Strength of skeletal muscle and quality of life in patients suffering from “typical male” carcinomas

Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma

Background

The aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma.

Methods

A narrative review of the relevant scientific literature and presentation of clinical experiences.

Results

In cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation.

Conclusion

In order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.

First exercise group for Turkish breast cancer patients in Vienna - a pilot project to include Turkish migrants

Background: The aim of this pilot study was to describe the acceptance and feasibility of an exercise intervention in breast cancer patients of Turkish origin in Austria by using a hand-held swinging-ring system.Methods: The inclusion period lasted 1 year (1 February 2016-31 January 2017). In a multicentre cooperation, Turkish female breast cancer patients were included by using face-to-face information, email, facebook^®, phone, and notice boards. The exercise program consisted of 1) supervised and 2) home-based exercise by using the smovey^® vibroswing system. Feasibility and acceptance were assessed by using the Austrian school grading system and a qualitative approach after 3 months. Furthermore, the six-minute walk test (6MWT), handgrip strength, body composition (BIA), and health-related quality of life (QOL) were assessed at baseline (T0) and after 3 months (T1).Results: Only 5 breast cancer patients could be included, from whom one dropped out due to breast cancer recurrence. The exercise intervention showed no side effects and was well accepted by all 4 patients. Furthermore, results of the 6MWT, handgrip strength, BIA, and QOL improved.Conclusion: These results indicate notable barriers towards regular physical activity in female Turkish breast cancer patients in Austria. Four out of five of those involved were comfortable with the intervention. Therefore, it seems to be essential to further address these barriers in order to plan and implement effective interventions.Implications for RehabilitationExercise is an effective means of improving health and quality of life experienced by female patients suffering from breast cancer.Although extensive efforts were taken only a minority of Turkish female patients attended a structured exercise program.It seems to be essential to further address barriers to exercise in order to plan and implement effective interventions.

Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center

Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.

Structured review of papers reporting specific functions in patients with cancer of the head and neck: 2006 - 2013

Health-related quality of life (HRQoL) focuses on 4 core domains: physical and psychological function, social interaction, disease, and treatment-related symptoms, and is a key outcome in patients with cancer of the head and neck. We reviewed papers published between 2006 and 2013 that used validated questionnaires to report functional outcome in this group. A total of 572 papers were identified and 118 of them concerned function. Specific outcomes included anxiety, chewing, maxillectomy, mucositis, pain, shoulder function, and trismus. The specific functions most often identified were xerostomia, speech or voice, and swallowing or dysphagia. A considerable body of evidence has now accumulated on HRQoL and functional outomes although the precise role of HRQoL during the planning of treatment remains controversial. Over time, the emphasis of the studies included has tended to move away from the reporting of outcomes in general to more hypothesis-driven and group-specific work.

Cancer rehabilitation in Austria--aspects of Physical Medicine and Rehabilitation

In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.

Feasibility, acceptance and long-term exercise behaviour in cancer patients: an exercise intervention by using a swinging-ring system

PURPOSE

Aim of this pilot study was to describe feasibility and acceptance of an exercise intervention by using an unique swinging-ring system with the goal to promote long-term exercise behaviour in cancer patients.

METHODS

The included cancer patients (n = 13, male:f emale (m:f) = 7:6, age = 56 ± 11, range 38-74a) were invited to perform a home-based exercise intervention. All participants of this pilot study were instructed how to use the smovey® Vibroswing. They could choose how to use the swinging-ring system, for example only indoor or only outdoor (single or in a group) or both. Feasibility and acceptance were assessed after 12 months (T2). Handgrip strength (Jamar hand dynamometer) and health-related quality of life (QOL, SF-36 Health survey) were assessed at baseline (T1) and after 12 months (T2).

RESULTS

A total of 10 (77%) patients (m:f = 5:5, 59 ± 9 years, range = 46-74) could be assessed at baseline and after 12 months. The exercise intervention showed no adverse events and was well accepted. Approximately 77% of patients of the study population have been exercising for more than 12 months. Furthermore, this intervention was able to increase handgrip strength in the participants. QOL improved as well in all domains.

CONCLUSIONS

The results of this small pilot study indicate that regular physical exercise with this swinging-ring system seems to be safe, and to promote long-term exercise behaviour of the included patients. Furthermore, this study population showed benefits in terms of increased handgrip strength and of improved QOL.

Advances in Supportive Care for Late Effects of Head and Neck Cancer

As the population of head and neck cancer survivors increases, it has become increasingly important for health care providers to understand and manage late complications of therapy. Functional deficits can be categorized as general health deficits resulting in frailty or debility, head and neck-specific functional deficits such as swallowing and speech, and musculoskeletal impairment as a result of tumor and treatment. Of critical importance is the growing data indicating that swallow therapy and physical therapy may prevent or ameliorate long-term functional deficits. Oral health complications of head and neck therapy may manifest months or years after the completion of treatment. Patients with hyposalivation are at high risk for dental caries and thus require aggressive oral hygiene regimens and routine dental surveillance. Swallowing abnormalities, xerostomia, and poor dentition may result in dietary adaptations that may cause nutritional deficiencies. Identification and management of maladaptive dietary strategies are important for long-term health. Follow-up with primary care physicians for management of comorbidities such as diabetes and hyperlipidemia may help to limit late vascular complications caused by radiation therapy. Herein, we review late effects of head and neck cancer therapy, highlighting recent advances.

The Effects of Resistance Training on Physical Function and Quality of Life in Breast Cancer Survivors

Breast cancer survivors (BCS) exhibit decreased physical function and quality of life (QOL) following cancer treatments. Resistance training (RT) may elicit positive changes in physical and mental well-being. This study assessed 27 BCS, pre-and post-intervention (six months) on the following variables: muscular strength (via one repetition maximum (1RM) of chest press and leg extension), physical function (via the Continuous Scale-Physical Functional Performance test) and QOL (via the Short Form-36 survey). RT consisted of two days/week of ten exercises including two sets of 8-12 repetitions at 52%-69% of their 1RM. A repeated measures analysis of variance revealed BCS significantly (p < 0.05) increased upper (71 ± 22 to 89 ± 22 kg) and lower body (74 ± 18 to 93 ± 24 kg) strength, total physical function (65.5 ± 12.1 to 73.6 ± 12.2 units) and the subcomponents of physical function: upper body strength (63.5 ± 16.3 to 71.2 ± 16.8 units), lower body strength (58.5 ± 14.9 to 68.6 ± 16.3 units), balance and coordination (66.5 ± 12.2 to 74.6 ± 11.6 units), and endurance (67.2 ± 12.0 to 75.0 ± 11.6 units). No changes were observed over time for subjective measures of physical function and QOL. Results showed RT could be an effective means to improve objective physical function in BCS. Further research is needed to clarify the effects of RT on subjective physical function and QOL.

Assessment of anticancer-treatment outcome in patients with metastatic castration-resistant prostate cancer-going beyond PSA and imaging, a systematic literature review

BACKGROUND

In the past years, there has been significant progress in anticancer drug development for patients with metastatic castration-resistant prostate cancer (CRPC). However, the current instruments to assess clinical treatment response have limitations and may not sufficiently reflect patient benefit. Our objective was to systematically identify tools to evaluate both patient benefit and clinical anticancer-treatment response as basis for an international consensus process and development of a specific pragmatic instrument for men with CRPC.

METHODS

PubMed, Embase and CINAHL were searched to identify currently available tools to assess anticancer-treatment benefit, other than standard imaging procedures and prostate-specific antigen measurements, namely quality of life (QoL), detailed pain assessment, physical function and objective measures of other complex cancer-related syndromes in patients with CRPC. Additionally, all CRPC phase III trials published in the last 5 years were reviewed as well as studies using physical function tools in a general cancer population. The PRIMSA statement was followed for the systematic review process.

RESULTS

The search generated 1096 hits, 185 full-text papers were screened and finally 73 publications were included. Additional 89 publications were included by hand-search. We identified a total of 98 tools used in CRPC trials and grouped these into three categories: 22 tools assessing QoL domains and subgroups, 47 tools for pain assessment and 29 tools for objective measures, mainly physical function and assessment of skeletal disease burden.

CONCLUSION

A wide variety of assessment tools and also efforts to standardize and harmonize patient-reported outcomes and pain assessment were identified. However, the specific needs of the increasing CRPC population living longer with their incurable cancer are insufficiently captured and objective physical outcome measures are under-represented. In the age of new anticancer drug targets and principles, new methods to monitor patient relevant outcomes of antineoplastic therapy are of utmost importance.

Strength of skeletal muscle and self-reported physical performance in Austrian glioblastoma-patients

BACKGROUND

Aim of this study was to describe longitudinal assessments of handgrip strength, strength of thigh muscles, and self-reported physical performance in patients with glioblastoma after neurosurgical intervention undergoing chemoradiation.

METHODS

Strength testing was performed in 24 Austrian glioblastoma patients (m:f = 19:5, 52 ± 14a, BMI = 26 ± 3 kg/m²) at baseline and follow up after chemoradiation (interval between baseline and follow up = 14 ± 9 weeks). Isokinetic testing of knee extension/flexion was performed by using a Biodex 3 dynamometer. Handgrip strength was measured by using a Jamar hand-dynamometer. Physical performance was assessed by using the subscales "physical functioning" and "role physical" of the SF-36 Health Survey.

RESULTS

Peak torque of knee extensors (peak torque) were clearly lower than expected for age- and sex-related values (p < 0.0001). In comparison with age- and sex-related reference values, deficits of "role physical" (p < 0.0001) and "physical functioning" (p = 0.010) were found. Effects of measurements of muscle strength on "physical functioning" were significant (peak torque:p < 0.001; handgrip strength:p < 0.001). No significant change could be detected after follow up for peak torque (p = 0.337), handgrip strength (p = 0.995), "physical functioning" (p = 0.824), and "role physical" (0.594).

CONCLUSIONS

In this study, notable deficits especially in muscular strength of thigh muscles and general physical performance of patients with glioblastoma have been found before and after chemoradiation. Reduced muscle strength and impaired self-reported physical performance seem to be clinically relevant functional deficits in (Austrian) glioblastoma patients. Therefore, rehabilitation and supportive care should also include options to increase muscle strength.