1
|
Skiba MB, El-Gohary M, Horak F, Dieckmann NF, Guidarelli C, Meyers G, Hayes-Lattin B, Winters-Stone K. Assessment of Mobility Trajectories Using Wearable Inertial Sensors During Autologous Hematopoietic Cell Transplant. Arch Phys Med Rehabil 2024; 105:1106-1115. [PMID: 38354878 PMCID: PMC11144568 DOI: 10.1016/j.apmr.2024.01.019] [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: 06/22/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study aimed to characterize mobility patterns using wearable inertial sensors and serial assessment across autologous hematopoietic cell transplant (autoHCT) and investigate the relation between mobility and perceived function in patients with hematologic cancer. DESIGN Prospective longitudinal study. SETTING Hospital adult transplant clinic followed by discharge. PARTICIPANTS 78 patients with hematological cancer receiving autoHCT. MAIN OUTCOME MEASURES Mobility was measured across 3 clinical phases (pretransplant, pre-engraftment, and post-engraftment) in using inertial sensors worn during prescribed performance tests in the hospital. Perceived function was assessed using validated provider-reported (Eastern Cooperative Oncology Group [ECOG] Performance Status Scale) and patient-reported [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) measures. Trajectories of 5 selected mobility characteristics (turn duration, gait speed, stride time variability, double support time, and heel strike angle) across the clinical phases were also evaluated using piecewise linear mixed-effects models. RESULTS Using Principal Components Analysis, 4 mobility patterns were identified pretransplant: Gait Limitation, Sagittal Sway, Coronal Sway, and Balance Control. Gait Limitation measured pretransplant was significantly inversely associated with perceived function reported by the provider- (β = -0.11; 95% CI: -0.19, -0.02) and patient- (β = -4.85; 95% CI: -7.72, -1.99) post-engraftment in age-adjusted linear regression models. Mobility characteristics demonstrated immediate declines early pre-engraftment with stabilization by late pre-engraftment. CONCLUSION Patients with hematological cancer experiencing gait limitations pretransplant are likely to have worse perceived function post-engraftment. Mobility declines in early phases post-transplant and may not fully recover, indicating an opportunity for timely rehabilitation referrals. Wearable inertial sensors can be used to identify early mobility problems and patients who may be at risk for future functional decline who may be candidates for early physical rehabilitation.
Collapse
Affiliation(s)
- Meghan B Skiba
- Advanced Nursing Practice and Science Division, College of Nursing, University of Arizona, Tucson, AZ; University of Arizona Cancer Center, Tucson, AZ; Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR
| | | | - Fay Horak
- APDM, a Clario Inc Company, Portland, OR; Department of Neurology, School of Medicine, Oregon Health & Science University, Portland OR
| | | | - Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR
| | - Gabrielle Meyers
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR.
| |
Collapse
|
2
|
Leite VF, Oza S, Parke SC, Barksdale T, Herbert A, Bansal V, Fu JB, Ngo-Huang A. Assessment of rehabilitation practices during hematopoietic stem cell transplantation in the United States: a survey. REHABILITATION ONCOLOGY 2024; 42:91-99. [PMID: 38912164 PMCID: PMC11192508 DOI: 10.1097/01.reo.0000000000000363] [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] [Indexed: 06/25/2024]
Abstract
Background Rehabilitation therapy is important to treat physical and functional impairments that may occur in individuals receiving physically taxing, yet potentially curative hematopoietic stem cell transplants (HSCT). However, there is scarce data on how rehabilitation is delivered during HSCT in real-life setting. Our objective is to assess the rehabilitation practices for adult patients hospitalized for HSCT in the United States. Methods A 48-question online survey with cancer centers with the top 10% HSCT volumes (per American registries). We obtained data on patient characteristics, rehabilitation therapy details (timing, indication, administering providers), physical function objective and subjective outcome measures, and therapy activity precautions. Results Fourteen (out of 21) institutions were included. Rehabilitation therapy referrals occurred at admission for all patients at 35.7% of the centers for: functional decline (92.9%), fall risk (71.4%), and discharge planning (71.4%). Participating institutions had physical therapists (92.9%), occupational therapists (85.7%), speech language pathologists (64.3%) and therapy aides (35.7%) in their rehabilitation team. Approximately 71% of centers used objective functional measures including sit-to-stand tests (50.0%), balance measures (42.9%), and six-minute walk/gait speed (both 35.7%). Monitoring of blood counts to determine therapy modalities frequently occurred and therapies held for low platelet or hemoglobin values; but absolute neutrophil values were not a barrier to participate in resistance or aerobic therapies (42.9%). Discussion Rehabilitation practices during HSCT varied among the largest volume cancer centers in the United States, but most centers provided skilled therapy, utilized objective, clinician and patient reported outcomes, and monitored blood counts for safety of therapy administration.
Collapse
Affiliation(s)
- Victor F Leite
- Department of Rehabilitation, Hospital Israelita Albert Einstein, São Paulo, Brazil; and A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Sonal Oza
- Department of Physical Medicine and Rehabilitation; Emory University, Atlanta, Georgia, United States
| | - Sara C Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, United States
| | - Touré Barksdale
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, United States
| | - Aliea Herbert
- Department of Physical Medicine and Rehabilitation, Swedish Cancer Institute, Seattle, Washington, United States
| | - Vishal Bansal
- Department of Physical Medicine and Rehabilitation, UT Health Houston McGovern Medical School, Houston, Texas, United States
| | - Jack B Fu
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, United States
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, United States
| |
Collapse
|
3
|
Fu JB, Morishita S. Inpatient Rehabilitation of Hematopoietic Stem Cell Transplant Patients: Managing Challenging Impairments and Medical Fragility. Am J Phys Med Rehabil 2024; 103:S46-S51. [PMID: 38364030 PMCID: PMC10878715 DOI: 10.1097/phm.0000000000002408] [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] [Indexed: 02/18/2024]
Abstract
ABSTRACT Hematopoietic stem cell transplants play an important role in the treatment of cancer, particularly hematologic malignancies. These patients can encounter functional impairments unique to hematopoietic stem cell transplant, including deconditioning, cancer-related fatigue, steroid myopathy, graft versus host disease, and capillary leak syndrome. Medical fragility and increased risk of infection may make rehabilitation challenging on the acute care and postacute care settings. Patients admitted to acute inpatient rehabilitation experience a high rate of transfer to the primary acute service and high rate of mortality after transfer back. Physical medicine and rehabilitation physicians can use a number of strategies to mitigate these patients' risk of medical complications including evidence-based predictive models to assist with postacute rehabilitation triage, physiatry-led consult-based rehabilitation, and oncology hospitalist comanagement on inpatient rehabilitation.
Collapse
Affiliation(s)
- Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, Section of Physical Medicine & Rehabilitation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | |
Collapse
|
4
|
Takekiyo T, Morishita S. Effect of rehabilitation in patients undergoing hematopoietic stem cell transplantation. Fukushima J Med Sci 2023; 69:73-83. [PMID: 37164764 PMCID: PMC10480509 DOI: 10.5387/fms.2022-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/22/2023] [Indexed: 05/12/2023] Open
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) tend to experience decline in physical function, mental function, and quality of life (QOL) after HSCT due to low activity caused by adverse reactions to chemotherapy used in pre-transplantation treatment and post-transplant complications. Rehabilitation for HSCT patients is effective in preventing decline in physical function, reducing fatigue, and improving QOL. A combination of aerobic exercise and strength training is recommended for exercise therapy. Risk management is also important in the implementation of exercise therapy, and the exercise intensity should be determined according to the presence of anemia, low platelet counts, or post-transplant complications. On the other hand, post-transplant complications can decrease the patient's motivation and daily activity level. A multidisciplinary approach, which includes physicians and nurses, is important to achieve early discharge from the hospital and as quick a return to society as possible.
Collapse
Affiliation(s)
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Science, Fukushima Medical University
| |
Collapse
|
5
|
Purdy GM, Nanad R, Ternes L, Dolgoy ND, Sellar CM, Francis G, Crisp N, Pituskin E, de Guzman Wilding M, Perry S, Sandhu I, Venner CP, McNeely ML. Exercise Preferences, Barriers, and Facilitators of Individuals With Cancer Undergoing Chemotherapy Before Stem Cell Transplantation: A Mixed-Methods Study. Cancer Nurs 2023:00002820-990000000-00135. [PMID: 37058603 DOI: 10.1097/ncc.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Exercise can help mitigate side effects of hematopoietic stem cell transplantation (HSCT), particularly when initiated before HSCT. However, the exercise-related barriers, facilitators, and preferences of this population remain unclear. OBJECTIVE This study aimed to explore the patient experience to inform future implementation of a prehabilitation intervention. INTERVENTIONS/METHODS A 2-phase sequential explanatory mixed-methods study was conducted using (1) cross-sectional survey and (2) focus groups. Survey questions aligned with the Theoretical Domains Framework. Focus group data were analyzed using a directed content analysis approach, followed by inductive thematic analysis to generate themes that represented the exercise-related barriers, facilitators, and preferences of participants. RESULTS Twenty-six participants completed phase 1 (n = 22 with multiple myeloma). Fifty percent of participants (n = 13) were fairly/very confident in their ability to exercise pre-HSCT. Eleven participants completed phase 2. Exercise barriers included knowledge/skill limitations, inadequate healthcare provider support, and the emotional toll of treatment. Facilitators included social support and goals. Exercise preferences were related to 2 themes: (1) program structure (subthemes: prescription and scheduling, mode of delivery) and (2) support (subthemes: support from personnel, tailoring, and education). CONCLUSION Key exercise-related barriers included knowledge limitations, disease/treatment effects, and inadequate support. Prehabilitation should be tailored, flexible, and include education and a virtual or hybrid delivery model in this population. IMPLICATIONS FOR PRACTICE Nurses are well positioned to identify functional limitations and counsel and refer patients to exercise programming and/or physiotherapy services. Including an exercise professional in the pretransplant care team would provide key supportive care assistance for the nursing team.
Collapse
Affiliation(s)
- Graeme M Purdy
- Author Affiliations: Department of Physical Therapy, Faculty of Rehabilitation Medicine (Mr Purdy, Mrs Nanad, Mrs Ternes, and Drs Dolgoy, Sellar, and McNeely), and Faculty of Nursing (Dr Pituskin), University of Alberta, Edmonton, Alberta; Cumming School of Medicine, University of Calgary, Calgary, Alberta (Drs Francis and Perry); Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta (Mrs Crisp); Department of Oncology, Cross Cancer Institute, Edmonton, Alberta (Drs Pituskin, Sandhu, and Venner); Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada (Mrs de Guzman Wilding and Drs Perry and McNeely)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
The immediate impact of physical function and quality of life after hematopoietic stem cell transplantation. Support Care Cancer 2022; 30:7439-7446. [PMID: 35622147 DOI: 10.1007/s00520-022-07161-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Although hematopoietic stem cell transplantation (HSCT) is a curative treatment for hematologic malignancies, HSCT survivors often experience declined physical function and quality of life (QoL). However, the physical function and QoL changes in acute post-transplant patients remain unclear. This study aimed to investigate the impact of HSCT on physical function. METHOD This retrospective control study included 107 HSCT patients. Physical function was evaluated weekly from admission to discharge using the de Morton Mobility Index (DEMMI). Impaired physical function was defined as a baseline raw ordinal DEMMI score of < 17 and a decrease of ≥ 2 points. We collected the Visual Analog Scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Zung Self-rating Depression Scale (SDS) at enrollment and discharge. RESULTS Based on the DEMMI scores, 41 patients (38.3%) showed impaired physical function. A notable decrease in the DEMMI score was found in the first week after HSCT. In the EORTC QLQ-C30, physical function differed between the groups at admission and discharge. The good physical function group showed better cognitive function and social function. For the SDS, the impaired physical function group showed significantly higher depression at discharge. CONCLUSION A third of the patients showed physical impairment during the acute transplant period. Patients with low physical function suffered more from depression and lower QoL. Evaluating patients' pre-transplant physical function and early detection is needed as impaired physical function mainly occurs at 1 week post-transplant.
Collapse
|
7
|
Murao M, Hamada R, Kondo T, Miyasaka J, Yoshida M, Yonezawa H, Arai Y, Kanda J, Nankaku M, Ikeguchi R, Takaori-Kondo A, Matsuda S. Analysis of factors associated with patient-reported physical functioning scores at discharge of allogeneic hematopoietic stem cell transplantation patients: a cross-sectional study. Support Care Cancer 2021; 29:7569-7576. [PMID: 34120260 DOI: 10.1007/s00520-021-06323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to clarify the independent factors related to patient-reported physical functioning (PF) scores at discharge of patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS A total of 103 patients who underwent allo-HSCT were included in this cross-sectional study. As a screening method, a single regression analysis was conducted with the PF domain in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at discharge as the dependent variable, and body mass index, adverse events related to HSCT, and objective physical functions as independent variables. Multiple regression analysis was performed with PF as the dependent variable and variables that passed the screening by single regression analysis and confounders as independent variables. RESULTS The mean PF score at discharge of the patients was 76.5 (standard deviation: 15.2). Based on the results of screening by the single regression analysis, length of stay, infections (+ / -), acute graft-versus-host disease grade, brief fatigue inventory score (BFI), knee extensor strength, and 6-min walk distance (6MWD) were included in the multiple regression analysis. BFI (B = - 11.94, p < 0.001) and 6MWD (per 10 m) (B = 0.56, p = 0.001) were extracted as significant independent variables governing the PF at discharge in the multiple regression model (adjusted R2 = 0.59). CONCLUSION Higher exercise tolerance and lower fatigue in patients who underwent allo-HSCT were associated independently with patient-reported better PF scores at discharge.
Collapse
Affiliation(s)
- Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Junsuke Miyasaka
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Michiko Yoshida
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Honami Yonezawa
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.,Department of Clinical Laboratory Medicine and Center for Research and Application of Cellular Therapy, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
8
|
Wildes TM, Artz AS. Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies. Am Soc Clin Oncol Educ Book 2021; 41:1-9. [PMID: 33979197 DOI: 10.1200/edbk_320141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With the aging of the population, the number of older adults with hematologic malignancies is growing, and treatment paradigms for these patients are rapidly evolving. Use of allogeneic stem cell transplant has been expanding to include septuagenarians but remains a potentially morbid procedure, creating an opportunity for a geriatric-focused evaluation to improve assessment of the individual's risk in undergoing the procedure. Although age alone should not be the sole determinant for transplant eligibility, geriatric assessment often identifies vulnerabilities that are not captured in assessing performance status and comorbidities alone. Those vulnerabilities may be optimized in an approach employing three sequential steps: characterize resiliency, bolster resilience, and harmonize with patient goals. Data are emerging that show that this approach is associated with lower nonrelapse mortality, shorter length of stay, and better survival after transplant. In older adults with myeloma, treatment recommendations also aim to balance the expected efficacy and toxicity profile and incorporate the patient's goals and preferences. Assessment of frailty allows for more personalized estimates of risk of toxicity. Currently, the European Myeloma Network currently recommends using the International Myeloma Working Group frailty scale as a standard approach to defining frail or at-risk populations with myeloma. In addition to treatment selection, the care of older adults with myeloma must include consideration of other issues, including reducing early mortality with antibiotic prophylaxis, polypharmacy, depression, cognition, and falls. Overall, appreciation of the aging-associated vulnerabilities will allow for the ultimate personalized care and treatment of older adults with hematologic malignancies.
Collapse
Affiliation(s)
| | - Andrew S Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| |
Collapse
|
9
|
Functional capacity, pulmonary function, and quality of life in hematopoietic stem cell transplantation survivors. Support Care Cancer 2021; 29:4015-4021. [PMID: 33394196 DOI: 10.1007/s00520-020-05947-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Hematopoietic stem cell transplantation (HSCT) is used as a treatment for several diseases. The objective was to evaluate the functional capacity, pulmonary function, and quality of life (QoL) in HSCT survivors. METHODS The patients were submitted to spirometry and six-minute walk test (6MWT) and evaluation of QoL (Functional Assessment of Cancer Therapy Bone Marrow Transplantation-FACT-BMT) and the level of physical activity (Human Activity Profile-HAP) in the post-HSCT outpatient ambulatory. RESULTS The sample was composed of 103 individuals with a mean age of 42.1 ± 12 and a median HSCT time of 5 (2-11) years. The average distance walked in the 6MWT was 524.7 ± 73.5 m; the FACT-BMT score, 82 ± 8.7 points; FEV1, 76.8 ± 22.6%; and HAP, 71.9 ± 11.2 points. There was a significant difference between debilitated and physically active individuals for the variables: forced expiratory volume in the first second (FEV1) in liters (p = 0.008) and % of predicted (p = 0.017), FEV1/FVC (p = 0.032), distance on the 6MWT (p < 0.001), fatigue after the 6MWT (p < 0.001), and physical well-being (p = 0.005). CONCLUSIONS HSCT survivors have long-term changes in functional capacity, pulmonary function, and QoL. Subjects more active had better results in pulmonary function and functional capacity.
Collapse
|
10
|
Functional capacity, lung function, and muscle strength in patients undergoing hematopoietic stem cell transplantation: A prospective cohort study. Hematol Oncol Stem Cell Ther 2020; 14:126-133. [PMID: 32997971 DOI: 10.1016/j.hemonc.2020.08.004] [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: 09/08/2019] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE/BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a treatment for benign and malignant hematological diseases. These aggressive treatments cause reduced levels of physical activity, decreased lung function, and worse quality of life. Alterations in pulmonary function tests before HSCT are associated with the risk of respiratory failure and early mortality. The objective of this study was to evaluate functional capacity and lung function before and after HSCT and identify the predictors of mortality after 2 years. METHODS A prospective cohort study was carried out with individuals with oncohematological diseases. The evaluations were carried out in two moments during hospitalization and at hospital discharge. Follow-up was carried out after 48 months. Assessments were carried out on 34 adults, using spirometry, manovacuometry, 6-Minute Walk Test (6MWT), Handgrip Strength Test, and 30-Second Chair Stand Test (30-s CST). RESULTS There was a statistically significant reduction for the variables in forced vital capacity, forced expiratory volume predicted in the 1st second, Tiffeneau index, handgrip strength, and distance covered (% predicted) on the 6MWT (p < .05). There was a significant difference in the 30-s CST when individuals were compared according to the type of transplant. We found that a 10% reduction in the values of maximum inspiratory pressure (MIP) can predict an increased risk for mortality. CONCLUSIONS Individuals undergoing HSCT have reduced functional capacity, lung function, and muscle strength during the hospitalization phase. Reduction in the values of MIP increases the risk of nonrelapse mortality.
Collapse
|
11
|
Exercise before, during, and after Hospitalization for Allogeneic Hematological Stem Cell Transplant: A Feasibility Randomized Controlled Trial. J Clin Med 2020; 9:jcm9061854. [PMID: 32545872 PMCID: PMC7355733 DOI: 10.3390/jcm9061854] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/26/2020] [Accepted: 06/10/2020] [Indexed: 01/14/2023] Open
Abstract
People with cancer who undergo allogeneic hematological stem cell transplant (allo-HSCT) experience significant deconditioning that can compromise quality of life. Exercise has shown to be beneficial before or after allo-HSCT; however, little is known about exercise therapy delivered across the continuum of care. We conducted a feasibility randomized controlled trial of exercise delivered prior to admission, during the inpatient stay, and after discharge versus control in people with planned allo-HSCT. Feasibility was assessed via recruitment and retention rates, the incidence of adverse events, and adherence to the exercise prescription. Estimates of efficacy were measured at baseline, one week prior to hospital admission, and 100 days and one year after transplant. The recruitment and retention rates were 20% and 33%, respectively. One serious adverse event occurred during the baseline six-minute walk test that precluded participation in the study and no adverse events were associated with the intervention. From baseline to pre-transplant, the intervention group improved six-minute walk test distances by 45 m (95% CI: −18.0 to 108.7)—a finding that warrants further investigation with an adequately powered trial. Our study contributes important feasibility considerations and pilot data for future exercise intervention research in allo-HSCT recipients.
Collapse
|
12
|
Effects of partly supervised and home-based exercise program in patients undergoing hematopoietic stem cell transplantation: a case-control study. Support Care Cancer 2020; 28:5851-5860. [DOI: 10.1007/s00520-020-05432-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
|
13
|
Morishita S, Tsubaki A, Hotta K, Fu JB, Fuji S. The benefit of exercise in patients who undergo allogeneic hematopoietic stem cell transplantation. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2019; 2:54-61. [PMID: 31131374 DOI: 10.4103/jisprm.jisprm_2_19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is increasingly used in the treatment of hematologic cancers such as leukemias, lymphomas, and myeloma, and for other hematologic disorders such as primary immunodeficiency, aplastic anemia, and myelodysplasia. Allo-HSCT entails a conditioning regimen of frequent high-dose chemotherapy in combination with total body irradiation, followed by infusion of donor-harvested bone marrow or peripheral blood stem cells. As an aggressive and demanding medical therapy that profoundly impacts patient quality of life (QOL), allo-HSCT is associated with numerous treatment-related physical, psychological, and psychosocial side effects. The procedure can result in decreased respiratory and balance function, skeletal muscle strength, and exercise capacity. Thus, as physical exercise has been shown to positively effect physical and psychosocial function and QOL in allo-HSCT patients, it is a recommended intervention for improving essential functions and offsetting lost exercise capacity after the procedure. Furthermore, recent evidence has shown that physical exercise can influence survival rate and mortality in allo-HSCT patients. This review provides an overview of the current research on the effectiveness of physical exercise for allo-HSCT patients.
Collapse
Affiliation(s)
- Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Tel: +81-25-257-4300
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Tel: +81-25-257-4300
| | - Kazuki Hotta
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Tel: +81-25-257-4300
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA, Tel: +1-713-745- 2327
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan, Tel: +81-6-6945-1900
| |
Collapse
|
14
|
Boşnak Güçlü M, Barğı G, Sucak GT. Impairments in dyspnea, exercise capacity, physical activity and quality of life of allogeneic hematopoietic stem cell transplantation survivors compared with healthy individuals: a cross sectional study. Physiother Theory Pract 2019; 37:52-63. [PMID: 30958713 DOI: 10.1080/09593985.2019.1594473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: A limited number of studies have reported impairments in physical activity, exercise capacity and quality of life (QOL) in allogeneic hematopoietic stem cell transplantation (allogeneic-HSCT) recipients. We aimed to compare dyspnea, exercise capacity, physical activity and QOL in allogeneic-HSCT recipients with age-gender matched healthy individuals, since this has not been investigated hitherto. Methods: A total of 80 allogeneic-HSCT recipients (>100 days status post-transplantation) (38.88 ± 13.25 years) and 60 healthy individuals (35.92 ± 10.83 years) were compared. Exercise capacity [6-minute walk test (6-MWT)], physical activity level (total and active energy expenditure, moderate and severe physical activity duration, number of steps, average metabolic equivalent, lying down and sleeping duration) [metabolic holter], QOL [European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTCQOL)], dyspnea [Modified Medical Research Council Dyspnea scale] and pulmonary functions [spirometry] were evaluated. Clinical trials #NCT03606005. Results: Six-MWT distance, energy expenditure, physical activity duration, number of steps, average metabolic equivalent, global health status, functional and social function subscales of EORTCQOL were significantly lower in recipients compared with controls; dyspnea score, lying down, sleep durations, symptom and fatigue subscales of EORTCQOL were significantly higher in recipients compared with controls (p < 0.05). Conclusion: Dyspnea during daily living activities, exercise capacity, physical activity level and QOL are considerably impaired in allogeneic-HSCT recipients during post-engraftment period. To improve impaired outcomes, allogeneic-HSCT recipients should be oriented to cardiopulmonary rehabilitation programs.
Collapse
Affiliation(s)
- Meral Boşnak Güçlü
- Department of Physiotherapy and Rehabilitation, Gazi University , Ankara, Turkey
| | - Gülşah Barğı
- Department of Physiotherapy and Rehabilitation, Gazi University , Ankara, Turkey
| | - Gülsan Türköz Sucak
- Department of Hematology, Bone Marrow Transplantation Unit, Hospital of Bahçelievler Medical Park , Istanbul, Turkey
| |
Collapse
|