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Pilegaard MS, la Cour K, Baldursdóttir F, Morgan D, Oestergaard LG, Brandt Å. Assistive devices among people living at home with advanced cancer: Use, non-use and who have unmet needs for assistive devices? Eur J Cancer Care (Engl) 2022; 31:e13572. [PMID: 35289004 PMCID: PMC9539586 DOI: 10.1111/ecc.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/21/2022] [Accepted: 03/02/2022] [Indexed: 12/25/2022]
Abstract
Objective To investigate which assistive devices people with advanced cancer have and whether they are in use. In addition, to explore the characteristics of people with advanced cancer who have unmet needs for assistive devices. Methods This descriptive cross‐sectional study used data from a randomised controlled trial evaluating efficacy of an occupational therapy‐based intervention. Participants were 237 people with advanced cancer. Data were collected by means of instruments about demography, functioning and assistive devices. Results The most frequent assistive devices possessed by the participants were as follows: (1) small aids for dressing (47%), (2) Pillow for positioning (40%) and (3) electrically operated adjustable bed (39%). The prevalence of assistive devices was 92% (95% confidence interval [CI]: 88%–95%) with 14.2% non‐use, largest for trolley tables (50%). In all, 27.4% of the participants were found to have unmet needs for assistive devices. These participants had similar characteristics to the other participants except from lower activity of daily living (ADL) ability (p values = <0.001). Conclusion The assistive devices possessed by the participants were primarily for positioning and resting, and most were in use. More than a fourth of the participants had unmet needs for assistive devices and were characterised by lower ADL ability.
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Affiliation(s)
- Marc Sampedro Pilegaard
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Fjóla Baldursdóttir
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Deidre Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), Flinders University, Adelaide, South Australia, Australia
| | - Lisa Gregersen Oestergaard
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark
| | - Åse Brandt
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
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2
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Long-term Functional Outcome in Young Adult Survivors of Childhood Brain Tumor. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Sampedro Pilegaard M, la Cour K, Brandt Å, Lozano-Lozano M, Gregersen Oestergaard L. Impact of pain, fatigue and dyspnoea on occupational performance in people with advanced cancer: A longitudinal study. Scand J Occup Ther 2019; 27:507-516. [PMID: 31729272 DOI: 10.1080/11038128.2019.1690042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pain, fatigue and dyspnoea are symptoms commonly experienced by people with advanced cancer, which may impact on their occupational performance. It is not known whether these symptoms impact their occupational performance over time.Objective: To examine correlation between pain, fatigue and dyspnoea and occupational performance and the impact of such symptoms on occupational performance over time in people with advanced cancer.Material and Methods: A longitudinal study was conducted including 242 participants assessed at baseline and after six and 12 weeks. Spearman's rank-order test and mixed linear models were performed.Results: The correlation between pain, fatigue and dyspnoea and occupational performance at baseline spanned from trivial to moderate (Spearman's rho: -0.004 to 0.34). Only pain had a statistically significant impact on activities of daily living (ADL) motor ability over time (p = 0.01). Participants with no pain problems had the largest decrease in ADL motor ability (-0.24 logits (95%-CI: -0.37 to -0.12)), but the observed decrease was not clinically relevant (≥-0.30).Conclusion: Pain, fatigue and dyspnoea did not seem to highly correlate with occupational performance or impact occupational performance over time of people with advanced cancer.
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Affiliation(s)
- Marc Sampedro Pilegaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Denmark
| | - Karen la Cour
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Åse Brandt
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Mario Lozano-Lozano
- The Department of Physical Therapy, University of Granada, Granada, Spain.,The "Cuídate", Support Unit for Oncology Patients (UAPO), Granada, Spain.,Department of Physical and Occupational Therapy, The Sport and Health Joint University Institute (IMUDS), Granada, Spain
| | - Lisa Gregersen Oestergaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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4
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Brekke MF, la Cour K, Brandt Å, Peoples H, Wæhrens EE. The Association between ADL Ability and Quality of Life among People with Advanced Cancer. Occup Ther Int 2019; 2019:2629673. [PMID: 31531007 PMCID: PMC6745094 DOI: 10.1155/2019/2629673] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/09/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Occupational therapy and occupational science are founded on the theoretical core assumption that occupation and quality of life (QoL) are closely related. However, such theoretical core assumptions must be supported through empirically based research. OBJECTIVE To investigate the association between QoL and occupation, here self-reported and observed ADL abilities as a part of occupation, among people with advanced cancer, including determining whether self-reported or observed ADL ability had the stronger association with QoL. METHODS The study was nested in a cross-sectional study. The association between ADL ability and QoL among 108 people with advanced cancer was investigated using the ADL Interview (ADL-I), the Assessment of Motor and Process Skills (AMPS), and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30). RESULTS AND CONCLUSIONS Results showed that high observed ADL motor ability was associated with high QoL. In contrast, observed ADL process ability and self-reported ADL ability were not significantly associated with QoL. Oppositely expected, observed ADL ability had a stronger association with QoL than self-reported ADL ability. Thereby, the study to some extent contributes knowledge confirming the theoretical core assumptions about the relation between occupation, here performance of ADL, and QoL.
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Affiliation(s)
- Mette Falk Brekke
- Department of Occupational Therapy, University College Absalon, Næstved, Denmark
| | - Karen la Cour
- Department of Public Health, Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
- The Danish Knowledge Center for Rehabilitation and Palliative Care, REHPA, Vestergade 17, 5800 Nyborg, Denmark
- Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy, University of Southern Denmark, Odense, Denmark
| | - Åse Brandt
- Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy, University of Southern Denmark, Odense, Denmark
- Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense, Denmark
| | - Hanne Peoples
- Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy, University of Southern Denmark, Odense, Denmark
- Faculty of Health Sciences, Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
| | - Eva Ejlersen Wæhrens
- Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy, University of Southern Denmark, Odense, Denmark
- The Parker Institute, Copenhagen University Hospital Bispebjerg & Frederiksberg, Copenhagen, Denmark
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5
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McKenzie C, Barker K. Occupational therapy rehabilitation for sarcoma patients following limb salvage surgery: a scoping review. Disabil Rehabil 2019; 43:284-296. [PMID: 31180732 DOI: 10.1080/09638288.2019.1620874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Sarcomas are rare cancers of bone and soft tissue, and limb salvage surgery is the standard treatment followed by multidisciplinary rehabilitation. The scoping review aimed to summarize the evidence for occupational therapy intervention for adult sarcoma patients following limb salvage surgery.Methods: A review of the literature using a scoping framework was undertaken starting with a systematic database search, followed by an analysis of the literature. The literature was described using a numerical analysis, and the following headings; (a) rehabilitation, (b) activity limitations and participation restrictions, (c) functional outcomes.Findings: Seventeen articles met the review criteria, papers were diverse in study location, type, population, methods and outcomes used. Following limb salvage surgery patients experience functional deficits, activity limitations and participation restrictions in life roles and loss of previous identity. Prehabilitation can influence functional outcomes. Functional activity was found to plateau at 4-12 months following limb salvage surgery, with some patients identifying a need for further rehabilitation.Conclusion: The review identified limited evidence guiding occupational therapy practice for sarcoma patients following limb salvage surgery. Further research is needed to demonstrate the effectiveness of occupational therapy intervention in the early and late stages of rehabilitation and develop evidence based guidelines.Implications for rehabilitationSarcoma patients experience activity limitations and participation restrictions in activities of daily living, work and leisure following limb salvage surgery.Prehabilitation and early intervention can influence functional outcomes.Functional ability may plateau at 4-12 months following limb salvage surgery.Some groups of patients will benefit from late rehabilitation to maximize their rehabilitation potential.
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Affiliation(s)
- Clare McKenzie
- Occupational Therapy Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Gerber LH, Hodsdon B, Comis LE, Chan L, Gallin JI, McGarvey CL. A Brief Historical Perspective of Cancer Rehabilitation and Contributions From the National Institutes of Health. PM R 2018; 9:S297-S304. [PMID: 28942904 DOI: 10.1016/j.pmrj.2017.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
People who have cancer diagnoses often need care throughout their lives through all stages of their illness. These stages include diagnosis, primary treatment, survivorship, and end of life. The management of people with cancer, now a common and chronic illness with long-term survival improving, is complex, challenging, and rapidly changing. Rehabilitation for people with cancer diagnoses is a new specialty and is charged with providing care throughout the trajectory of illness and wellness to maximize potential for function and mitigate disability. Rehabilitation interventions include the application of physical and occupational therapeutics, speech and language interventions, and physical medicine in order to help patients reach their individual goals and to promote life satisfaction. The Department of Rehabilitation in the Clinical Center of the National Institutes of Health has pioneered this field through research and clinical care models over the past 40 years. Staff of this department has supported clinical research investigators at the National Institutes of Health in their exploration of new treatments using chemotherapies, surgery, radiation, and psychosocial interventions. They have also engaged in research specific to rehabilitation to devise and improve functional outcome measures, design exercise interventions, devise orthotics, and prosthetic devices for adaptation to functional loss. Collectively, the staff has published widely in oncology textbooks and professional journals in order to share findings and improve the quality of cancer rehabilitation treatment across the continuum of care.
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Affiliation(s)
- Lynn H Gerber
- Department of Medicine, Inova Fairfax Medical Campus, Inova Health System, Fairfax, VA; 4400 University Dr., MS 2G7, George Mason University, Fairfax, VA 22030(∗).
| | - Bonnie Hodsdon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(†)
| | - Leora Ellen Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(‡)
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD(§)
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7
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Hoang NT, Acevedo LA, Mann MJ, Tolani B. A review of soft-tissue sarcomas: translation of biological advances into treatment measures. Cancer Manag Res 2018; 10:1089-1114. [PMID: 29785138 PMCID: PMC5955018 DOI: 10.2147/cmar.s159641] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Soft-tissue sarcomas are rare malignant tumors arising from connective tissues and have an overall incidence of about five per 100,000 per year. While this diverse family of malignancies comprises over 100 histological subtypes and many molecular aberrations are prevalent within specific sarcomas, very few are therapeutically targeted. Instead of utilizing molecular signatures, first-line sarcoma treatment options are still limited to traditional surgery and chemotherapy, and many of the latter remain largely ineffective and are plagued by disease resistance. Currently, the mechanism of sarcoma oncogenesis remains largely unknown, thus necessitating a better understanding of pathogenesis. Although substantial progress has not occurred with molecularly targeted therapies over the past 30 years, increased knowledge about sarcoma biology could lead to new and more effective treatment strategies to move the field forward. Here, we discuss biological advances in the core molecular determinants in some of the most common soft-tissue sarcomas - liposarcoma, angiosarcoma, leiomyosarcoma, rhabdomyosarcoma, Ewing's sarcoma, and synovial sarcoma - with an emphasis on emerging genomic and molecular pathway targets and immunotherapeutic treatment strategies to combat this confounding disease.
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Affiliation(s)
- Ngoc T Hoang
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Luis A Acevedo
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Michael J Mann
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Bhairavi Tolani
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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8
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Pilegaard MS, la Cour K, Gregersen Oestergaard L, Johnsen AT, Lindahl-Jacobsen L, Højris I, Brandt Å. The 'Cancer Home-Life Intervention': A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer. Palliat Med 2018; 32:744-756. [PMID: 29299957 PMCID: PMC5881790 DOI: 10.1177/0269216317747199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'. AIM To evaluate the efficacy of the 'Cancer Home Life-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life. DESIGN AND INTERVENTION A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored, occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. SETTING/PARTICIPANTS Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. Secondary outcomes were activities of daily living process ability, difficulty performing prioritised everyday activities, participation restrictions and health-related quality of life. RESULTS A total of 242 participants were randomised either to the intervention group ( n = 121) or the control group ( n = 121). No effect was found on the primary outcome (between-group mean change: -0.04 logits (95% confidence interval: -0.23 to 0.15); p = 0.69). Nor was any effect on the secondary outcomes observed. CONCLUSION In most cases, the 'Cancer Home-Life Intervention' was delivered through only one home visit and one follow-up telephone contact, which not was effective in maintaining or improving participants' everyday activities and health-related quality of life. Future research should pay even more attention to intervention development and feasibility testing.
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Affiliation(s)
- Marc Sampedro Pilegaard
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Lisa Gregersen Oestergaard
- 3 Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,4 Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anna Thit Johnsen
- 5 Department of Psychology, University of Southern Denmark, Odense, Denmark.,6 Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Inger Højris
- 8 Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Åse Brandt
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,9 Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense, Denmark
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9
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Sampedro Pilegaard M, Oestergaard LG, la Cour K, Thit Johnsen A, Brandt Å. Subgroup effects of occupational therapy-based intervention for people with advanced cancer. Scand J Occup Ther 2018; 27:517-523. [PMID: 29571271 DOI: 10.1080/11038128.2018.1455897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Many people with advanced cancer have decreased ability to perform activities of daily living (ADL). We recently performed a randomized, controlled trial (RCT) assessing the efficacy of an occupational therapy-based program, the 'Cancer Home-Life Intervention' in people with advanced cancer (N = 242) and found no overall effects on ADL ability. However, heterogeneity of treatment effect may disguise subgroup differences.Objective: To investigate whether subgroups of people with advanced cancer gain positive effects from the 'Cancer Home-Life Intervention' on ADL ability.Material and method: An exploratory subgroup analysis including 191 participants from a RCT. The outcome was ADL motor ability measured by the Assessment of Motor and Process Skills (AMPS). Subgroups were defined by age, gender, years of education, type of primary tumor, functional level, and activity problems.Results: The 'Cancer Home-Life Intervention' had no statistically significant effect in the six subgroups. Modifying effects of age (0.30 [95% CI: -0.05 to 0.64]) and gender (0.23 [95% CI: -0.11 to 0.57]) were not found.Conclusion: There were no subgroup effects of the 'Cancer Home-Life Intervention'on ADL motor ability. Some indications suggest greater effects for those aged below 69 years; however, this result should be interpreted with caution.
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Affiliation(s)
- Marc Sampedro Pilegaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark.,Institute of Public Health, Aarhus University, Aarhus C, Denmark
| | - Karen la Cour
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Anna Thit Johnsen
- Department of Psychology, University of Southern Denmark, Odense M, Denmark.,Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - Åse Brandt
- Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense C, Denmark.,Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense C, Denmark
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10
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Hobusch GM, Tiefenboeck TM, Patsch J, Krall C, Holzer G. Do Patients After Chondrosarcoma Treatment Have Age-appropriate Bone Mineral Density in the Long Term? Clin Orthop Relat Res 2016; 474:1508-15. [PMID: 26883654 PMCID: PMC4868166 DOI: 10.1007/s11999-016-4741-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/26/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND In long-term survivors of osteosarcoma and Ewing sarcoma treated with the addition of radio- and chemotherapy, low bone mineral density (BMD) and fractures have been observed, presumably resulting from these adjuvants. Because patients with chondrosarcoma usually are not treated with conventional adjuvant treatment, observation of low BMD in patients with chondrosarcoma presumably would be the result of other mechanisms. However, BMD in patients with a history of chondrosarcoma has not been well characterized. QUESTIONS/PURPOSES The aim of our study was to address the following questions: (1) Do long-term survivors of chondrosarcoma have normal BMD and, if not, which factors contribute to low BMD? (2) Is there a greater risk of fracture and does the Fracture Risk Assessment Tool (FRAX(®)) score reflect fracture likelihood? METHODS All known patients with a history of chondrosarcoma treated at our institution before 2006 were identified. Of 127 patients believed to be alive at the time of this study, 30 agreed to participate in this study (11 females, 19 males; mean age at surgery, 39 ± 12 years; mean followup, 12 ± 5 years). With the data available, the 30 participants were not different from the 97 nonparticipants in terms of age, sex, BMI, tumor grade, tumor location (axial versus appendicular, lower extremity versus elsewhere), and use of any treatment known to influence osteopenia (chemotherapy, lower extremity surgery). BMD was measured and history of fractures was assessed using a questionnaire. The patients´ BMD measurements in this study were sex- and age-matched with a normative sex- and age-categorized reference population reported by Kudlacek et al. Associations were tested by univariate regressions and ANOVAs of all measures of BMD and eligible oncologic and demographic factors. RESULTS Eighteen of 30 (60%) patients had a pathologic BMD according to the WHO dual-energy x-ray absorptiometry definition, 15 (50%) had osteopenia, and three (10%) had osteoporosis. T-scores in the study cohort were lower than reference values for the femur neck (mean difference, 0.64; 95% CI, 0.27-1.01; p < 0.0015), but not for the spine (mean difference, 0.39; 95% CI, -0.06 to 0.84; p = 0.09). Thirteen patients (45%) reported a history of fractures not distinguishing between low and high impact. The incidence of fractures was 2.8 greater than expected from a comparison with a published microcensus survey of the Austrian population. No effect of the FRAX(®) score on fracture risk could be identified (p = 0.057). CONCLUSIONS Long-term survivors of chondrosarcoma appear to be at greater risk for having low BMD develop than the healthy population. Although these results are preliminary and based on a very small sampling of patients, if they can be confirmed in larger studies, BMD assessment by dual-energy x-ray absorptiometry might be considered as these patients are followed posttreatment by sarcoma care units. The reasons for low BMD still must be elucidated. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- Gerhard M Hobusch
- Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas M Tiefenboeck
- Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Janina Patsch
- Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Krall
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Gerold Holzer
- Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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11
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Brandt Å, Pilegaard MS, Oestergaard LG, Lindahl-Jacobsen L, Sørensen J, Johnsen AT, la Cour K. Effectiveness of the "Cancer Home-Life Intervention" on everyday activities and quality of life in people with advanced cancer living at home: a randomised controlled trial and an economic evaluation. BMC Palliat Care 2016; 15:10. [PMID: 26801394 PMCID: PMC4724076 DOI: 10.1186/s12904-016-0084-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/19/2016] [Indexed: 11/28/2022] Open
Abstract
Background During the past decade an increasing number of people live with advanced cancer mainly due to improved medical treatment. Research has shown that many people with advanced cancer have problems with everyday activities, which have negative impact on their quality of life, and that they spend a considerable part of their time at home. Still, research on interventions to support the performance of and participation in everyday activities is only scarcely available. Therefore, the occupational therapy-based “Cancer Home-Life Intervention” consisting of tailored adaptive interventions applied in the participant’s home environment was developed. The objective of this study is to examine the effectiveness and cost-effectiveness of the Cancer Home-Life Intervention compared to usual care on the performance of and participation in everyday activities and quality of life in people with advanced cancer living at home. Methods The study is a randomised, controlled trial (RCT) including an economic evaluation. The required sample size of 272 adults living at home will be recruited from outpatient clinics at two Danish hospitals. They should be diagnosed with cancer; evaluated incurable by the responsible oncologist; and with a functional level 1–2 on the WHO performance scale. The primary outcome is the quality of performance of activities of daily living. Secondary outcomes are problems with prioritised everyday activities; autonomy and participation; and health-related quality of life. Participants are randomly assigned to: a) The Cancer Home-Life Intervention in addition to usual care, and b) Usual care alone. Discussion The trial will show whether the Cancer Home-Life Intervention provides better support for people with advanced cancer living at home in performing and participating in everyday activities, and whether it contributes to their health-related quality of life. The economic evaluation alongside the RCT will show if the Cancer Home-Life Intervention is cost-effective. The trial will also show the acceptability of the intervention to the target group, and whether subgroups of participants will benefit more than others. Trial registration ClinicalTrials.gov Identifier NCT02356627. Registered 02/02/2015.
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Affiliation(s)
- Å Brandt
- The National Board of Social Services, 5000, Odense C, Denmark. .,The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark. .,OPEN Odense Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000, Odense C, Denmark.
| | - M S Pilegaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000, Odense C, Denmark
| | - L G Oestergaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000, Odense C, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8000, Aarhus C, Denmark.,Institute of Public Health, Aarhus University, 8000, Aarhus C, Denmark
| | - L Lindahl-Jacobsen
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000, Odense C, Denmark
| | - J Sørensen
- Centre of Health Economics Research (COHERE), Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark
| | - A T Johnsen
- Department of Psychology, University of Southern Denmark, 5230, Odense M, Denmark.,Department of Palliative Medicine, Bispebjerg Hospital, 2400, Copenhagen, NV, Denmark
| | - K la Cour
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital and University of Southern Denmark, 5000, Odense C, Denmark
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12
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Demers C, Gélinas I, Carret AS. Activities of Daily Living in Survivors of Childhood Brain Tumor. Am J Occup Ther 2015; 70:7001220040p1-8. [DOI: 10.5014/ajot.2016.014993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
OBJECTIVE. This cross-sectional, descriptive study evaluated the performance in activities of daily living (ADLs) of youth and young adult survivors of childhood brain tumor (BT) and explored associations with health-related quality of life (HRQoL).
METHOD. Thirty-six participants were examined using the Assessment of Motor and Process Skills to evaluate their quality of ADL task performance and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF–12) to evaluate HRQoL.
RESULTS. Participants had significantly lower performance in ADLs compared with age norms (p < .05), and their functional level was positively associated with the SF–12 Physical (r 2 = .5) and Mental (r 2 = .3) scales.
CONCLUSION. Participants had significant limitations in both motor and process skills, which affected their performance in ADLs. Study results emphasize the importance of long-term follow-up and rehabilitation services aimed at improving the functional level and HRQoL of BT survivors.
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Affiliation(s)
- Catherine Demers
- Catherine Demers, MSc, is Graduate Student, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, and Occupational Therapist, Division of Haematology-Oncology, Sainte-Justine University Hospital Centre, Montreal, Quebec;
| | - Isabelle Gélinas
- Isabelle Gélinas, PhD, is Associate Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, and Researcher, Montreal Center for Interdisciplinary Research in Rehabilitation–Jewish Rehabilitation Hospital Research Site, Laval, Quebec
| | - Anne-Sophie Carret
- Anne-Sophie Carret, MD, is Pediatric Haematologist–Oncologist, Division of Haematology–Oncology, Sainte-Justine University Hospital Centre, Montreal, Quebec
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Naumann FL, Hunt M, Ali D, Wakefield CE, Moultrie K, Cohn RJ, Cohn RJ. Assessment of Fundamental Movement Skills in Childhood Cancer Patients. Pediatr Blood Cancer 2015; 62:2211-5. [PMID: 26228925 DOI: 10.1002/pbc.25676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The improved treatment protocols and subsequent improved survival rates among childhood cancer patients have shifted the focus toward the long-term consequences arising from cancer treatment. Children who have completed cancer treatment are at a greater risk of delayed development, diminished functioning, disability, compromised fundamental movement skill (FMS) attainment, and long-term chronic health conditions. The aim of the study was to compare FMS of childhood cancer patients with an aged matched healthy reference group. METHODS Pediatric cancer patients aged 5-8 years (n = 26; median age 6.91 years), who completed cancer treatment (<5 years) at the Sydney Children's Hospital, were assessed performing seven key FMS: sprint, side gallop, vertical jump, catch, over-arm throw, kick, and leap. Results were compared to the reference group (n = 430; 6.56 years). RESULTS Childhood cancer patients scored significantly lower on three out of seven FMS tests when compared to the reference group. These results equated to a significantly lower overall score for FMS. CONCLUSIONS This study highlighted the significant deficits in FMS within pediatric patients having completed cancer treatment. In order to reduce the occurrence of significant FMS deficits in this population, FMS interventions may be warranted to assist in recovery from childhood cancer, prevent late effects, and improve the quality of life in survivors of childhood cancer.
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Affiliation(s)
- Fiona L Naumann
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | | | - Dulfikar Ali
- School of Medical Sciences, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kevin Moultrie
- TRANSFORM-US Fitness for Kids Pty Ltd., Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Kovar H. Blocking the road, stopping the engine or killing the driver? Advances in targeting EWS/FLI-1 fusion in Ewing sarcoma as novel therapy. Expert Opin Ther Targets 2014; 18:1315-28. [PMID: 25162919 DOI: 10.1517/14728222.2014.947963] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Ewing sarcoma (ES) represents the paradigm of an aberrant E-twenty-six (ETS) oncogene-driven cancer. It is characterized by specific rearrangements of one of five alternative ETS family member genes with EWSR1. There is experimental evidence that the resulting fusion proteins act as aberrant transcription factors driving ES pathogenesis. The transcriptional gene regulatory network driven by EWS-ETS proteins provides the oncogenic engine to the tumor. Therefore, EWS-ETS and their downstream machinery are considered ideal tumor-specific therapeutic targets. AREAS COVERED This review critically discusses the literature on the development of EWS-ETS-directed ES targeting strategies considering current knowledge of EWS-ETS biology and cellular context. It focuses on determinants of EWS-FLI1 function with an emphasis on interactions with chromatin structure. We speculate about the relevance of poorly investigated aspects in ES research such as chromatin remodeling and DNA damage repair for the development of targeted therapies. EXPERT OPINION This review questions the specificity of signature-based screening approaches to the identification of EWS-FLI1-targeted compounds. It challenges the view that targeting the downstream gene regulatory network carries potential for therapeutic breakthroughs because of resistance-inducing network rewiring. Instead, we propose to combine targeting of the fusion protein with epigenetic therapy as a future treatment strategy in ES.
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Affiliation(s)
- Heinrich Kovar
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, and Medical University Vienna, Department of Pediatrics , Zimmermannplatz 10, A1090 Vienna , Austria +43 1 40470 4092 ; +43 1 40470 64092 ;
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15
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Leone M, Viret P, Bui HT, Laverdière C, Kalinova É, Comtois AS. Assessment of gross motor skills and phenotype profile in children 9-11 years of age in survivors of acute lymphoblastic leukemia. Pediatr Blood Cancer 2014; 61:46-52. [PMID: 24115507 DOI: 10.1002/pbc.24731] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/18/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the usefulness of a new gross motor skill test battery in acute lymphoblastic leukemia (ALL) children who have been off therapy for at least 1 year and to assess its discriminatory power (discriminant analysis) from healthy children. PROCEDURE Twenty children (10 males and 10 females) 9-11 years of age (median age = 10.6 years) were assessed by the UQAC-UQAM test battery and then compared to recent provincial norms. This pilot study was also an opportunity to validate this test battery as a reliable tool for clinical or research purposes in the area of chronic or disabling diseases in children. Eleven motor skill variables grouped into five factors have been measured (speed, agility, balance, coordination, and reaction time). RESULTS Scores from 10 of the 11 motor skill tests showed significant differences when compared to the control group (P ≤ 0.05). Nearly 50% of patients obtained an average score below the 15th percentile. Furthermore, stepwise discriminant analysis allowed classifying successfully 88.4% of children in the correct group (ALL or Control). The normal development of GMS among children affected by ALL appears to have been compromised. The UQAC-UQAM test battery seems to be sensitive enough to quantify with precision the extent of the motor impairment in these children. CONCLUSION The UQAC-UQAM test battery appears to be a useful tool to evaluate the extent to which ALL survivors are affected. Early motor intervention should be considered for those patients even during the treatment periods.
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Affiliation(s)
- Mario Leone
- Kinesiology Department of Health Sciences, Kinesiology Division and Health Sciences Department, University of Québec in Chicoutimi, Saguenay, Québec, Canada; Centre de Recherche Interdisciplinaire sur la Qualité et les Saines Habitudes de vie, University of Québec in Chicoutimi, Saguenay, Québec, Canada
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Greene M, Kobierska M, Kent PM, Piasecki P. Survivorship in young patients with bone cancer. Curr Probl Cancer 2013; 37:236-43. [DOI: 10.1016/j.currproblcancer.2013.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Merchant MS. Long-term impact of cancer care on activities of daily living: are we causing our sarcoma survivors to grow up too quickly? Pediatr Blood Cancer 2009; 53:531-2. [PMID: 19588522 DOI: 10.1002/pbc.22166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Melinda S Merchant
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1104, USA.
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