Predictors of functional capacity in colorectal cancer patients

A causal model of health-related quality of life in colorectal cancer patients post-surgery

PURPOSE

this study aims to develop and test a model examining the causal relationship between self-efficacy, social support, fatigue, pain, functional status, and health-related quality of life (HRQL).

METHODS

A cross-sectional correlation study was conducted using a multi-stage sampling technique to recruit 256 individuals aged 20 to 59 with colorectal cancer (CRC) post-surgery from three hospitals in Northern Vietnam. The hypothesized model, based on Ferrans' HRQL conceptual model and literature review, was validated using structural equation modeling (SEM) and Mplus.

RESULTS

the model fit the data well, explaining 52% of the variance of HRQL. Self-efficacy emerged as the most influential factor directly impacting HRQL (β = .494, p < .05) and also had negative indirect effects on HRQL through fatigue and pain (β = -.271, p < .05). Social support had a positive direct (β = .406, p < .001) and negative indirect effects on HRQL via fatigue and pain (β = -.143, p < .05). Fatigue and pain had negative indirect effects on HRQL through functional status (β = -.336, p < .05 and β = -.219, p < .05, respectively). Functional status had a positive direct effect on HRQL (β = .418, p < .001).

CONCLUSIONS

The study's findings highlight the importance of improving self-efficacy, social support, and functional status, while reducing fatigue and pain to enhance HRQL among individuals with CRCpost-surgery. These insights can inform the development of targeted interventions to improve the well-being of this population.

The Relationship between Exercise Capacity and Muscle Strength, Physical Activity, Fatigue and Quality of Life in Patients with Cancer Cachexia

BACKGROUND

Exercise capacity is a significant determinant of mortality for cancer patients, so knowing the possible determinants of exercise capacity will produce physical and psychological benefits for individuals with cancer cachexia.

PURPOSE

To investigate the relationship between exercise capacity on peripheric and respiratory muscle strength, physical activity, fatigue and quality of life in subjects with cancer cachexia.

METHODS

The study included 31 patients diagnosed with cancer cachexia. Functional capacity was assessed by 6-Minute Walk Test, hand grip strength and proximal muscle mass by hand dynamometer, respiratory muscle strength by the Maximum Expiratory Pressure and Maximum Inspiratory Pressure measurements, physical activity by International Physical Activity Questionnaire Short Form, fatigue by Brief Fatigue Inventory, and quality of life by EORT-QLQ-C30. The relationship between functional capacity and continuous independent variables was determined using Spearman's or Pearson's tests.

RESULTS

A strong positive correlation was observed between exercise capacity and expiratory muscle strength (r = 0.75, p < 0.001), activity level (r = 0.68, p < 0.001), and quality of life global health status (r = 0.74, p < 0.001). Conversely, a strong negative correlation was found between exercise capacity and fatigue severity (r = -0.64, p < 0.001).

CONCLUSION

Higher exercise capacity in cancer cachexia patients is linked to reduced fatigue, improved respiratory muscle strength, increased physical activity levels, and enhanced quality of life. When designing rehabilitation programs or exercise interventions for individuals with cancer cachexia, it is crucial to assess their exercise capacity and tailor the programs accordingly.

Walking capacity of Japanese patients with colorectal cancer relates to early postoperative health-related quality of life: a multi-center cohort study

PURPOSE

This study investigated the impact of surgical treatment on the health-related quality of life (HRQOL) of Japanese patients with colorectal cancer (CRC).

METHODS

This three-institution cohort study included 106 Japanese patients with CRC (69 men; mean age: 62.6 ± 12.4 years; age range = 30-85 years). HRQOL was evaluated using the Short-Form 36-Item Health Survey version 2 one to two days prior to surgery (baseline) and four weeks after surgery. Clinical characteristics, social characteristics, and HRQOL at baseline were investigated.

RESULTS

Physical functioning, role-physical, bodily pain, and social functioning decreased significantly at four weeks after surgery compared with baseline, whereas mental health significantly improved. Physical functioning and general health perception showed an especially strong relation with the six-minute walk test (6MWT) at four weeks after surgery and HRQOL scores at baseline. The cutoff value for the 6MWT for clinically relevant improvement was 552.5 meters for physical functioning (area under curve [AUC] = 0.780, 95% confidence interval [CI] = 0.692-0.867) and 480.3 meters for general health perception (AUC = 0.721, 95% CI = 0.626-0.817).

CONCLUSION

Patients with CRC could potentially improve their postoperative HRQOL by increasing their walking capacity post-surgery, and they may need follow-up interventions after discharge such as physical rehabilitation to do so. The results provide a potential pathway for improving HRQOL of Japanese patients with CRC.

Predictors of the 6-min walk test in patients with ovarian cancer

PURPOSE

To identify the predictors of the 6-min walk test (6MWT) and investigate the relationship between 6MWT, performance status, functional mobility, fatigue, quality of life, neuropathy, physical activity level, and peripheral muscle strength in patients with ovarian cancer (OC).

METHODS

Twenty-four patients diagnosed with stage II-III ovarian cancer were included in the study. Patients were assessed using the following measurement methods: 6MWT for walking capacity, Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, an armband physical activity monitor for physical activity level, Checklist Individual Strength (CIS) for fatigue, Functional Cancer Treatment Evaluation with Quality of Life-Extreme (FACT-O) for quality of life, Functional Evaluation of Cancer Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, a hand-held dynamometer for peripheral muscle strength, and 30-s chair-stand test for functional mobility.

RESULTS

The mean 6MWT distance was 578.48 ± 115.33 meters. 6MWT distance correlated with ECOG-PS score (r = -0.438, p = 0.032), handgrip strength (r = 0.452, p= 0030), METs (r = 0.414, p = 0.044) 30s-CST (r= 0.417, p= 0.043), and neuropathy score (r = 0.417, p = 0.043) significantly. There was no relationship between 6MWT distance and other parameters (p> 0.05). Multiple linear regression analysis demonstrated that performance status was the sole predictor of 6MWT.

CONCLUSION

The walking capacity seems to be associated with performance status, peripheral muscle strength, level of physical activity, functional mobility, and severity of neuropathy in patients with ovarian cancer. Evaluating these may help clinicians to understand factors behind the decreased walking capacity.

Factors that affect early postoperative health-related quality of life in patients with gastrointestinal cancer: a three-center cohort study

[Purpose] In this study, we investigated the preoperative and early postoperative health-related quality of life in patients who underwent surgical treatment for gastrointestinal cancer and also the factors that affect postoperative health-related quality of life. [Participants and Methods] The study included 198 patients who underwent elective surgery for gastrointestinal cancer (129 males and 69 females, age: 65.4 ± 11.8 years). Health-related quality of life was evaluated using the Short-Form 36-Item Health Survey version 2 at the following time points: 1–2 days preoperatively (baseline) and 4 weeks postoperatively. [Results] Compared with baseline levels, physical functioning, bodily pain, vitality, as well as physical, social, and emotional role functioning significantly decreased 4 weeks postoperatively. In contrast, compared with baseline levels, mental health significantly improved 4 weeks postoperatively. Physical functioning and general health evaluated 4 weeks postoperatively were significantly associated with income, baseline health-related quality of life, and the 6-minute walk test. [Conclusion] It is important to consider baseline income and health-related quality of life and increase postoperative exercise capacity to improve health-related quality of life in patients who undergo surgical treatment for gastrointestinal cancer.

Minimal clinically important difference in postoperative recovery among patients with gastrointestinal cancer

PURPOSE

The minimal clinically important difference (MCID) based on patient-reported outcomes is the smallest outcome change sufficiently significant to influence management and is crucial to the design and interpretation of comparative effectiveness trials. The purpose of this study was to estimate the MCID for postoperative recovery metrics in gastrointestinal cancer patients.

METHODS

This was a three-institutional cohort study. Participants were 219 patients scheduled for gastrointestinal cancer elective surgery. Body mass index (BMI), isometric knee extension torque (IKET), 6-min walk test (6 MWT), and Short-Form 36-Item Health Survey (SF-36) version 2 were evaluated 1-2 days prior to surgery (baseline) and 4 weeks after surgery. Patients received postoperative rehabilitative care from a physical therapist during hospitalization. The MCID used anchor-based methods. The anchor was a score on the SF-36 physical functioning subscale greater or lower than the average score of the general Japanese population.

RESULTS

The receiver operating curve indicated a cutoff value on the 6 MWT of -7.8 m for clinically relevant decline (area under curve [AUC] = 0.67, 95% confidence interval [CI] = 0.599-0.741) or a 1.5% change. The cutoff value on the SF-36 role-physical subscale was -34.4 for clinically relevant decline (AUC = 0.691, 95% CI = 0.621-0.761) or a 36.6% decrease. No significant correlation was found between changes in BMI, IKET, and anchor.

CONCLUSION

Plausible MCIDs are present in patients with gastrointestinal cancer. These values can assist the interpretation of clinical trials and observation of the postoperative clinical course of gastrointestinal cancer surgery.

Prehabilitation exercise therapy for cancer: A systematic review and meta-analysis

OBJECTIVE

The purpose of this study was to determine the impact of prehabilitation exercise intervention with respect to (1) acceptability, feasibility, and safety; and (2) physical function, measured by 6-minute-walk test (6MWT).

DATA SOURCES

PRISMA guidelines were used to systematically search PubMed, Embase, and CINAHL databases evaluating prehabilitation exercise interventions.

STUDY SELECTION

The inclusion criteria were studies investigating patients who underwent surgery for their cancer and underwent prehabilitation exercise.

DATA EXTRACTION AND SYNTHESIS

Guidelines were applied by independent extraction by multiple observers. Data were pooled using a random-effects model.

MAIN OUTCOME(S) AND MEASURE(S)

Acceptability, feasibility, and safety rates were calculated. 6MWT (maximum distance a person can walk at their own pace on a hard, flat surface, measured in meters, with longer distance indicative of better performance status) was compared using two arms using the DerSimonian and Laird method.

RESULTS

Objective 1. Across 21 studies included in this review, 1564 patients were enrolled, 1371 (87.7%) accepted the trial; of 1371, 1230 (89.7% feasibility) completed the intervention. There was no grade 3+ toxicities. Objective 2. Meta-analysis of five studies demonstrated a statistically significant decrease in 6MWT distance postoperatively in the control group (mean difference = +27.9 m; 95% confidence interval (CI): 9.3; 46.6) and a significant improvement postoperatively in the prehabilitation group (mean difference = -24.1 m; 95% CI: -45.7; -2.6). Meta-analysis demonstrated improvements in 6MWT distance 4-8 weeks postoperatively in the prehabilitation group compared to the control group (mean difference = -58.0 m, 95% CI: -92.8; -23.3).

CONCLUSIONS AND RELEVANCE

Prehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible with a statistically significant improvement in the 6MWT, indicating that prehabilitation can improve postoperative functional capacity.

Factors influencing early postoperative health-related quality of life in patients with alimentary system cancer

PURPOSE

The purpose of this study was to investigate changes in early postoperative health-related quality of life (HRQOL) in patients with gastrointestinal cancer and to examine the factors influencing such changes.

METHODS

Participants were 106 patients scheduled for elective surgery for gastrointestinal cancer (61 male and 45 females; aged 62.6 ± 12.0 years). HRQOL was evaluated using the Short-Form 36-Item Health Survey version 2 (SF-36) at two time points: 1-2 days prior to surgery (baseline) and 4 weeks after surgery. Clinical and social characteristics based on previous studies were investigated as potential factors influencing changes in early postoperative HRQOL.

RESULTS

Physical functioning, physical role functioning, bodily pain, vitality, social role functioning, and emotional role functioning significantly decreased at 4 weeks after surgery compared with baseline. Mental health at 4 weeks after surgery significantly improved compared with baseline. The scores on each SF-36 subscale at 4 weeks after surgery were significantly associated with gender, clinical stage of cancer, neoadjuvant therapy, surgical site, postoperative complications, HRQOL at baseline, and 6-min walk test at 4 weeks after surgery.

CONCLUSION

To increase early postoperative HRQOL in surgical patients with gastrointestinal cancer, it may be necessary to not only improve postoperative management but also increase exercise capacity after surgery and HRQOL before surgery.

Nutrition and physical activity: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS)

This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently, in addition to anticancer treatments, supportive care including nutritional support and PA plays a central role in the management of digestive cancers. It is crucial to detect malnutrition (diagnostic criteria updated in 2019) early, to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition and PA in digestive oncology for each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). Guidelines for nutrition and PA management aim at increasing awareness about malnutrition in oncology. They are continuously evolving and need to be regularly updated.

Factors associated with fatigue one month after surgery in patients with gastrointestinal cancer

OBJECTIVE

The purpose of this study was to examine the factors associated with the occurrence of cancer-related fatigue (CRF) one month after surgery in patients with gastrointestinal cancer.

METHOD

The study included 96 patients with gastrointestinal cancer (50 males and 46 females, mean age 62.7 ± 11.4 years). Data of the Cancer Fatigue Scale (CFS), 6-minute walk distance (6MWD), and hospital anxiety and depression scale (HADS) were obtained before surgery and one month after surgery. The subjects were divided into the following two groups: severe CRF group (CFS score of ≥19 points) and mild CRF group (CFS score of <19 points). Each parameter was compared between the severe and mild CRF groups. The factors associated with CRF were identified by logistic regression analysis involving factors with significant differences between the groups.

RESULT

The CFS score showed a significant interaction, and the CFS score, 6MWD, and HADS score showed significant differences both before and one month after surgery between the two groups. The CFS score was significantly higher in the severe CRF group than in the mild CRF group both before and one month after surgery. Additionally, the 6MWD was significantly lower in the severe CRF group than in the mild CRF group both before and one month after surgery. The factors identified on logistic regression analysis were the preoperative CFS score and preoperative 6MWD.

CONCLUSION

CRF occurring one month after surgery might be affected by preoperative fatigue and preoperative exercise tolerance.

The impact of surviving bowel cancer on occupation: A scoping review

Introduction

The number of people surviving bowel cancer is increasing globally, with many of those affected living with long-term psychological and physical sequelae that potentially disrupt occupations.

Method

A scoping review – guided by Arksey and O’Malley’s methodological framework – was conducted to provide an overview of what is known about the impact of having had bowel cancer on occupations, and to reveal the potential role of occupational therapy. A systematic search of four databases and a grey literature repository generated 244 results. Applying inclusion and exclusion criteria, 33 items addressing bowel cancer and occupations were selected and thematically analysed.

Results

Researchers have identified six domains of occupation that are impacted by bowel cancer (social activity, physical activity, sexual activity, employment and role functioning, physical functioning, and self-care) but survivors report a distinct lack of health professional support after completion of medical treatment and being left to devise self-management strategies to accommodate the long-term effects of their cancer.

Conclusion

The sequelae of bowel cancer can have a significant impact on occupational participation. There is scope for increasing and improving occupational therapy input to assist people with cancer-related loss of function to re-engage in valued occupations and improve wellbeing.

J, Giraldo PC, Gonçalves AK. Quality of life in breast cancer survivors

Summary Objective: To evaluate the influence of functional capacity (FC) and how it affects quality of life (QoL) in breast cancer survivors. Method: A total of 400 breast cancer survivors were studied - 118 without metastasis, 160 with locoregional metastasis and 122 with distant metastasis. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire--Core 30 (EORTC QLQ-C30), Breast Cancer-Specific (EORTC QLQ-BR23), and the Karnofsky Performance Scale (KPS) were used to evaluate FC and QoL. Results: Women with distant metastases presented lower KPS 75.3 (SD=12.5) (p<0.001). For QLQ-C30, the mean of the Functional Scale for patients with distant metastasis was 57 (SD=19) (p<0.001), and the mean of the Symptom Scale for patients with distant metastasis was 37 (SD=20) (p<0.001). Both the scales for pain and fatigue showed the highest mean in the groups. For the Global Health Scale, patients without metastasis scored a mean of 62 (SD=24) points, while those with locoregional metastases scored a mean of 63 (SD=21.4), and distant metastasis scored 51.3 (SD=24) points. In the group with distant metastases, 105 (87%) had pain, and the average KPS was 74 (SD=12.0) (p=0.001). Conclusion: Breast cancer was associated with decreased FC, compromised QoL in women with locoregional and distant metastases compared to those without metastasis.