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Gell NM, Bae M, Patel KV, Schmitz K, Dittus K, Toth M. Physical function in older adults with and without a cancer history: Findings from the National Health and Aging Trends Study. J Am Geriatr Soc 2023; 71:3498-3507. [PMID: 37431861 PMCID: PMC10782821 DOI: 10.1111/jgs.18508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/26/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Previous studies identified physical function limitations in older cancer survivors, but few have included objective measures and most focused on breast and prostate cancer survivors. The current study compared patient-reported and objective physical function measures between older adults with and without a cancer history. METHODS Our cross-sectional study used a nationally representative sample of community-dwelling, Medicare beneficiaries from the 2015 National Health and Aging Trends Study (n = 7495). Data collected included patient-reported physical function, including a composite physical capacity score and limitations in strength, mobility, and balance, and objectively measured physical performance metrics, including gait speed, five time sit-to-stand, tandem stand, and grip strength. All analyses were weighted to account for the complex sampling design. RESULTS Thirteen percent of participants (n = 829) reported a history of cancer, of which more than half (51%) reported a diagnosis other than breast or prostate cancer. In models adjusted for demographics and health history, older cancer survivors had lower Short Physical Performance Battery scores (unstandardized beta [B] = -0.36; 95% CI: -0.64, -0.08), slower gait speed (B = -0.03; 95% CI: -0.05, -0.01), reduced grip strength (B = -0.86; 95% CI: -1.44, -0.27), worse patient-reported composite physical capacity (B = -0.43; 95% CI: -0.67, -0.18) and patient-reported upper extremity strength (B = 1.27; 95% CI: 1.07, 1.50) compared to older adults without cancer. Additionally, the burden of physical function limitations was greater in women than in men, which may be explained by cancer type. CONCLUSIONS Our results extend studies in breast and prostate cancer to show worse objective and patient-reported physical function outcomes in older adults with a range of cancer types compared to those without a cancer history. Moreover, these burdens seem to disproportionately affect older adult women, underscoring the need for interventions to address functional limitations and prevent further health consequences of cancer and its treatment.
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Affiliation(s)
- Nancy M. Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT
- University of Vermont Cancer Center, Burlington, VT
| | - Myeongjin Bae
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT
| | - Kushang V. Patel
- Department of Anesthesiology and Pain Medicine, University of Washington
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
| | - Kathryn Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Kim Dittus
- University of Vermont Cancer Center, Burlington, VT
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT
| | - Michael Toth
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT
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2
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Kızılırmak AS, Karadibak D, Gultekin SC, Ozsoy I, Yavuzsen HT, Yavuzsen T, Oztop I. Predictors of the 6-min walk test in patients with ovarian cancer. Support Care Cancer 2023; 31:248. [PMID: 37017764 DOI: 10.1007/s00520-023-07706-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/26/2023] [Indexed: 04/06/2023]
Abstract
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.
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Affiliation(s)
- Ayse Sezgi Kızılırmak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Democracy University, Izmir, Turkey
| | - Didem Karadibak
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Sukriye Cansu Gultekin
- Faculty of Physical Therapy and Rehabilitation, Graduate School of Health Sciences, Dokuz Eylul University, Balcova, Izmir, Turkey.
| | - Ismail Ozsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selcuk University, Konya, Turkey
| | - Husnu Tore Yavuzsen
- Clinic of Gynecology and Obstetrics, Buca Obstetrics Gynecology and Pediatrics Disease Hospital, Izmir, Turkey
| | - Tugba Yavuzsen
- Department of Medical Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
| | - Ilhan Oztop
- Department of Medical Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
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3
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Sattar S, Haase KR, Alibhai SM, Penz K, Szafron M, Harenberg S, Amir E, Kuster S, Pitters E, Campbell D, McNeely ML. Feasibility and efficacy of a remotely delivered fall prevention exercise program for community-dwelling older adults with cancer: Protocol for the STABLE trial. J Geriatr Oncol 2022; 13:1273-1280. [DOI: 10.1016/j.jgo.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
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“Life Isn't as Carefree as It Used to Be”: A Mixed-Methods Evaluation of the Experiences of Women With Fear of Falling During Cancer Survivorship. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000217] [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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5
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McCrary JM, Goldstein D, Trinh T, Timmins HC, Li T, Menant J, Friedlander M, Lewis CR, Hertzberg M, O'Neill S, King T, Bosco A, Harrison M, Park SB. Balance Deficits and Functional Disability in Cancer Survivors Exposed to Neurotoxic Cancer Treatments. J Natl Compr Canc Netw 2020; 17:949-955. [PMID: 31390588 DOI: 10.6004/jnccn.2019.7290] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) persists after treatment in up to 40% of cancer survivors and has been linked with increased balance deficits, disabilities, and fall occurrences. This study aimed to comprehensively assess the links between CIPN, balance deficits, and functional disability and to inform the development of clinical screening tools for patients at risk of these events. PATIENTS AND METHODS A total of 190 cancer survivors exposed to neurotoxic chemotherapies (age, 57 ± 13 years; average time from completion of neurotoxic therapy, 12 ± 11 months) attended a neurology research clinic for a single cross-sectional assessment of patient-reported and objective CIPN, standing balance in 4 conditions of increasing difficulty, and functional disability. RESULTS Most patients (68%) reported CIPN symptoms at assessment. Symptomatic patients displayed increased functional disability (F=39.4; P<.001) and balance deficits (F=34.5; P<.001), with degree of balance impairments consistent with a healthy elderly population (age ≥65 years) reporting multiple falls over the subsequent year. Increasing CIPN severity correlated with increasing functional disability (clinically assessed R2=0.46; patient-reported R2=0.49; P<.001) and balance deficits (clinically assessed R2=0.41; patient-reported R2=0.30; P<.001). A 5-factor model of key independent correlates-patient-reported numbness/tingling, weakness, and balance deficit; age; and vibration perception-was strongly linked to balance deficits (R2=0.46; P<.001) and functional disability (R2=0.56; P<.001). CONCLUSIONS This study confirms links between increasing CIPN severity and increasing balance deficits and functional disability using comprehensive CIPN assessment methodology. The extent of balance deficits in patients with CIPN underscores the functional consequences of neurotoxicity. A 5-factor model provides a foundation for clinical screening tools to assess balance deficits and functional disability in patients exposed to neurotoxic chemotherapies.
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Affiliation(s)
- J Matt McCrary
- Prince of Wales Clinical School, University of New South Wales, Kensington
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Kensington
| | | | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Camperdown
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Mark Hertzberg
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | | | - Tracy King
- Royal Prince Alfred Hospital, Camperdown.,Sydney Nursing School, The University of Sydney, Camperdown
| | - Annmarie Bosco
- Prince of Wales Hospital, Randwick.,School of Medical Sciences, University of New South Wales, Kensington; and
| | - Michelle Harrison
- School of Medical Sciences, University of New South Wales, Kensington; and.,School of Medical Sciences, University of New South Wales, Kensington; and
| | - Susanna B Park
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Brain and Mind Centre, The University of Sydney, Camperdown
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6
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Functional Benefits of Fitness Boxing for Survivors Diagnosed With Breast or Ovarian Cancer: A Pilot Study. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Tomczak U, Sattar S, Schoenbeck KL, Cordner T, Wildes TM. Circumstances around falls in older adults with Cancer. J Geriatr Oncol 2020; 12:91-95. [PMID: 32576521 DOI: 10.1016/j.jgo.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Falls are increasingly worrisome to older adults with cancer due to the side effects of cancer and its treatments. Understanding the circumstances of falls is important in the development of fall prevention strategies. The aim of this study is to understand the circumstances of falls in older patients with cancer. MATERIALS AND METHODS This study is a secondary analysis of a prospective cohort study in which adults aged ≥65 years with cancer receiving systemic cancer therapy were followed for fall outcomes for six months. Falls were assessed by monthly fall calendars; 51 participants who reported a fall were interviewed regarding the fall. RESULTS The cohort had an average age of 72.2 ± 5.2 years; 37% were female and 90% were white. Half (25/51) had experienced falls in the six months prior to enrollment. During the follow-up period, 78 falls occurred in 51 individuals over 6 months: 36 patients had 1 fall, 9 patients had 2 falls, 3 had 3 falls, and 1 each had 4, 5, or 6 falls. Nearly half of falls (51%) took place in the home and 38 (49%) occurred outside of the home. CONCLUSIONS Falls occurred at similar rates both inside the home and outside the home, indicating that familiarity with the person's surroundings does not protect against falls. Symptoms of cancer treatments were not mentioned during fall assessment, which may indicate a need for more awareness of the side effects of cancer medications and future developments of fall prevention methods.
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Affiliation(s)
| | | | | | | | - Tanya M Wildes
- Washington University School of Medicine, St Louis, MO, USA.
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8
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Morris R, Lewis A. Falls and Cancer. Clin Oncol (R Coll Radiol) 2020; 32:569-578. [PMID: 32291190 DOI: 10.1016/j.clon.2020.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
Abstract
Falls among older people are common and are associated with substantial morbidity, mortality and healthcare costs. Increasingly cancer is becoming a disease of older people and fall rates are higher in elders living with cancer. Cancer and its treatments potentiate important risk factors for falls, including muscle weakness, poor balance, proprioception, cognitive impairment and functional disability. Sarcopenia refers to the progressive deterioration in muscle strength, mass and quality with ageing. Chronic conditions and cancer amplify this decline and are associated with a greater negative effect on function. Age-related impairments of lower limb neurological function are commonly exacerbated by neurotoxic chemotherapy, resulting in gait and balance deficits. Postural instability and falls erode confidence and result in a negative cycle of diminishing activity levels, further deconditioning and a higher risk of further falls. Cancer-related fatigue, sleep and mood disturbances compound this progressive frailty, further worsening treatment tolerance and outcomes. Cognitive impairment is a potent risk factor for falling and is frequently associated with gait abnormalities. The well-recognised effects of cancer treatment on working memory, attention, processing speed and executive function are often apparent (when their presence is sought) before treatment and may be as much the result of the cancer itself as they are 'chemo brain'. Structured exercise programmes focusing on progressively challenging strength and balance training are of proven benefit in falls prevention. Regular aerobic exercise accrues additional benefits in improved cardiorespiratory resilience and concomitant positive effects on treatment tolerance. Increased activity levels positively influence cognition, mood and foster an improved sense of well-being. Simple, practicable clinic-based tests of physical functioning, cognition and neurological function can help to identify those at high risk of falls and functional decline. The use of such instruments can aid judicious treatment planning and identify those most likely to benefit from more detailed specialist comprehensive geriatric assessment.
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Affiliation(s)
- R Morris
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
| | - A Lewis
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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9
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Evans ES, Ketcham CJ, Hibberd JC, Cullen ME, Basiliere JG, Murphy DL. Examination of clinical and laboratory measures of static and dynamic balance in breast cancer survivors. Physiother Theory Pract 2019; 37:1199-1209. [DOI: 10.1080/09593985.2019.1692391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Elizabeth S. Evans
- Department of Physical Therapy Education, Elon University, Elon, NC, USA
| | | | - Julie C. Hibberd
- Department of Physical Therapy Education, Elon University, Elon, NC, USA
- Department of Exercise Science, Elon University, Elon, NC, USA
| | | | | | - Dorriea L. Murphy
- Department of Physical Therapy Education, Elon University, Elon, NC, USA
- Department of Rehabilitation Services, Alamance Regional Medical Center, Burlington, NC, USA
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10
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Morishita S, Hirabayashi R, Tsubaki A, Aoki O, Fu JB, Onishi H, Tsuji T. Assessment of the Mini-Balance Evaluation Systems Test, Timed Up and Go test, and body sway test between cancer survivors and healthy participants. Clin Biomech (Bristol, Avon) 2019; 69:28-33. [PMID: 31288138 DOI: 10.1016/j.clinbiomech.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer survivors experience late and long-term effects of treatment; also, the disease itself might be responsible for persisting functional impairments. The purpose of this study was to investigate muscle strength, balance function using the Mini-Balance Evaluation Systems Test and Timed Up and Go test with single and cognitive dual tasks and body sway in breast cancer survivors and healthy women and non-breast cancer survivors and healthy participants. METHODS Twenty-six cancer survivors and 19 healthy participants were assessed for grip and knee extension strength with the Mini-Balance Evaluation Systems Test, Timed Up and Go, and body sway test performance. FINDINGS Breast cancer survivors had significantly lower hand grip strength (p < .05) and Mini-Balance Evaluation Systems Test scores than healthy women (p < .05). Additionally, in breast cancer survivors, hand grip strength had a significant relationship with Mini-Balance Evaluation Systems Test and Timed Up and Go scores (p < .05) but had no relationship with the total center of pressure length. Hand grip strength and Mini-Balance Evaluation Systems Test scores were not significantly different in non-breast cancer survivors and healthy participants. In non-breast cancer survivors, knee extension strength had a significant relationship with the Timed Up and Go scores (p < .05). INTERPRETATION The relationship between muscle strength and balance function may be characterized by the different diagnoses in cancer survivors. The current findings showed the changes in balance function and muscle strength among cancer survivors.
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Affiliation(s)
- Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan.
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan.
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan.
| | - Osamu Aoki
- Faculty of Rehabilitation, Shijonawate Gakuen University, Osaka 574-0011, Japan.
| | - Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan.
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
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11
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Screening and Examination of Fall Risk in Older Cancer Survivors. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000166] [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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12
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Wogksch MD, Howell CR, Wilson CL, Partin RE, Ehrhardt MJ, Krull KR, Brinkman TM, Mulrooney DA, Hudson MM, Robison LL, Ness KK. Physical fitness in survivors of childhood Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort. Pediatr Blood Cancer 2019; 66:e27506. [PMID: 30362255 PMCID: PMC6344300 DOI: 10.1002/pbc.27506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND There are limited data describing fitness and associated health-related quality of life (HRQoL) in survivors of childhood Hodgkin lymphoma (HL). PROCEDURE Fitness was evaluated among 336 adult survivors of childhood-onset HL treated at St. Jude Children's Research Hospital and 327 controls who never had childhood cancer. The controls were frequency matched on age, sex, and race. Associations were examined between chronic disease and fitness and between fitness and HRQoL using a multivariable linear and logistic regression. RESULTS Male survivors had lower endurance (6-min walk [6MW] distance 604.4 ± 7.9 m vs 637.0 ± 7.5 m, P < 0.01), and worse neuropathy (modified Total Neuropathy Score [mTNS] 2.7 ± 0.2 vs 1.4 ± 0.2, P < 0.01) compared to controls. Female survivors had lower endurance (6MW distance 564.5 ± 6.9 m vs 590.6 ± 7.0 m, P < 0.01), quadriceps strength (145.7 ± 4.0 vs 163.4 ± 4.0 N·m per kilogram, P < 0.01), and worse neuropathy (mTNS 3.2 ± 0.2 vs 1.4 ± 0.3, P < 0.01) compared to controls. Moderate, severe/disabling, or life-threatening (grades 2-4) neurological conditions were associated with impaired quadriceps strength (odds ratio [OR] 2.94, 99% confidence interval [CI] 1.24-6.96) and impaired endurance (OR 2.96, 99% CI 1.28-6.69). Cardiovascular (OR 2.36, 99% CI 1.00-5.61) and pulmonary (OR 2.78, 99% CI 1.30-5.94) conditions were associated with impaired endurance. Quadriceps strength (β -6.44 ± 2.01, P < 0.01), endurance (β -4.63 ± 1.54, P < 0.01), and neuropathy (β -4.98 ± 1.14, P < 0.01) were associated with a lower physical component summary on the HRQoL. CONCLUSION Survivors of childhood HL, particularly those with neurological, cardiac, and pulmonary chronic conditions, are at risk for impaired fitness and HRQoL.
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Affiliation(s)
- Matthew D. Wogksch
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Robyn E. Partin
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J. Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Abstract
PURPOSE The aim of the study was to identify risk factors for falls among cancer survivors. DESIGN Integrative literature review. METHODS We searched PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and PEDro for studies investigating fall risk in cancer. Reports of randomized controlled trials, descriptive studies (quantitative and qualitative), and theoretical papers meeting predetermined criteria were included. Quality ratings of included studies were done, and data were extracted and compiled by two independent reviewers. FINDINGS Twenty-nine articles met inclusion criteria. Literature quality was moderate (median quality score: 1.67 out of 3 possible points). Heterogeneity of statistics and reporting methods precluded calculation of summary effect sizes, but physical function, cognitive function, balance/gait, and certain medication types appear to increase fall risk. CONCLUSIONS AND CLINICAL RELEVANCE Modifiable risk factors, such as those identified in this review, represent tangible intervention targets for rehabilitation professionals for decreasing the risk of falls among cancer survivors.
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14
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Bahcaci U, Demirbuken I. Effects of chemotherapy process on postural balance control in patients with breast cancer. Indian J Cancer 2019; 56:50-54. [DOI: 10.4103/ijc.ijc_47_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Miyata K, Hasegawa S, Iwamoto H, Otani T, Kaizu Y, Shinohara T, Usuda S. Structural validity of Balance Evaluation Systems Test assessed using factor and Rasch analyses in patients with stroke. J Phys Ther Sci 2018; 30:1446-1454. [PMID: 30568332 PMCID: PMC6279694 DOI: 10.1589/jpts.30.1446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The Balance Evaluation Systems Test (BESTest) is a comprehensive assessment
tool, although it is not confined for use in stroke patients. This study aimed to
determine the structural validity of the BESTest in self-ambulatory patients with stroke
using both factor and Rasch analyses. [Participants and Methods] This retrospective study
included 140 self-ambulatory patients with stroke. The structural validity of the BESTest
was analyzed according to principal component, exploratory factor, Rasch, confirmatory
factor, and correlation analyses. [Results] The analytical results supported a four-factor
model comprising 25 items. The four factors included dynamic postural control with gait,
static postural control, stepping reaction, and stability limits in sitting. Evidence of
high structural validity and reliable internal consistency suggested that the 25-item
BESTest is valid and reliable. Each factor was significantly correlated with lower
extremity motor function and walking ability. [Conclusion] Eleven items in the BESTest
were poorly correlated, and the remaining 25 items were grouped into four factors that
demonstrated good structural validity for patients with stroke. Further studies should
validate the applicability of the 25-item BESTest four-factor model in a larger sample of
patients with stroke in a clinical setting.
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Affiliation(s)
- Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science: 4669-2, Ami-Machi, Inashiki-gun, Ibaraki, 300-0394 Japan.,Gunma University Graduate School of Health Sciences, Japan
| | - Satoshi Hasegawa
- Gunma University Graduate School of Health Sciences, Japan.,Public Nanokaichi Hospital, Japan
| | | | | | | | | | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences, Japan
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Predictors of falls in older survivors of breast and prostate cancer: A retrospective cohort study of surveillance, epidemiology and end results-Medicare health outcomes survey linkage. J Geriatr Oncol 2018; 10:89-97. [PMID: 29752141 DOI: 10.1016/j.jgo.2018.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/03/2018] [Accepted: 04/25/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To identify predictors of falls in older breast and prostate cancer survivors. METHODS This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC). RESULTS At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers. CONCLUSIONS Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks.
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Factors associated with falls in older adults with cancer: a validated model from the Cancer and Aging Research Group. Support Care Cancer 2018; 26:3563-3570. [PMID: 29705872 DOI: 10.1007/s00520-018-4212-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Falls in older adults with cancer are common, yet factors associated with fall-risk are not well-defined and may differ from the general geriatric population. This study aims to develop and validate a model of factors associated with prior falls among older adults with cancer. METHODS In this cross-sectional secondary analysis, two cohorts of patients aged ≥ 65 with cancer were examined to develop and validate a model of factors associated with falls in the prior 6 months. Potential independent variables, including demographic and laboratory data and a geriatric assessment (encompassing comorbidities, functional status, physical performance, medications, and psychosocial status), were identified. A multivariate model was developed in the derivation cohort using an exhaustive modeling approach. The model selected for validation offered a low Akaike Information Criteria value and included dichotomized variables for ease of clinical use. This model was then applied in the validation cohort. RESULTS The development cohort (N = 498) had a mean age of 73 (range 65-91). Nearly one-fifth (18.2%) reported a fall in the prior 6 months. The selected model comprised nine variables involving functional status, objective physical performance, depression, medications, and renal function. The AUC of the model was 0.72 (95% confidence intervals 0.65-0.78). In the validation cohort (N = 250), the prevalence of prior falls was 23.6%. The AUC of the model in the validation cohort was 0.62 (95% confidence intervals 0.51-0.71). CONCLUSION In this study, we developed and validated a model of factors associated with prior falls in older adults with cancer. Future study is needed to examine the utility of such a model in prospectively predicting incident falls.
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Schulz KH, Patra S, Spielmann H, Klapdor S, Schlüter K, van Eckert S. Physical condition, nutritional status, fatigue, and quality of life in oncological out-patients. SAGE Open Med 2017; 5:2050312117743674. [PMID: 29318010 PMCID: PMC5753892 DOI: 10.1177/2050312117743674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/29/2017] [Indexed: 12/22/2022] Open
Abstract
Objective: Early detection of limited physical activity and nutritional deficiencies in cancer survivors could contribute to early treatment and preservation of quality of life. The aim of this study is to describe the association of physical condition and nutritional status with fatigue and quality of life in oncological out-patients. Methods: Data in this descriptive study was collected on bioelectrical impedance analysis, postural stability (stability index), body mass index, Karnofsky Index, quality of life (Short-Form 36-Item Health Survey) and fatigue (multidimensional fatigue inventory-20) in a consecutive sample of 203 oncological out-patients. Phase angle was calculated from bioelectrical impedance analysis. Values were intercorrelated and compared to appropriate standard values. Results: Phase angle and stability index outcomes were far below the values of a healthy population of similar age (p < 0.001). Quality of life was significantly lower than in the normal population (p < 0.001), and the level of fatigue was significantly higher (p < 0.001). Phase angle correlated with Karnofsky Index (p = 0.002) and Short-Form 36-Item Health Survey Summary physical function (p < 0.001). Furthermore, multidimensional fatigue inventory-20 scales ‘physical fatigue’ and ‘reduced activity’ were significantly associated with phase angle (p = 0.04, p = 0.005). Stability indices correlated with Short-Form 36-Item Health Survey physical function. Conclusion: The physical condition and the nutritional status are key components determining the individual quality of life of oncological out-patients. These variables also showed an association with the manifestation of fatigue. Results highlight the need for interdisciplinary cooperation to detect physical, nutritional and psychological deficiencies in oncological out-patients.
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Affiliation(s)
- Karl-Heinz Schulz
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Universitäres Kompetenzzentrum für Sport- und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Patra
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Universitäres Kompetenzzentrum für Sport- und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah Spielmann
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Universitäres Kompetenzzentrum für Sport- und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Kathrin Schlüter
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Universitäres Kompetenzzentrum für Sport- und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Abteilung Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Sandra van Eckert
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Universitäres Kompetenzzentrum für Sport- und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Fakultät für Gesundheitswissenschaften, Technische Universität Brandenburg, Cottbus, Germany
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Miaskowski C, Wong ML, Cooper BA, Mastick J, Paul SM, Possin K, Steinman M, Cataldo J, Dunn LB, Ritchie C. Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy. J Pain Symptom Manage 2017; 54:263-272. [PMID: 28716620 PMCID: PMC5610084 DOI: 10.1016/j.jpainsymman.2017.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Although physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX). OBJECTIVES Identify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality-of-life (QOL) outcomes. METHODS Latent profile analysis was used to identify groups of older oncology patients (n = 363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary score from the Short Form 12. Differences, among the groups, in demographic and clinical characteristics and QOL outcomes were evaluated using parametric and nonparametric tests. RESULTS Three groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative Physical Component Summary scores. Characteristics associated with membership in the Well Below class included the following: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared with the Above class, patients in the other two classes had significantly poorer QOL outcomes. CONCLUSION Almost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high-risk patients and initiate appropriate interventions.
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Affiliation(s)
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Katherine Possin
- School of Medicine, University of California, San Francisco, California, USA
| | - Michael Steinman
- School of Medicine, University of California, San Francisco, California, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California, USA
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20
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Hajek A, König HH. Falls and subjective well-being. Results of the population-based German Ageing Survey. Arch Gerontol Geriatr 2017; 72:181-186. [PMID: 28692833 DOI: 10.1016/j.archger.2017.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/04/2017] [Accepted: 06/23/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of the current study was to determine the relationship between falling in the past 12 months and subjective well-being in a broader sense. METHODS Cross-sectional data were gathered from a representative sample of community-dwelling individuals in the second half of life (40 to 95 years; n=7808) in Germany. While life satisfaction was quantified using the Satisfaction with Life Scale (SWLS), positive and negative affect was measured using the Positive and Negative Affect Schedule (PANAS). RESULTS The prevalence of falling in the preceding 12 months was 17.6%. After controlling for sociodemographic factors, various lifestyle factors, self-rated health, and morbidity, multiple linear regression analysis revealed that falling in the past 12 months was associated with higher negative affect (β=0.08, p<0.001), lower positive affect (β=-0.04, p<0.05) as well as lower life satisfaction (β=-0.12, p<0.001). CONCLUSION The present study stresses the relationship between falls and subjective well-being. Future longitudinal studies are needed to validate the findings of the present cross-sectional study and to better understand the nature of this relationship.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany.
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21
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Zak M, Biskup M, Macek P, Krol H, Krupnik S, Opuchlik A. Identifying predictive motor factors for falls in post-menopausal breast cancer survivors. PLoS One 2017; 12:e0173970. [PMID: 28306736 PMCID: PMC5357067 DOI: 10.1371/journal.pone.0173970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Breast cancer treatment, including radical surgery, is also pursued as late as the 7th - 8th decade of women's lives. Standard physical rehabilitation procedures offered to those women are predominantly focused on attenuating specific functional deficits of the upper limb and trunk. Seldom do they entail any regimens specifically aimed at recovering overall functionality, and reducing exposure to falls-risk. The study aimed to assess potential interrelationships between the self-reported falls, individual functional capabilities and appreciably reducing exposure to falls-risk in a group of post-menopausal, post-surgical breast cancer survivors. METHODS The study recruited 102 women (aged 65-79; mean age 70.2), post-surgical breast cancer survivors. The subjects were stratified by age into three groups: Group 1 (65-69 years); Group 2 (70-74 years), and Group 3 (75-79 years). Individual functional capabilities were assessed with Eight-foot up & go test (8UG), chair stand test (CST), and 2-minute step test (2ST). Tinetti POMA test was applied to assess gait and balance disorders. Self-reported falls in the past year were ascertained through a questionnaire. RESULTS Assessment of individual aerobic endurance (2ST) also demonstrated a clear deficit in the mean scores category in all respective age sub-groups, as compared against the reference values. The deficits ranged from 4.86 to 15.90 steps less than the normative values; the oldest subjects demonstrating the largest deficit. The aerobic endurance tests results significantly impacted the ultimate assessment of an individual falls-risk in the oldest group. The analysis of the number of falls sustained within the recent year indicated that 43.67% of the subjects fell victim of such incidents. CONCLUSION An individual exposure to falls-risk was found to be appreciably more dependent upon individual aerobic endurance rather than overall strength of the lower part of the body in the breast cancer survivors over 75.
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Affiliation(s)
- Marek Zak
- Department of Physical Rehabilitation in Rheumatology and Geriatrics, University School of Physical Education, Krakow, Poland
| | - Malgorzata Biskup
- Department of Rehabilitation, Holycross Cancer Centre, Kielce, Poland
- Faculty of Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Pawel Macek
- Department of Epidemiology and Cancer Control, Holycross Cancer Centre, Kielce, Poland
- Faculty of Medical Sciences, School of Economics, Law and Medical Sciences, Kielce, Poland
| | - Halina Krol
- Department of Rehabilitation, Holycross Cancer Centre, Kielce, Poland
- Faculty of Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Szymon Krupnik
- Department of Physical Rehabilitation in Rheumatology and Geriatrics, University School of Physical Education, Krakow, Poland
| | - Anna Opuchlik
- Department of Rehabilitation, Holycross Cancer Centre, Kielce, Poland
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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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23
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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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24
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Preliminary Validation of a Short Version of the Balance Evaluation Systems Test in Cancer Survivors Living in the Community. REHABILITATION ONCOLOGY 2016. [DOI: 10.1097/01.reo.0000000000000016] [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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25
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Pandya C, Magnuson A, Dale W, Lowenstein L, Fung C, Mohile SG. Association of falls with health-related quality of life (HRQOL) in older cancer survivors: A population based study. J Geriatr Oncol 2016; 7:201-10. [PMID: 26907564 DOI: 10.1016/j.jgo.2016.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/04/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association between falls and health-related quality of life (HRQOL) in older cancer survivors. MATERIALS AND METHODS Using the 2006-2011 Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey (SEER-MHOS) linkage database, a cross-sectional analysis was performed including 17,958 older cancer survivors. Multivariable regression models were used to evaluate the association of falls with HRQOL measured by the physical component summary (PCS) and mental component summary (MCS) scores on the Veteran RAND 12-item health survey after controlling for demographic, health- and cancer-related factors. A longitudinal analysis using the analysis of covariance (ANCOVA) models was also conducted comparing changes in HRQOL of older cancer survivors who fell with HRQOL of older patients with cancer who did not fall. RESULTS In the cross-sectional analysis, 4524 (25%) cancer survivors who fell reported a significantly lower PCS (-2.18; SE=0.16) and MCS (2.00; SE=0.17) scores compared to those who did not (N=13,434). In the longitudinal analysis, after adjusting for baseline HRQOL scores and covariates, patients who fell reported a decline in mean HRQOL scores of both PCS (-1.54; SE=0.26) and MCS (-1.71; SE=0.27). Presence of depression, functional impairment and comorbidities was significantly associated with lower HRQOL scores. CONCLUSION Falls are associated with lower HRQOL scores and are associated with a significant prospective decline in HRQOL in older cancer survivors. Further research is necessary to determine if assessment and intervention programs can help improve HRQOL by reducing the likelihood of falls.
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Affiliation(s)
- Chintan Pandya
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - William Dale
- Division of Geriatrics and Palliative Care, University of Chicago, Chicago, IL, USA
| | - Lisa Lowenstein
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Chunkit Fung
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya G Mohile
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
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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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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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Croarkin E, Eisenfeld R, Zampieri C, Rekant J. Custom Orthotics to Mitigate Effects of Chemotherapy-induced Peripheral Neuropathy. REHABILITATION ONCOLOGY 2015; 33:43-50. [PMID: 38405036 PMCID: PMC10888503 DOI: 10.1097/01893697-201533030-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) is a complication commonly involving extremities characterized by dysthesias. Given the predilection towards diminished proprioceptive feedback, balance and gait deficits often result, leading to an increase in falls risk. To date there is no published evidence to support the use of orthotics in the treatment of balance dysfunction secondary to CIPN. Purpose This report describes custom foot orthotics with a closed cell foam overlay to improve postural stability and mobility in CIPN. Case Description An individual experiencing progressive balance dysfunction was provided orthotics when standard interventions were not effective. Expectations were that improved joint contact via midfoot compression and improved bony alignment would alter proprioceptive feedback throughout the kinetic chain and result in greater postural stability. Finding a cosmetically appealing shoe to provide sufficient tactile cues and support, without undue pressure challenged clinical decision making. Outcome Measures Computerized dynamic posturography and accelerometry were used to measure postural sway. Three conditions (barefoot, shoes only, and shoe plus orthotics) were tested to differentiate effects of orthotics and shoes. With orthotic use measures of sway velocity and area improved as did his ability to stand unassisted. Timed Up and Go and gait speed measures also improved.
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Affiliation(s)
- Earllaine Croarkin
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Rachel Eisenfeld
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Cris Zampieri
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Julie Rekant
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
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Oncology Section Task Force on Breast Cancer Outcomes: Clinical Measures of Balance A Systematic Review. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533010-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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