neuropathy Score and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale should be considered for future use. In addition, neuropathy-related results from numerous phase III trials in breast cancer are discussed, and the latest evidence regarding pharmacologic interventions for TIPN is briefly summarized.
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137
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A polyamine-deficient diet prevents oxaliplatin-induced acute cold and mechanical hypersensitivity in rats. PLoS One 2013; 8:e77828. [PMID: 24204988 PMCID: PMC3813736 DOI: 10.1371/journal.pone.0077828] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/06/2013] [Indexed: 11/19/2022] Open
Abstract
Background Oxaliplatin is an anticancer drug used for the treatment of advanced colorectal cancer, but it can also cause painful peripheral neuropathies. The pathophysiology of these neuropathies has not been yet fully elucidated, but may involve spinal N-methyl-D-aspartate (NMDA) receptors, particularly the NR2B subunit. As polyamines are positive modulators of NMDA-NR2B receptors and mainly originate from dietary intake, the modulation of polyamines intake could represent an interesting way to prevent/modulate neuropathic pain symptoms by opposing glutamate neurotransmission. Methods The effect of a polyamine deficient diet was investigated in an animal model of oxaliplatin-induced acute pain hypersensitivity using behavioral tests (mechanical and cold hypersensitivity). The involvement of spinal glutamate neurotransmission was monitored by using a proton nuclear magnetic resonance spectroscopy based metabolomic approach and by assessing the expression and phosphorylation of the NR2B subunit of the NMDA receptor. Results A 7-day polyamine deficient diet totally prevented oxaliplatin-induced acute cold hypersensitivity and mechanical allodynia. Oxaliplatin-induced pain hypersensitivity was not associated with an increase in NR2B subunit expression or phosphorylation, but with an increase of glutamate level in the spinal dorsal horn which was completely prevented by a polyamine deficient diet. As a validation that the oxaliplatin-induced hypersensitivity could be due to an increased activity of the spinal glutamate system, an intrathecal administration of the specific NR2B antagonist, ifenprodil, totally reversed oxaliplatin-induced mechanical and cold hypersensitivity. Conclusion A polyamine deficient diet could represent a promising and valuable nutritional therapy to prevent oxaliplatin-induced acute pain hypersensitivity.
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138
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Chen TY, Janke MC. Predictors of falls among community-dwelling older adults with cancer: results from the health and retirement study. Support Care Cancer 2013; 22:479-85. [DOI: 10.1007/s00520-013-2000-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
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139
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Pain in chemotherapy-induced neuropathy--more than neuropathic? Pain 2013; 154:2877-2887. [PMID: 23999056 DOI: 10.1016/j.pain.2013.08.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/16/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022]
Abstract
Chemotherapy-induced neuropathy (CIN) is an adverse effect of chemotherapy. Pain in CIN might comprise neuropathic and nonneuropathic (ie, musculoskeletal) pain components, which might be characterized by pain patterns, electrophysiology, and somatosensory profiling. Included were 146 patients (100 female, 46 male; aged 56 ± 0.8 years) with CIN arising from different chemotherapy regimens. Patients were characterized clinically through nerve conduction studies (NCS) and quantitative sensory testing (QST). Questionnaires for pain (McGill) and anxiety/depression (Hospital Anxiety and Depression Scale) were supplied. Patients were followed-up after 17 days. Large- (61%) and mixed- (35%) fibre neuropathies were more frequent than small-fibre neuropathy (1.4%). The 5 major chemotherapeutic regimens impacted differently on large- but not on small-fibre function and did not predict painfulness. Chronic pain associated with CIN was reported in 41.7%. Painless and painful CIN did not differ in QST profiles or electrophysiological findings, but different somatosensory patterns were found in CIN subgroups (pain at rest [RestP], n = 25; movement-associated pain [MovP], n = 15; both pain characteristics [MovP+RestP], n = 21; or no pain [NonP], n = 85): small-fibre function (cold-detection threshold, CDT: z score: -1.46 ± 0.21, P < 0.01) was most impaired in RestP; mechanical hyperalgesia was exclusively found in MovP (z score: +0.81 ± 0.30, P < 0.05). "Anxiety" discriminated between painful and painless CIN; "CDT" and "anxiety" discriminated between patients with ongoing (RestP) and movement-associated pain (MovP) or pain components (MovP+RestP). The detrimental effect of chemotherapy on large fibres failed to differentiate painful from painless CIN. Patients stratified for musculoskeletal or neuropathic pain, however, differed in psychological and somatosensory parameters. This stratification might allow for the application of a more specific therapy.
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140
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Significance of Kampo, traditional Japanese medicine, in supportive care of cancer patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:746486. [PMID: 23861712 PMCID: PMC3703882 DOI: 10.1155/2013/746486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/28/2013] [Indexed: 02/06/2023]
Abstract
The current standard treatment for cancer is a multidisciplinary therapy whereby various types of treatment are properly combined. Chemotherapy with multiple anticancer drugs is now common, and traditional, complementary, and alternative therapies are adopted as supportive measures. Medical care in Japan is distinguished by the ability for patients to access both Western and Kampo medical cares at the same time. There is a high degree of trust in the safety of Kampo therapies because they are practiced by medical doctors who are educated with fundamental diagnosis of Western medicine. Highly reliable clinical studies are being published, demonstrating that palliative or supportive care for cancer patients using Kampo preparations alleviates adverse effects of chemotherapy or radiotherapy. This paper reports the circumstances around cancer care in Japan where traditional therapeutic Kampo formulas are used for patients undergoing cancer treatment with cutting-edge chemotherapy, specifically to alleviate adverse effects of anticancer drugs.
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141
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Kalsi T, Payne S, Brodie H, Mansi J, Wang Y, Harari D. Are the UK oncology trainees adequately informed about the needs of older people with cancer? Br J Cancer 2013; 108:1936-41. [PMID: 23632484 PMCID: PMC3670491 DOI: 10.1038/bjc.2013.204] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/14/2013] [Accepted: 04/01/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Outcomes for older people with cancer are poorer in the United Kingdom compared with that in other countries. Despite this, the UK oncology curricula do not have dedicated geriatric oncology learning objectives. This cross-sectional study of UK medical oncology trainees investigates the training, confidence level and attitudes towards treating older people with cancer. METHODS A web-based survey link was sent to the delegates of a national medical oncology trainee meeting. Responses were collected in October 2011. RESULTS The response rate was 93% (64 out of 69). The mean age of the respondents was 32.3 years (range 27-42 years) and 64.1% were female. A total of 66.1% of the respondents reported never receiving training on the particular needs of older people with cancer, 19.4% reported to have received this training only once. Only 27.1% of the trainees were confident in assessing risk to make treatment recommendations for older patients compared with 81.4% being confident to treat younger patients. Even fewer were confident with older patients with dementia (10.2%). CONCLUSION This first study of the UK medical oncology trainees highlights the urgent need for change in curricula to address the complex needs of older people with cancer.
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Affiliation(s)
- T Kalsi
- POPS-GOLD, Older Person's Assessment Unit, Department of Ageing of Health, Guys Hospital, Guys and St Thomas' NHS Foundation Trust, London SE1 9RT, UK.
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Falls and functional impairments in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN): a University of Rochester CCOP study. Support Care Cancer 2013; 21:2059-66. [PMID: 23446880 DOI: 10.1007/s00520-013-1766-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE This study was conducted in order to characterize the prevalence of falls and functional impairments (FIs) and their association with chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors. METHODS We analyzed baseline assessments from a phase III RCT in cancer survivors with self-reported CIPN scores of >4 out of 10. Patients completed the EORTC QLQ-CIPN-20 for neuropathy and reported falls in the previous 3 months. FIs were defined using the Activities of Daily Living subsection of the Vulnerable Elder's Scale. Associations of baseline characteristics and CIPN with falls and FIs were examined using logistic regression. RESULTS Of 421 patients, 11.9 % experienced recent falls and 26.6 % reported FIs. Motor neuropathy was the only factor associated with falls (OR = 1.127, p = 0.01). Factors associated with FIs included non-white race (OR = 0.335 white relative to non-white, 0.781, p = 0.01) and greater motor neuropathy scores (OR = 1.262, p < 0.0001). CONCLUSION CIPN, primarily motor, is associated with falls and FIs. Future prospective research should investigate the ability of motor neuropathy severity to predict falls.
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143
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Tofthagen C, Visovsky C, Berry DL. Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research. Oncol Nurs Forum 2013; 39:E416-24. [PMID: 22940521 DOI: 10.1188/12.onf.e416-e424] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the evidence for strength- and balance-training programs in patients at high risk for falls, discuss how results of existing studies might guide clinical practice, and discuss directions for additional research. DATA SOURCES A search of PubMed and CINAHL® databases was conducted in June 2011 using the terms strength, balance training, falls, elderly, and neuropathy. Only clinical trials conducted using specific strength- or balance-training exercises that included community-dwelling adults and examined falls, fall risk, balance, and/or strength as outcome measures were included in this review. DATA SYNTHESIS One matched case-control study and two randomized, controlled studies evaluating strength and balance training in patients with diabetes-related peripheral neuropathy were identified. Eleven studies evaluating strength and balance programs in community-dwelling adults at high risk for falls were identified. CONCLUSIONS The findings from the reviewed studies provide substantial evidence to support the use of strength and balance training for older adults at risk for falls, and detail early evidence to support strength and balance training for individuals with peripheral neuropathy. IMPLICATIONS FOR NURSING The evidence demonstrates that strength and balance training is safe and effective at reducing falls and improving lower extremity strength and balance in adults aged 50 years and older at high risk for falls, including patients with diabetic peripheral neuropathy. Future studies should evaluate the effects of strength and balance training in patients with cancer, particularly individuals with chemotherapy-induced peripheral neuropathy.
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Affiliation(s)
- Cindy Tofthagen
- College of Nursing, University of South Florida, Tampa, FL, USA.
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144
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Kim HY, Kang JH, Song CE, Youn HJ. Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Breast Cancer Patients. ASIAN ONCOLOGY NURSING 2013. [DOI: 10.5388/aon.2013.13.4.222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hye Young Kim
- College of Nursing, Chonbuk National University, Jeonju, Korea
| | - Jeong Hee Kang
- College of Nursing, Chonbuk National University, Jeonju, Korea
| | - Chi Eun Song
- Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
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145
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Tofthagen* C, McAllister RD, Visovsky C. Peripheral neuropathy caused by Paclitaxel and docetaxel: an evaluation and comparison of symptoms. J Adv Pract Oncol 2013; 4:204-15. [PMID: 25032002 PMCID: PMC4093436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The purpose of this study was to explore the prevalence, severity, distress, and timing of neuropathic symptoms in cancer patients receiving taxanes and to explore neuropathy-related interference with activities. In this descriptive, cross-sectional study, 68 adult outpatients receiving paclitaxel (n = 36) and docetaxel (n = 32) completed the Chemotherapy Induced Peripheral Neuropathy Assessment Tool and a demographic questionnaire. Muscle or joint aches were the most prevalent symptom. Muscle or joint aches were also the most severe and distressing symptom in persons receiving paclitaxel. Participants receiving paclitaxel reported that neuropathic symptoms interfered with a mean of 7.3 (standard deviation [SD] = 4.1) of 14 activities. Nerve pain was the most severe and distressing symptom in persons receiving docetaxel. Participants receiving docetaxel reported that neuropathic symptoms interfered with a mean of 7.1 (SD = 4.1) of 14 activities. Numbness in the feet was the most frequent or constant symptom in persons receiving paclitaxel or docetaxel. Patients receiving paclitaxel and docetaxel experienced similar symptoms of peripheral neuropathy and interference with activities. Continued focus on treatment of painful neuropathy including myalgias and arthralgias is needed.
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146
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Commentary Overcoming Barriers to Physical Activity in Rural Breast Cancer Survivors. REHABILITATION ONCOLOGY 2013. [DOI: 10.1097/01893697-201331040-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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147
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The fall rate of older community-dwelling cancer patients. Support Care Cancer 2012; 21:775-83. [DOI: 10.1007/s00520-012-1579-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 08/13/2012] [Indexed: 11/26/2022]
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148
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Ami N, Okamoto K, Oshima H. Analgesic effect of magnetic stimulation on paclitaxel-induced peripheral neuropathic pain in mice. Brain Res 2012; 1461:24-9. [DOI: 10.1016/j.brainres.2012.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 04/17/2012] [Accepted: 04/21/2012] [Indexed: 12/18/2022]
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149
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Stubblefield MD, McNeely ML, Alfano CM, Mayer DK. A prospective surveillance model for physical rehabilitation of women with breast cancer. Cancer 2012; 118:2250-60. [DOI: 10.1002/cncr.27463] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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150
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Mohile SG, Klepin HD, Rao AV. Considerations and controversies in the management of older patients with advanced cancer. Am Soc Clin Oncol Educ Book 2012:321-328. [PMID: 24451757 DOI: 10.14694/edbook_am.2012.32.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The incidence of cancer increases with age. Oncologists need to be adept at assessing physiologic and functional capacity in older patients in order to provide safe and efficacious cancer treatment. Assessment of underlying health status is especially important for older patients with advanced cancer, for whom the benefits of treatment may be low and the toxicity of treatment high. The comprehensive geriatric assessment (CGA) is the criterion standard for evaluation of the older patient. The combined data from the CGA can be used to stratify patients into categories to better predict risk for chemotherapy toxicity as well as overall outcomes. The CGA can also be used to identify and follow-up on possible functional consequences from treatment. A variety of screening tools might be useful in the oncology practice setting to identify patients who may benefit from further testing and intervention. In this chapter, we discuss how the principles of geriatrics can help improve the clinical care of older adults with advanced cancer. Specifically, we discuss assessing tolerance for treatment, options for chemotherapy scheduling and dosing for older patients with advanced cancer, and management of under-recognized symptoms in older patients with cancer.
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Affiliation(s)
- Supriya Gupta Mohile
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
| | - Heidi D Klepin
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
| | - Arati V Rao
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
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