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Liegl G, Fischer FH, Canaud B, Woodward M, Barth C, Davenport A, Török M, Strippoli GFM, Hegbrant J, Cromm K, Bots ML, Blankestijn PJ, Fischer KI, Rose M. Using a measurement type-independent metric to compare patterns of determinants between patient-reported versus performance-based physical function in hemodialysis patients. Qual Life Res 2024:10.1007/s11136-024-03745-6. [PMID: 39103575 DOI: 10.1007/s11136-024-03745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE We applied a previously established common T-score metric for patient-reported and performance-based physical function (PF), offering the unique opportunity to directly compare measurement type-specific patterns of associations with potential laboratory-based, psychosocial, sociodemographic, and health-related determinants in hemodialysis patients. METHODS We analyzed baseline data from the CONVINCE trial (N = 1,360), a multinational randomized controlled trial comparing high-flux hemodialysis with high-dose hemodiafiltration. To explore the associations of potential determinants with performance-based versus patient-reported PF, we conducted multiple linear regression (backward elimination with cross-validation and Lasso regression). We used standardized T-scores as estimated from the PROMIS PF short-form 4a (patient-reported PF) and the Physical Performance Test (performance-based PF) as dependent variables. RESULTS Performance-based and patient-reported PF were both significantly associated with a laboratory marker-based indicator of muscle mass (simplified creatinine index), although the effects were relatively small (partial f2 = 0.04). Age was negatively associated with PF; the effect size was larger for performance-based (partial f2 = 0.12) than for patient-reported PF (partial f2 = 0.08). Compared to performance-based PF, patient-reported PF showed a stronger association with self-reported health domains, particularly pain interference and fatigue. When using the individual difference between patient-reported and performance-based T-scores as outcome, we found that younger age and more fatigue were associated with lower patient-reported PF compared to performance-based PF (small effect size). CONCLUSION Patient-reported and performance-based assessments were similarly associated with an objective marker of physical impairment in hemodialysis patients. Age and fatigue may result in discrepancies when comparing performance-based and patient-reported scores on the common PF scale. Trial Registration CONVINCE is registered in the Dutch Trial Register (Register ID: NL64750.041.18). The registration can be accessed at: https://onderzoekmetmensen.nl/en/trial/52958 .
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Affiliation(s)
- Gregor Liegl
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, 10117, Berlin, Germany.
| | - Felix H Fischer
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, 10117, Berlin, Germany
| | - Bernard Canaud
- Global Medical Office, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
- School of Medicine, Montpellier University, Montpellier, France
| | - Mark Woodward
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Claudia Barth
- Medical Scientific Affairs, B. Braun Avitum AG, Melsungen, Germany
| | - Andrew Davenport
- Department of Renal Medicine, UCL, Royal Free Hospital & University College London, London, UK
| | | | - Giovanni F M Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) University of Bari, Italy & School of Public Health, University of Sydney, Darlington, Australia
| | - Jörgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Krister Cromm
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, 10117, Berlin, Germany
- Global Medical Office, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kathrin I Fischer
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, 10117, Berlin, Germany
| | - Matthias Rose
- Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, 10117, Berlin, Germany
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Performance of the SARC-F in identifying low grip strength and physical performance in older adults with cancer. J Geriatr Oncol 2023; 14:101424. [PMID: 36657248 DOI: 10.1016/j.jgo.2022.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Remote, online geriatric assessment (GA) is gaining attention in oncology. Most GA domains can be assessed remotely. However, there is limited evidence identifying reliable tools that can be used in lieu of objective measures of physical function, such as grip strength and physical performance during remote, online GA. In this prospective cohort study, we aimed to assess the performance of the SARC-F, a screening questionnaire for sarcopenia, in identifying low grip strength and the Short Physical Performance Battery (SPPB). Additionally, we assessed the satisfaction of clinical staff with using the SARC-F in the clinic. MATERIALS AND METHODS Data were prospectively collected from older adults with cancer of any type and stage who underwent GA in the geriatric oncology clinic of a tertiary cancer centre. Following GA, patients were asked to complete the SARC-F tool. Spearman correlations were performed between objective measures of physical function, SARC-F domains, and SARC-F total score. Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value were assessed to evaluate the performance of SARC-F to detect low grip strength and SPPB. RESULTS Eighty (n = 80) older adults (mean age: 80 years) with cancer completed the SARC-F. A positive SARC-F was found in 31.3% of the cohort. Moderate correlations were found between the SPPB per point and Assistance in walking (r = -0.69), as well as the SPPB per point and total SARC-F score (r = -0.66). SARC-F exhibited moderate sensitivity in identifying low grip strength using the Foundation for the National Institutes of Health (FNIH) criteria (sensitivity: 64.3%) or the Sarcopenia Definitions and Outcomes Consortium (SDOC) criteria (sensitivity: 40.4%). However, specificity was high (>75%) regardless of the criteria applied. Similarly, moderate sensitivity (52.2%), but excellent specificity (97.1%) was found for SPPB. When low grip strength per FNIH was combined with low SPPB, SARC-F demonstrated high sensitivity (80%) and specificity (75.7%). DISCUSSION SARC-F exhibited promising performance in identifying low grip strength per FNIH and low SPPB combined. To definitively assess the performance of the SARC-F in detecting low grip strength and SPPB, larger studies are warranted.
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The role of grip strength and short physical performance battery test in predicting chemotherapy-related outcomes in older adults with cancer. J Geriatr Oncol 2021; 13:318-324. [PMID: 34924306 DOI: 10.1016/j.jgo.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/18/2021] [Accepted: 12/03/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Grip strength (GS) and the Short Physical Performance Battery (SPPB) are brief objective tests used during a comprehensive geriatric assessment (CGA) to assess physical performance. Abnormal GS and SPPB scores are associated with greater morbidity and mortality in older adults with cancer but their relationship with chemotherapy tolerability is unclear. We explored the performance of GS and SPPB in predicting therapy delay, dose reduction, and treatment completion in older adults undergoing chemotherapy or chemoradiation. Additionally, we examined associations between GS, SPPB, and instrumental activities of daily living (IADLs). METHODS Retrospective review of patients ≥65 years old who had undergone a pre-treatment CGA in a geriatric oncology clinic were retrieved from electronic charts and institutional databases. Abnormal GS was defined as <26 kg and < 16 kg for men and women, respectively. Abnormal SPPB was defined as ≤9 points. Logistic regression was used to examine the associations between abnormal GS or SPPB alone or combined with chemotherapy-related outcomes (e.g., delay, dose reduction, completion). Chi-squared tests were used to determine associations between physical performance measures (GS and SPPB) and IADLs. RESULTS A total of 85 participants (mean age 79.1 years old) with mixed cancer diagnoses were included. Approximately 67% of participants exhibited abnormal GS or SPPB prior to treatment. Abnormal GS or SPPB (combined) was associated with treatment delay (odds ratio (OR) = 7.58, 95% confidence interval (CI) = 1.77, 32.43, P = 0.006). When physical performance measures were examined separately, only SPPB predicted treatment delay (OR = 3.26, 95%CI = 1.04, 10.21, P = 0.043). Abnormal GS or SPPB were not associated with dose reduction or treatment completion. Abnormal GS and SPPB alone or combined demonstrated only modest sensitivity (41.9-76.7%) and negative predictive value (57.9-64.2%) in identifying IADLs dependence. CONCLUSION GS and SPPB may be used to predict treatment delay in older adults prior to chemotherapy and chemoradiation. Additional studies are warranted to examine whether GS and/or SPPB can predict dose reduction and treatment completion in older adults prior to receiving chemotherapy or chemoradiation.
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Blackwood J, Rybicki K. Physical function measurement in older long-term cancer survivors. J Frailty Sarcopenia Falls 2021; 6:139-146. [PMID: 34557613 PMCID: PMC8419850 DOI: 10.22540/jfsf-06-139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To establish reliability, validity, and minimal detectable change in measures of function in older long-term cancer survivors. METHODS Older cancer survivors were recruited to perform functional measures; 5 Times Sit-to-Stand (5xSTS), 30-second Timed Chair Rise (30sTCR), Short Physical Performance Battery (SPPB), Physical Performance Test-7 (PPT-7). Two testing sessions were completed two weeks apart. Test-retest reliability was examined using the intraclass correlation coefficient (ICC2,1), convergent and discriminant validity using Spearman's rho and Minimal Detectable Change (MDC95) was calculated. RESULTS Forty-seven older long-term cancer survivors participated. Test-retest reliability was good for 5xSTS (ICC2,1=0.86), 30sTCR (ICC2,1=0.89), and SPPB (ICC2,1=0.85) and poor for PPT-7 (ICC2,1=0.48). Both convergent and discriminant validity was established. CONCLUSIONS SPPB, 5xSTS, and 30sTCR are reliable and valid tools to measure function in older long-term cancer survivors. MDC95 values were larger than those reported in geriatrics and should be interpreted with caution. Residual effects of cancer treatment, comorbidity, and physical inactivity may contribute to decreased physical function in older long-term cancer survivors, therefore valid and reliable measures like SPPB and the timed chair rise tests should be used objectively measure function throughout the survivorship spectrum.
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Affiliation(s)
| | - Kateri Rybicki
- Physical Therapy Department, University of Michigan-Flint, USA
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5
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van Seventer E, Marquardt JP, Troschel AS, Best TD, Horick N, Azoba C, Newcomb R, Roeland EJ, Rosenthal M, Bridge CP, Greer JA, El-Jawahri A, Temel J, Fintelmann FJ, Nipp RD. Associations of Skeletal Muscle With Symptom Burden and Clinical Outcomes in Hospitalized Patients With Advanced Cancer. J Natl Compr Canc Netw 2021; 19:319-327. [PMID: 33513564 DOI: 10.6004/jnccn.2020.7618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Low muscle mass (quantity) is common in patients with advanced cancer, but little is known about muscle radiodensity (quality). We sought to describe the associations of muscle mass and radiodensity with symptom burden, healthcare use, and survival in hospitalized patients with advanced cancer. METHODS We prospectively enrolled hospitalized patients with advanced cancer from September 2014 through May 2016. Upon admission, patients reported their physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used CT scans performed per routine care within 45 days before enrollment to evaluate muscle mass and radiodensity. We used regression models to examine associations of muscle mass and radiodensity with patients' symptom burden, healthcare use (hospital length of stay and readmissions), and survival. RESULTS Of 1,121 patients enrolled, 677 had evaluable muscle data on CT (mean age, 62.86 ± 12.95 years; 51.1% female). Older age and female sex were associated with lower muscle mass (age: B, -0.16; P<.001; female: B, -6.89; P<.001) and radiodensity (age: B, -0.33; P<.001; female: B, -1.66; P=.014), and higher BMI was associated with higher muscle mass (B, 0.58; P<.001) and lower radiodensity (B, -0.61; P<.001). Higher muscle mass was significantly associated with improved survival (hazard ratio, 0.97; P<.001). Notably, higher muscle radiodensity was significantly associated with lower ESAS-Physical (B, -0.17; P=.016), ESAS-Total (B, -0.29; P=.002), PHQ-4-Depression (B, -0.03; P=.006), and PHQ-4-Anxiety (B, -0.03; P=.008) symptoms, as well as decreased hospital length of stay (B, -0.07; P=.005), risk of readmission or death in 90 days (odds ratio, 0.97; P<.001), and improved survival (hazard ratio, 0.97; P<.001). CONCLUSIONS Although muscle mass (quantity) only correlated with survival, we found that muscle radiodensity (quality) was associated with patients' symptoms, healthcare use, and survival. These findings underscore the added importance of assessing muscle quality when seeking to address adverse muscle changes in oncology.
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Affiliation(s)
- Emily van Seventer
- 1Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and
| | - J Peter Marquardt
- 2Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amelie S Troschel
- 2Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Till D Best
- 2Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,3Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | - Nora Horick
- 4Department of Statistics, Massachusetts General Hospital and Harvard Medical School
| | - Chinenye Azoba
- 1Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and
| | - Richard Newcomb
- 1Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and
| | - Eric J Roeland
- 1Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and
| | - Michael Rosenthal
- 5Dana-Farber Cancer Institute.,6Department of Radiology, Brigham and Women's Hospital
| | - Christopher P Bridge
- 7Massachusetts General Hospital and Brigham and Women's Hospital Center for Clinical Data Science, and
| | - Joseph A Greer
- 8Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- 1Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and
| | - Jennifer Temel
- 1Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and
| | - Florian J Fintelmann
- 2Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan D Nipp
- 1Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and
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Jensen BT, Lauridsen SV, Jensen JB. Optimal Delivery of Follow-Up Care After Radical Cystectomy for Bladder Cancer. Res Rep Urol 2020; 12:471-486. [PMID: 33117747 PMCID: PMC7569073 DOI: 10.2147/rru.s270240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose of Review To identify components representing optimal delivery of follow-up care after radical cystectomy because of bladder cancer and report the current level of evidence. Methods We conducted a systematic literature search of the following databases: Cochrane, MEDLINE, Embase, CINAHL, Web of Science, Physiotherapy Evidence Database and ClinicalTrials.gov. The search results were managed in Covidence Reference Manager and abstracts were screened by title. Articles relevant to the subject of interest were included and the results are reported narratively. Results Several studies have evaluated the positive impact of enhanced recovery after surgery (ERAS) on length of stay, albeit not on the further impact on 90-day postoperative complication rate, functional recovery, or mortality. Minimally invasive surgery may result in a slighter shorter length of stay compared to open surgery. Physical training combined with nutritional intervention can improve functional recovery up to one year after surgery. Nutritional supplements can preserve muscle and bone mass, and potentially improve recovery. Patient education in stoma care and prevention of infection can significantly improve self-efficacy and avoid symptoms of infection postoperatively. Moreover, specific devices like applications (apps) can support these efforts. Continued smoking increases the risk of developing postoperative complications while no evidence was found on the impact of continued alcohol drinking. Currently, there is no evidence on psychological well-being, sexual health, or shared decision making interventions with an impact on rehabilitation after radical cystectomy. Conclusion Data are scarce but indicate that peri- and postoperative multi-professional interventions can reduce prevalence of sarcopenia, and improve functional recovery, physical capacity, nutritional status, and self-efficacy in stoma care (level 1 evidence). Continued smoking increases the risk of complications, but the effects of a smoking and alcohol intervention remain unclear (level 3 evidence). The results of this review provide guidance for future directions in research and further attempts to develop and test an evidence-based program for follow-up care after radical cystectomy.
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Affiliation(s)
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark and WHO-CC, Clinical Health Promotion Centre, The Parker Institute Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hadzibegovic S, Sikorski P, Potthoff SK, Springer J, Lena A, Anker MS. Clinical problems of patients with cachexia due to chronic illness: a congress report. ESC Heart Fail 2020; 7:3414-3420. [PMID: 33012131 PMCID: PMC7754899 DOI: 10.1002/ehf2.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sara Hadzibegovic
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Philipp Sikorski
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Sophia K Potthoff
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Jochen Springer
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Alessia Lena
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Kume Y, Kodama A, Maekawa H. Preliminary report; Comparison of the circadian rest-activity rhythm of elderly Japanese community-dwellers according to sarcopenia status. Chronobiol Int 2020; 37:1099-1105. [PMID: 32164426 DOI: 10.1080/07420528.2020.1740725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated in a preliminarily study the circadian rest-activity rhythm of elderly Japanese community-dwellers according to sarcopenia status based upon the 2019 updated classification criteria of the Asian Working Group for Sarcopenia. A total of 30 participants were recruited from a single rehabilitation center in northern Japan between July and November 2019. The rest-activity rhythm of those with and without sarcopenia was assessed for 7 consecutive 24 h spans by wrist actigraphy in free-living condition and gait performance in the clinic. As group phenomena, the circadian activity rhythm of the sarcopenia cohort (N = 11) was of significantly lower amplitude and more fragmented than the non-sarcopenia cohort (N = 19). The nonparametric circadian rest activity (RAR) parameters of intra-daily variability (IV), relative amplitude (RA), most active 10-h span (M10), and the least active 5-h span (L5), but not interdaily stability (IS), of the sarcopenia group, were all significantly worse than those of the non-sarcopenia group. Gait performance for the sarcopenia group correlated strongly with the fragmentation and altered amplitude of the RAR. These preliminary findings motivated future longitudinal investigation both to improve the detection of sarcopenia in community dwelling elderly and to inform novel preventive or rehabilitative strategies.
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Affiliation(s)
- Yu Kume
- Graduate School of Medicine, Course of Health Sciences, Department of Occupational Therapy, Akita University , Akita, Japan
| | - Ayuto Kodama
- Katagami, Katagami Community-Rehabilitation Station , Japan
| | - Hiroki Maekawa
- Graduate School of Medicine, Master Course in Health Sciences, Akita University , Akita, Japan
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Koll TT, Magnuson A, Dale W, LaBarge MA, Leach CR, Mohile S, Muss H, Sedenquist M, Klepin HD. Developing a clinical and biological measures of aging core: Cancer and Aging Research Group infrastructure. J Geriatr Oncol 2020; 11:343-346. [PMID: 31537478 PMCID: PMC7054170 DOI: 10.1016/j.jgo.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/08/2019] [Accepted: 09/05/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Thuy T Koll
- Division of Geriatrics, Gerontology, Palliative Care Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Allison Magnuson
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States of America; James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States of America
| | - Mark A LaBarge
- Department of Population Sciences, Beckman Research Institute at City of Hope, Duarte, CA, United States of America
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, United States of America
| | - Supriya Mohile
- Department of Hematology and Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States of America; James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hyman Muss
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Geriatric Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Margaret Sedenquist
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Heidi D Klepin
- Section of Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
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Dunne RF, Loh KP, Williams GR, Jatoi A, Mustian KM, Mohile SG. Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review. Cancers (Basel) 2019; 11:cancers11121861. [PMID: 31769421 PMCID: PMC6966439 DOI: 10.3390/cancers11121861] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022] Open
Abstract
Cancer cachexia is a syndrome characterized by weight loss with accompanying loss of muscle and/or fat mass and leads to impaired patient function and physical performance and is associated with a poor prognosis. It is prevalent in older adults with cancer; age-associated physiologic muscle wasting and weakness, also known as sarcopenia, can compound deficits associated with cancer cachexia in older adults and makes studying this condition more complex in this population. Multiple measurement options are available to assess the older patient with cancer and cachexia and/or sarcopenia including anthropometric measures, imaging modalities such as Dual X-ray absorptiometry (DEXA) and Computed Tomography (CT), muscular strength and physical performance testing, and patient-reported outcomes (PROs). A geriatric assessment (GA) is a useful tool when studying the older patient with cachexia given its comprehensive ability to capture aging-sensitive PROs. Interventions focused on nutrition and increasing physical activity may improve outcomes in older adults with cachexia. Efforts to develop targeted pharmacologic therapies with cachexia have not been successful thus far. Formal treatment guidelines, an updated consensus definition for cancer cachexia and the development of a widely adapted assessment tool, much like the GA utilized in geriatric oncology, could help advance the field of cancer cachexia over the next decade.
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Affiliation(s)
- Richard F. Dunne
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA; (K.P.L.); (K.M.M.); (S.G.M.)
- University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY 14642, USA
- Correspondence: ; Tel.: +1-585-275-5823; Fax: +1-585-276-1379
| | - Kah Poh Loh
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA; (K.P.L.); (K.M.M.); (S.G.M.)
- University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY 14642, USA
| | - Grant R. Williams
- Division of Hematology/Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA;
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Karen M. Mustian
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA; (K.P.L.); (K.M.M.); (S.G.M.)
- University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY 14642, USA
| | - Supriya G. Mohile
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA; (K.P.L.); (K.M.M.); (S.G.M.)
- University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY 14642, USA
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Loh KP, Dunne RF, Friedberg JW, Mohile SG. Integrating Assessment of Sarcopenia into Decision-making for Allogeneic Hematopoietic Cell Transplantation: Ready for Prime Time? J Natl Cancer Inst 2019; 111:757-759. [PMID: 31220297 PMCID: PMC6695298 DOI: 10.1093/jnci/djy233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kah Poh Loh
- See the Notes section for the authors’ affiliation
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12
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Pandya C, Magnuson A, Flannery M, Zittel J, Duberstein P, Loh KP, Ramsdale E, Gilmore N, Dale W, Mohile SG. Association Between Symptom Burden and Physical Function in Older Patients with Cancer. J Am Geriatr Soc 2019; 67:998-1004. [PMID: 30848838 DOI: 10.1111/jgs.15864] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/21/2018] [Accepted: 02/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the independent association between symptom burden and physical function impairment in older adults with cancer. DESIGN Cross-sectional. SETTING Two university-based geriatric oncology clinics. PARTICIPANTS Patients with cancer aged 65 years or older who underwent evaluation with geriatric assessment (GA). MEASUREMENTS Symptom burden was measured as a summary score of severity ratings (range = 0-10) of 10 commonly reported symptoms using a Clinical Symptom Inventory (CSI). Functional impairment was defined as the presence of one or more impairments of instrumental activities of daily living (IADLs), any significant physical activity limitation on the Medical Outcomes Survey (MOS), one or more recent falls in the previous 6 months, or a Short Physical Performance Battery (SPPB) score of 9 or less. Multivariate analysis evaluated the association between symptom burden and physical function impairment, adjusting for other clinical and sociodemographic variables. RESULTS From 2011 to 2015, 359 patients with cancer and a median age of 81 years (range = 65-95 y) consented. The mean CSI score was 23.2 ± 20.5 with an observed range of 0 to 90. Patients in the highest quartile of symptom burden (N = 91; CSI score 52 ± 13) had a higher prevalence of IADL impairment (91% vs 51%), physical activity limitation (93% vs 65%), falls (55% vs 21%), and SPPB score of 9 or less (92% vs 69%) (all P values <.01) when compared with those in the bottom quartile (N = 81; CSI score: 2 ± 2). With each unit increase in CSI score, the odds of having IADL impairment, physical activity limitations, falls, and SPPB scores of 9 or less increased by 4.8%, 4.4%, 2.9%, and 2.5%, respectively (P < .05 for all results). CONCLUSIONS In older patients with cancer, higher symptom burden is associated with functional impairment. Future studies are warranted to evaluate if improved symptom management can improve function in older cancer patients. J Am Geriatr Soc 67:998-1004, 2019.
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Affiliation(s)
- Chintan Pandya
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Magnuson
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marie Flannery
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York.,School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jason Zittel
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Erika Ramsdale
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nikesha Gilmore
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - William Dale
- City of Hope National Medical Center, Department of Supportive Care Medicine, Duarte, California
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
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13
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Soares JD, Gomes TL, Siqueira JM, Oliveira IC, Mota JF, Laviano A, Pimentel GD. Muscle function loss is associated with anxiety in patients with gastrointestinal cancer. Clin Nutr ESPEN 2019; 29:149-153. [DOI: 10.1016/j.clnesp.2018.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/02/2018] [Indexed: 12/24/2022]
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14
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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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15
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Ahn C, Fang X, Silverman P, Zhang Z. A quantitative method for measuring the relationship between an objective endpoint and patient reported outcome measures. PLoS One 2018; 13:e0205845. [PMID: 30359417 PMCID: PMC6201893 DOI: 10.1371/journal.pone.0205845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
Patient reported outcome measures (PROMs) become increasingly important for assessing the effectiveness of a drug or medical device. In order for a PROM to be claimed in labeling, the PROM has to be valid, reliable and able to detect a change if the targeted disease status changes. One approach to assess the quality of a patient reported outcome measure (PROM) is to investigate the association between the PROM and an objective clinical endpoint measuring the status of a disease/condition. However, methods assessing the association between continuous and discrete variables are limited, especially for correlated measurements. In this paper, we propose a method to assess such association with any type of samples with or without correlation. The method involves estimating the probability revealing the status of a subject’s disease/condition (called truth thereafter) through the subject’s reported outcomes. The probability is a conditional probability revealing truth given the relative location of the subject’s objective outcome compared to the subject-specific latent threshold in the objective endpoint. A consistent estimator for the probability is derived. The operating characteristics of the consistent estimator are illustrated using simulation. Our method is applied to hypothetical clinical trial data generated for an ophthalmic device as an illustration.
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Affiliation(s)
- Chul Ahn
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Xin Fang
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
| | - Phyllis Silverman
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Zhiwei Zhang
- Department of Statistics, University of California, Riverside, CA, United States of America
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16
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Exercise for managing cancer- and treatment-related side effects in older adults. J Geriatr Oncol 2018; 9:405-410. [DOI: 10.1016/j.jgo.2018.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 12/30/2022]
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17
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Sampedro Pilegaard M, Oestergaard LG, la Cour K, Thit Johnsen A, Brandt Å. Subgroup effects of occupational therapy-based intervention for people with advanced cancer. Scand J Occup Ther 2018; 27:517-523. [PMID: 29571271 DOI: 10.1080/11038128.2018.1455897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Many people with advanced cancer have decreased ability to perform activities of daily living (ADL). We recently performed a randomized, controlled trial (RCT) assessing the efficacy of an occupational therapy-based program, the 'Cancer Home-Life Intervention' in people with advanced cancer (N = 242) and found no overall effects on ADL ability. However, heterogeneity of treatment effect may disguise subgroup differences.Objective: To investigate whether subgroups of people with advanced cancer gain positive effects from the 'Cancer Home-Life Intervention' on ADL ability.Material and method: An exploratory subgroup analysis including 191 participants from a RCT. The outcome was ADL motor ability measured by the Assessment of Motor and Process Skills (AMPS). Subgroups were defined by age, gender, years of education, type of primary tumor, functional level, and activity problems.Results: The 'Cancer Home-Life Intervention' had no statistically significant effect in the six subgroups. Modifying effects of age (0.30 [95% CI: -0.05 to 0.64]) and gender (0.23 [95% CI: -0.11 to 0.57]) were not found.Conclusion: There were no subgroup effects of the 'Cancer Home-Life Intervention'on ADL motor ability. Some indications suggest greater effects for those aged below 69 years; however, this result should be interpreted with caution.
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Affiliation(s)
- Marc Sampedro Pilegaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark.,Institute of Public Health, Aarhus University, Aarhus C, Denmark
| | - Karen la Cour
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Anna Thit Johnsen
- Department of Psychology, University of Southern Denmark, Odense M, Denmark.,Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - Åse Brandt
- Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense C, Denmark.,Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense C, Denmark
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18
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Presley CJ, Reynolds CH, Langer CJ. Caring for the Older Population With Advanced Lung Cancer. Am Soc Clin Oncol Educ Book 2017; 37:587-596. [PMID: 28561726 DOI: 10.1200/edbk_179850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The management of advanced lung cancer is changing rapidly, with new drug approvals occurring almost monthly. The average age of a newly diagnosed patient with advanced lung cancer remains around age 70. Caring for the older adult with advanced cancer differs from the care of younger adults. Chronologic age often does not accurately reflect the physiologic and functional status of older adults. Selecting treatment based on age alone results in undertreatment and overtreatment of many older adults. Addressing issues such as multiple chronic conditions, polypharmacy, geriatric syndromes, and heterogeneity in functional status among an expanding menu of treatment options for advanced disease is increasingly difficult, particularly among older adults historically underrepresented in clinical trials. In this article, we highlight key issues in caring for the older adult with advanced non-small cell lung cancer and the continued need for data supporting current and emerging treatment options. Key issues include the unique challenges of managing advanced lung cancer and a summary of the current treatment evidence as they apply to the elderly lung cancer population including supportive care strategies, risk stratification, and patient-reported outcomes.
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Affiliation(s)
- Carolyn J Presley
- From the VA Connecticut Cancer Center and Yale Cancer Center, West Haven and New Haven, CT; Florida Cancer Specialists and Research Institute, Ocala, FL; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Craig H Reynolds
- From the VA Connecticut Cancer Center and Yale Cancer Center, West Haven and New Haven, CT; Florida Cancer Specialists and Research Institute, Ocala, FL; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Corey J Langer
- From the VA Connecticut Cancer Center and Yale Cancer Center, West Haven and New Haven, CT; Florida Cancer Specialists and Research Institute, Ocala, FL; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
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Nipp RD, Fuchs G, El-Jawahri A, Mario J, Troschel FM, Greer JA, Gallagher ER, Jackson VA, Kambadakone A, Hong TS, Temel JS, Fintelmann FJ. Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer. Oncologist 2017; 23:97-104. [PMID: 28935775 PMCID: PMC5759817 DOI: 10.1634/theoncologist.2017-0255] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/22/2017] [Indexed: 12/25/2022] Open
Abstract
Cancer cachexia and sarcopenia can occur frequently in patients with advanced cancer, and may negatively affect treatment outcomes. This article highlights the importance of assessing sarcopenia and describes the relationship between sarcopenia and patients' quality of life in patients with newly diagnosed, incurable cancer. Background. Patients with advanced cancer often experience muscle wasting (sarcopenia), yet little is known about the characteristics associated with sarcopenia and the relationship between sarcopenia and patients’ quality of life (QOL) and mood. Materials and Methods. As part of a randomized trial, we assessed baseline QOL (Functional Assessment of Cancer Therapy‐General [FACT‐G]) and mood (Hospital Anxiety and Depression Scale [HADS]) in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer, and prior to randomization. Using computed tomography scans collected as part of routine clinical care, we assessed sarcopenia at the level of the third lumbar vertebra with validated sex‐specific cutoffs. We used logistic regression to explore characteristics associated with presence of sarcopenia. To examine associations between sarcopenia, QOL and mood, we used linear regression, adjusted for patients’ age, sex, marital status, education, and cancer type. Results. Of 237 participants (mean age = 64.41 ± 10.93 years), the majority were male (54.0%) and married (70.5%) and had lung cancer (56.5%). Over half had sarcopenia (55.3%). Older age (odds ratio [OR] = 1.05, p = .002) and education beyond high school (OR = 1.95, p = .047) were associated with greater likelihood of having sarcopenia, while female sex (OR = 0.25, p < .001) and higher body mass index (OR = 0.79, p < .001) correlated with lower likelihood of sarcopenia. Sarcopenia was associated with worse QOL (FACT‐G: B = −4.26, p = .048) and greater depression symptoms (HADS‐depression: B = −1.56, p = .005). Conclusion. Sarcopenia was highly prevalent among patients with newly diagnosed, incurable cancer. The associations of sarcopenia with worse QOL and depression symptoms highlight the need to address the issue of sarcopenia early in the course of illness. Implications for Practice. This study found that sarcopenia, assessed using computed tomography scans acquired as part of routine clinical care, is highly prevalent in patients with newly diagnosed, incurable cancer. Notably, patients with sarcopenia reported worse quality of life and greater depression symptoms than those without sarcopenia. These findings highlight the importance of addressing muscle loss early in the course of illness among patients with incurable cancer. In the future, investigators should expand upon these findings to develop strategies for assessing and treating sarcopenia while striving to enhance the quality of life and mood outcomes of patients with advanced cancer.
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Affiliation(s)
- Ryan D Nipp
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Georg Fuchs
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Mario
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Fabian M Troschel
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
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20
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Schmidt H, Boese S, Lampe K, Jordan K, Fiedler E, Müller-Werdan U, Wienke A, Vordermark D. Trans sectoral care of geriatric cancer patients based on comprehensive geriatric assessment and patient-reported quality of life - Results of a multicenter study to develop and pilot test a patient-centered interdisciplinary care concept for geriatric oncology patients (PIVOG). J Geriatr Oncol 2017; 8:262-270. [DOI: 10.1016/j.jgo.2017.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/08/2017] [Accepted: 04/20/2017] [Indexed: 01/02/2023]
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21
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Associations of sleep disturbance with physical function and cognition in older adults with cancer. Support Care Cancer 2017; 25:3161-3169. [PMID: 28455547 DOI: 10.1007/s00520-017-3724-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Although sleep disturbances are common in older adults, studies evaluating the prevalence of sleep disturbance and its influence on functional outcomes in older adults with cancer are few. In this study, we examined the prevalence of sleep disturbance and its association with physical function and cognition in older adults with cancer. METHODS This is a cross-sectional study of patients who were referred and evaluated in the Specialized Oncology Care & Research in the Elderly (SOCARE) clinics at the Universities of Rochester and Chicago from May 2011 to October 2015. All patients underwent a geriatric assessment (GA) as part of their routine evaluation. Our final study cohort included patients who completed a sleep assessment and consented to the study. We collected demographics (age, sex, race, marital status, and education level) and clinical characteristics (depression, comorbidity, cancer type, and stage) from the GA and medical chart reviews. Presence of sleep disturbance was self-reported (yes/no). Physical function was assessed using Instrumental Activities of Daily Living (IADLs), physical activity (PA) survey, falls in the preceding 6 months, and Short Physical Performance Battery (SPPB). Cognition was screened using the Blessed Orientation-Memory-Concentration Test (impairment >4) or Montreal Cognitive Assessment (impairment <26). Bivariate and multivariable analyses were used to examine the associations between sleep disturbance with functional outcomes and cognition. RESULTS We included 389 older patients. The prevalence of sleep disturbance was 40%. Sixty-eight percent had ≥1 IADL impairment, 76% had PA limitation, 37% had ≥1 fall, 70% had impairment on SPPB, and 47% screened positive for cognitive impairment. On bivariate analyses, sleep disturbance was associated with IADL impairment (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.23-3.13, P = 0.005), and PA limitation (OR 2.43, 95% CI 1.38-4.28, P = 0.002). The associations remained significant on multivariable analyses. Sleep disturbance was not significantly associated with falls, impairment on SPPB, and performance on the cognitive screen. CONCLUSION Sleep disturbance was associated with IADL impairment and PA limitation. It is important for oncologists to inquire about sleep problems, and these patients should also be screened for functional impairment if sleep disturbance was present.
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22
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Steer CB. Supportive care in older adults with cancer – An update of research in 2015. J Geriatr Oncol 2016; 7:397-403. [DOI: 10.1016/j.jgo.2016.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/20/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022]
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23
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Sattar S, Alibhai SMH, Spoelstra SL, Fazelzad R, Puts MTE. Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2016; 24:4459-69. [PMID: 27450557 DOI: 10.1007/s00520-016-3342-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review was to update and expand the existing systematic review with the aim to answer the following questions: (1) How often do older adults (OA)s with cancer fall? (2) What are the predictors of falls in OA with cancer? (3) What is the rate of injurious falls and predictors of injurious falls in OA with cancer? (4) What are the circumstances and outcomes of falls in this population? (5) How do falls in cancer patients affect subsequent cancer treatment? METHODS Medline, Pubmed, Embase, and CINAHL were searched. Eligible studies included clinical trials, cross-sectional, cohort, case-control, and qualitative studies in which the entire sample or a sub-group of the sample were OA aged 60 and above, had cancer, in which falls were examined as a primary or secondary outcome and published in English. RESULTS Twenty-seven studies met our inclusion criteria with most involving the outpatient setting. Fall rates and injurious fall rates varied widely. Consistent predictors of falls were prior falls among outpatients and cognitive impairment among inpatients. There were no data on impact of falls on cancer treatment. Data on circumstances of falls were limited. CONCLUSION Falls and fall-related injuries are common in older cancer patients. However, little is known about circumstances of falls and impact of falls on cancer treatment. Many known fall predictors in community-dwelling OA have not been explored in oncology. More research is needed to address gaps in these areas.
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Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite, Toronto, ON, 130M5T 1P8, Canada.
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, 200 Elizabeth Street, Toronto, M5G 2C4, Canada
| | - Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan Street, NE, Michigan, MI, 49502, USA
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, 5-407, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite, Toronto, ON, 130M5T 1P8, Canada
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