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Wang A, Gonzaga K. Assistive Devices for Addressing Mobility Impairments Linked to Cancer and Cancer Treatment: An Expert Perspective. Semin Oncol Nurs 2024; 40:151683. [PMID: 38965022 DOI: 10.1016/j.soncn.2024.151683] [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: 03/01/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Cancer survivors often experience mobility impairments that negatively impact their ability to engage in everyday activities. Healthcare providers working with patients in the continuum of cancer care play essential roles in identifying and addressing mobility impairments. The objective of this article is to present common assistive devices valuable in managing cancer and cancer treatment-related mobility impairments. METHODS Peer-reviewed scientific publications and expert opinions. RESULTS This article highlights assistive devices commonly used in various settings of cancer care and describes how they address different impairments faced by cancer survivors. The information presented can potentially serve as a resource when training clinical staff (eg, oncology nursing staff) on device provision across all settings. The information can also be useful for patients and caregivers to learn about potential functional impairments linked to cancer and treatments and assistive devices that can be useful to improve patients' functional capacity and reduce caregiver burden. CONCLUSION It is essential to involve different team members to identify and select the most appropriate assistive devices that match the patient's functional needs and physical capacity and to train them in device use so they can safely carry out their daily routine. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are one of the first providers to identify mobility impairments in cancer patients. This article will help increase their knowledge in common assistive devices valuable for addressing various mobility impairments associated with cancer and treatments. With additional training on device provision, oncology nurses will be more empowered to collaborate with rehabilitation to identify potential mobility impairments, initiate device provision, and encourage their patients to work with therapy services. Ultimately this could reduce injuries linked to mobility impairments and improve the patient's functional independence and overall quality of life.
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Affiliation(s)
- Allison Wang
- Staff Physical Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York.
| | - Kimberley Gonzaga
- Senior Occupational Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York
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Lin WC, Weng CS, Ko AT, Jan YT, Lin JB, Wu KP, Lee J. Interpretable machine learning model based on clinical factors for predicting muscle radiodensity loss after treatment in ovarian cancer. Support Care Cancer 2024; 32:544. [PMID: 39046568 DOI: 10.1007/s00520-024-08757-z] [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: 01/25/2024] [Accepted: 07/21/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Muscle radiodensity loss after surgery and adjuvant chemotherapy is associated with poor outcomes in ovarian cancer. Assessing muscle radiodensity is a real-world clinical challenge owing to the requirement for computed tomography (CT) with consistent protocols and labor-intensive processes. This study aimed to use interpretable machine learning (ML) to predict muscle radiodensity loss. METHODS This study included 723 patients with ovarian cancer who underwent primary debulking surgery and platinum-based chemotherapy between 2010 and 2019 at two tertiary centers (579 in cohort 1 and 144 in cohort 2). Muscle radiodensity was assessed from pre- and post-treatment CT acquired with consistent protocols, and a decrease in radiodensity ≥ 5% was defined as loss. Six ML models were trained, and their performances were evaluated using the area under the curve (AUC) and F1-score. The SHapley Additive exPlanations (SHAP) method was applied to interpret the ML models. RESULTS The CatBoost model achieved the highest AUC of 0.871 (95% confidence interval, 0.870-0.874) and F1-score of 0.688 (95% confidence interval, 0.685-0.691) among the models in the training set and outperformed in the external validation set, with an AUC of 0.839 and F1-score of 0.673. Albumin change, ascites, and residual disease were the most important features associated with a higher likelihood of muscle radiodensity loss. The SHAP force plot provided an individualized interpretation of model predictions. CONCLUSION An interpretable ML model can assist clinicians in identifying ovarian cancer patients at risk of muscle radiodensity loss after treatment and understanding the contributors of muscle radiodensity loss.
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Affiliation(s)
- Wan-Chun Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St., Beitou District, Taipei, 112304, Taiwan
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Ai-Tung Ko
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St., Beitou District, Taipei, 112304, Taiwan
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Kun-Pin Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St., Beitou District, Taipei, 112304, Taiwan.
| | - Jie Lee
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
- Department of Radiation Oncology, MacKay Memorial Hospital, 92, Section 2, Chung Shan North Road, Taipei, 104217, Taiwan.
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Soria Rivas A, Escobar Álvarez Y, Blasco Cordellat A, Majem Tarruella M, Molina Mata K, Motilla de la Cámara M, Del Mar Muñoz Sánchez M, Zafra Poves M, Beato Zambrano C, Cabezón Gutierrez L. SEOM clinical guidelines for cancer anorexia-cachexia syndrome (2023). Clin Transl Oncol 2024:10.1007/s12094-024-03502-8. [PMID: 38822976 DOI: 10.1007/s12094-024-03502-8] [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: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 06/03/2024]
Abstract
Cancer-related anorexia-cachexia syndrome (CACS) is a debilitating condition afflicting up to 80% of advanced-stage cancer patients. Characterized by progressive weight loss, muscle wasting, and metabolic abnormalities, CACS significantly compromises patients' quality of life and treatment outcomes. This comprehensive review navigates through its intricate physiopathology, elucidating its stages and diagnostic methodologies. CACS manifests in three distinct stages: pre-cachexia, established cachexia, and refractory cachexia. Early detection is pivotal for effective intervention and is facilitated by screening tools, complemented by nutritional assessments and professional evaluations. The diagnostic process unravels the complex interplay of metabolic dysregulation and tumor-induced factors contributing to CACS. Management strategies, tailored to individual patient profiles, encompass a spectrum of nutritional interventions. These include dietary counseling, oral nutritional supplements, and, when necessary, enteral nutrition and a judicious use of parenteral nutrition. Specific recommendations for caloric intake, protein requirements, and essential nutrients address the unique challenges posed by CACS. While pharmacological agents like megestrol acetate may be considered, their use requires careful evaluation of potential risks. At its core, this review underscores the imperative for a holistic and personalized approach to managing CACS, integrating nutritional interventions and pharmacological strategies based on a nuanced understanding of patient's condition.
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Affiliation(s)
- Ainara Soria Rivas
- Medical Oncology Department, Hospital Univ. Ramón y Cajal, Madrid, Spain.
| | | | - Ana Blasco Cordellat
- Medical Oncology Department, Consorcio Hospital General Univ. de Valencia, Valencia, Spain
| | | | - Kevin Molina Mata
- Medical Oncology Department, Hospital Duran I Reynals, Institut Català D'Oncologia L'Hospitalet (ICO), Barcelona, Spain
| | | | | | - Marta Zafra Poves
- Medical Oncology Department, Hospital Univ. Morales Meseguer, Murcia, Spain
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Legido-Gómez Ó, Rico-Marco S, Lorenzo-Sánchez MV, Navarro-Jiménez S, Tárraga-Honrubia MA, Martínez-Ruiz J, Giménez-Bachs JM, Donate-Moreno MJ, Díaz de Mera-Sánchez-Migallón I, Segura-Martín M, Alcantud-Córcoles R, Abizanda-Soler P, Salinas-Sánchez AS. Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study. Actas Urol Esp 2024; 48:304-310. [PMID: 38373481 DOI: 10.1016/j.acuroe.2024.02.012] [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: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.
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Affiliation(s)
- Ó Legido-Gómez
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain.
| | - S Rico-Marco
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | - M V Lorenzo-Sánchez
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | - S Navarro-Jiménez
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | - M A Tárraga-Honrubia
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | - J Martínez-Ruiz
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | - J M Giménez-Bachs
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | - M J Donate-Moreno
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | | | - M Segura-Martín
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
| | - R Alcantud-Córcoles
- Servicio de Geriatría, Hospital Universitario Nuestra Señora del Perpetuo Socorro, Albacete, Spain
| | - P Abizanda-Soler
- Servicio de Geriatría, Hospital Universitario Nuestra Señora del Perpetuo Socorro, Albacete, Spain
| | - A S Salinas-Sánchez
- Servicio de Urología, Hospital General Universitario de Albacete, Albacete, Spain
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Stelmach-Mardas M, Warchoł W, Garczyk A, Warchoł E, Korczak J, Litwiniuk M, Brajer-Luftmann B, Mardas M. Influence of Androgen Deprivation Therapy on the Development of Sarcopenia in Patients with Prostate Cancer: A Systematic Review. Nutrients 2024; 16:656. [PMID: 38474784 PMCID: PMC10934555 DOI: 10.3390/nu16050656] [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: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
The changes in body composition during androgen deprivation therapy (ADT) in patients suffering from prostate cancer (PCa) are recognized by professionals more often as biomarker for effective treatment. The aim of this study was to investigate the impact of ADT on the sarcopenia development in PCa. The following databases were used: PubMed, Embase, Web of Science and Scopus databases. Out of 2183 studies, 7 were included in this review. The fixed-effect model was used in the meta-analysis. A significant increase in SATI (Subcutaneous Adipose Tissue Index) of 0.32 (95% CI: 0.13-0.51) p = 0.001, decrease in SMI (Skeletal Muscle Index) of -0.38 (95% CI: -0.57 to -0.19) p < 0.0001, and SMD (Skeletal Muscle Density) of -0.46 (95% CI: -0.69 to -0.24) p < 0.0001 were observed. No statistical association was visible between ADT and changes in BMI (Body Mass Index), 0.05 (95% CI: -0.18-0.28), p = 0.686, and VATI (Visceral Adipose Tissue Index): 0.17 (95% CI: -0.02 to 0.37), p = 0.074. In conclusion, the ADT significantly contributes to the body composition changes and sarcopenia development.
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Affiliation(s)
- Marta Stelmach-Mardas
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (A.G.); (E.W.)
| | - Wojciech Warchoł
- Department of Ophthalmology and Optometry, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Aleksandra Garczyk
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (A.G.); (E.W.)
| | - Emilia Warchoł
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (A.G.); (E.W.)
| | - Jolanta Korczak
- Department of Chemotherapy, The Greater Poland Cancer Center, 61-866 Poznan, Poland;
| | - Maria Litwiniuk
- Department of Cancer Pathology and Prevention, Poznan University of Medical Sciences, 61-866 Poznan, Poland;
| | - Beata Brajer-Luftmann
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland;
| | - Marcin Mardas
- Department of Gynecological Oncology, Institute of Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland;
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Kovač MB, Pavlin T, Čavka L, Ribnikar D, Spazzapan S, Templeton AJ, Šeruga B. The trajectory of sarcopenia following diagnosis of prostate cancer: A systematic review and meta-analysis. J Geriatr Oncol 2023; 14:101594. [PMID: 37482497 DOI: 10.1016/j.jgo.2023.101594] [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: 05/05/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Sarcopenia is a common skeletal muscle disorder in older people. Here we explore the prevalence of sarcopenia and its impact on men with prostate cancer. MATERIALS AND METHODS We searched PubMed, Embase, and Web of Science databases for relevant studies with an explicit definition of sarcopenia in men with prostate cancer which were published between years 2000 and 2022. Prevalence of sarcopenia and its association with time to biochemical recurrence (BCR), progression-free survival (PFS), non-cancer mortality, overall survival (OS), and treatment-related complications in men with prostate cancer were explored. The summary prevalence, hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated. RESULTS A total of 24 studies comprising 3,616 patients with early and advanced prostate cancer were included. The prevalence of sarcopenia and sarcopenic obesity was 43.8% (95% CI 19.2%-68.5%) and 24.0% (95% CI 5.0%-43.1%), respectively. Sarcopenia was not associated with a shorter time to BCR (HR 0.89, 95% CI 0.64-1.23, p = 0.48), a shorter PFS (HR 1.20, 95% CI 0.73-1.97, p = 0.48), or a shorter OS (HR 1.29, 95% CI 0.90-1.85, p = 0.16). In contrast, sarcopenia was significantly associated with a higher non-cancer mortality (HR 1.85, 95% CI 1.23-2.80, p = 0.003). In four out of five studies eligible for assessment, sarcopenia was not associated with an increased risk of treatment-related complications. DISCUSSION Sarcopenia increases the risk of death from other causes in men with prostate cancer. Patients with prostate cancer should be assessed and managed for sarcopenia in everyday clinical practice.
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Affiliation(s)
- Milena Blaž Kovač
- Ljubljana Community Health Centre, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Pavlin
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Luka Čavka
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Department of Oncology, University Medical Center Maribor, Maribor, Slovenia
| | - Domen Ribnikar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Simon Spazzapan
- S.O.C. Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Arnoud J Templeton
- St. Clara Research, St. Claraspital Basel and Faculty of Medicine, University of Basel, Switzerland
| | - Boštjan Šeruga
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
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Laufer M, Perelman M, Sarfaty M, Itelman E, Segal G. Low Alanine Aminotransferase, as a Marker of Sarcopenia and Frailty, Is Associated with Shorter Survival Among Prostate Cancer Patients and Survivors. A Retrospective Cohort Analysis of 4064 Patients. EUR UROL SUPPL 2023; 55:38-44. [PMID: 37693730 PMCID: PMC10485784 DOI: 10.1016/j.euros.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/12/2023] Open
Abstract
Background Sarcopenia is characterized by loss of muscle mass and function and is associated with frailty, a syndrome with higher likelihood of falls, fractures, physical disability, and mortality. Both frailty and sarcopenia are known markers of shorter survival in various cancer patient populations. Low alanine aminotransferase (ALT), reflecting loss of muscle mass (sarcopenia), may be associated with greater frailty and shorter survival in multiple cancers. Objective To assess the potential association between low ALT and shorter survival among prostate cancer (PCa) patients and survivors. Design setting and participants This was a retrospective analysis of a historical cohort of PCa patients and survivors. Patients were defined as those still actively receiving PCa treatment, while those no longer receiving such treatment were classified as PCa survivors. Outcome measurements and statistical analysis ALT data were obtained from results for basic biochemical blood testing carried out for patients on their first hospital admission. Patients were divided into two groups: those with ALT ≥17 IU/l and those with ALT <17 IU/l. Univariate and multivariable analyses were conducted for between-group survival comparisons. Results and limitations We identified 9489 PCa records. The final study cohort with ALT data available included 4064 patients with ALT <40 IU/l. Of this cohort, 536 patients were actively receiving medical anticancer therapy for PCa. The mean age for the entire cohort was 74.6 yr (standard deviation 9.6) and the median ALT level was 19.28 IU/l; 1676 patients (41%) had low ALT (<17 IU/l). On univariate analysis, low ALT was associated with a 78% increase in mortality risk (95% confidence interval [CI] 1.62-1.97; p < 0.001). A sensitivity analysis of the 536 patients actively receiving medical anticancer treatment revealed that low ALT was associated with a 48% increase in mortality risk (95% CI 1.19-1.85; p = 0.001). In a multivariable model controlled for age, kidney disease, history of cerebrovascular event/transient ischemic attack, and baseline prostate-specific antigen, low ALT was still associated with a 35% increase in mortality risk (95% CI 1.12-1.63; p = 0.001). Limitations include the single-center, retrospective design. Conclusions Low ALT, which is indicative of sarcopenia and frailty, is associated with shorter survival among PCa patients and survivors and could potentially be used for treatment personalization. Patient summary We compared survival for prostate cancer patients and survivors according to their blood level of the protein alanine aminotransferase (ALT). Low ALT levels in the general population are associated with loss of muscle mass. We found that in our group of prostate cancer patients and survivors, the risk of death from any cause was higher for those with low ALT levels.
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Affiliation(s)
- Menachem Laufer
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Maxim Perelman
- Department of Internal Medicine T, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Michal Sarfaty
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Edward Itelman
- Department of Internal Medicine E, Rabin Medical Center, Beilenson Campus, Peta-Tiqva, Israel§
- Cardiology Division, Rabin Medical Center, Beilenson Campus, Peta-Tiqva, Israel§
| | - Gad Segal
- Sheba Education Authority, Chaim Sheba Medical Center, Ramat Gan, Israel§
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Capela A, Antunes P, Coelho CA, Garcia CL, Custódio S, Amorim R, Costa T, Vilela E, Teixeira M, Amarelo A, Silva J, Joaquim A, Viamonte S, Brito J, Alves AJ. Effects of walking football on adherence, safety, quality of life and physical fitness in patients with prostate cancer: Findings from the PROSTATA_MOVE randomized controlled trial. Front Oncol 2023; 13:1129028. [PMID: 37025594 PMCID: PMC10070742 DOI: 10.3389/fonc.2023.1129028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
Aims To analyze the feasibility and impact of a walking football (WF) program on quality of life (QoL), cardiorespiratory fitness (CRF), muscle strength, and balance program in men with prostate cancer under androgen deprivation therapy (ADT). Methods Fifty patients with prostate cancer (stages IIb-IVb) under ADT were randomized to a 16-week WF program plus usual care (n=25) or usual care control group (n=25). The WF program consisted of three 90-minute sessions per week. Recruitment, withdrawal, adherence, enjoyment rate, and safety of the intervention were recorded throughout the study. Cardiorespiratory fitness was assessed before and after the interventions, while handgrip strength, lower limb muscle strength, static balance, and QoL were assessed before, during (week 8), and after (week 16) the interventions. Adverse events during sessions were also recorded. Results The WF group showed high levels of adherence (81.6 ± 15.9%) and enjoyment rate (4.5 ± 0.5 out of 5 points). In the intention-to-treat analysis, the WF group showed an improvement in chair sit-to-stand (p=0.035) compared to the control group. Within-group comparisons showed that handgrip strength in the dominant upper limb (p=0.024), maximal isometric muscle strength in the non-dominant lower limb (p=0.006), and balance in the dominant limb (p=0.009) improved over time in the WF group but not in the usual care group. The results obtained from the per-protocol analysis indicate that CRF improved significantly in the WF group as compared to the control group (p=0.035). Within-group analysis revealed that CRF (p=0.036), muscle strength in dominant (p=0.006) and non-dominant (p=0.001) lower limbs, and balance in the non-dominant lower limb (p=0.023) improved after 16 weeks of WF, but not in the control group. One major traumatic injury (muscle tear) was reported with a complete recovery before the end of the intervention. Conclusion This study suggests that WF is feasible, safe, and enjoyable in patients with prostate cancer under hormonal therapy. Furthermore, patients who adhere to the WF program can expect cardiorespiratory fitness, muscle strength, and balance improvements. Clinical trials registration clinicaltrials.gov, identifier NCT04062162.
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Affiliation(s)
- Andreia Capela
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Pedro Antunes
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Research Center in Sport Sciences, Health and Human Development (CIDESD), Sport Sciences Department, University of Beira Interior, Covilhã, Portugal
| | - César André Coelho
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Catarina Laranjeiro Garcia
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Research Center in Sport Sciences, Health and Human Development (CIDESD), Physical Education and Sport Sciences Department, University of Maia, Maia, Portugal
| | - Sandra Custódio
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Rui Amorim
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Telma Costa
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Eduardo Vilela
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Madalena Teixeira
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Anabela Amarelo
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Joana Silva
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Ana Joaquim
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - Sofia Viamonte
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Centro Hospitalar Vila Nova de Gaia – Espinho, Entidade pública empresaríal (EPE), Vila Nova de Gaia, Portugal
| | - João Brito
- Portugal Football School, Federação Portuguesa de Futebol, Oeiras, Portugal
| | - Alberto J. Alves
- ONCOMOVE® – Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Research Center in Sport Sciences, Health and Human Development (CIDESD), Physical Education and Sport Sciences Department, University of Maia, Maia, Portugal
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Sonmez HK, Sonmez G, Dogan S, Horozoglu F, Demirtas A, Evereklioglu C. Effects of Androgen Deprivation Therapy on Extraocular Muscles, Retrobulbar Orbital Fat, and the Optic Nerve in Patients with Prostate Cancer. Ophthalmic Res 2022; 66:272-280. [PMID: 36228576 DOI: 10.1159/000527387] [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: 08/02/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate radiologically the effects of long-term luteinizing hormone-releasing hormone (LHRH) agonist therapy on extraocular muscle thickness, retrobulbar orbital fat (ROF), and the optic nerve (ON) in prostate cancer (PCa) patients. METHODS The retrospective study included patients with primary or recurrent PCa who received androgen deprivation therapy (ADT) for at least 12 months. Each patient underwent gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography both before and at the end of the 12-month treatment. Thickness of the ON, lateral rectus muscle, medial rectus muscle, superior rectus muscle, and inferior rectus muscle were measured by using the coronal CT sections in soft tissue window. ROF, ocular protrusion, and ON length were measured in sagittal and coronal planes. Changes in these anatomical structures induced by LHRH analogs were investigated by comparing pre- and post-treatment measurements. RESULTS A total of 57 patients were included in the study. Median PSA and TT values of the patients before treatment were 36.5 (range, 19.6-51.2) ng/mL and 614.0 (range, 472.0-743.0) ng/dL, respectively, and these values decreased significantly after the treatment (10.6 [range, 5.2-14.2] ng/mL and 36.5 [range, 19.6-51.2] ng/dL, respectively, p < 0.001 for both). After the treatment, there was a statistically significant decrease in the areas of inferior rectus muscle, superior rectus muscle, lateral rectus muscle, and medial rectus muscle (p < 0.001 for all), while significant increases were observed in ROF (11.9%, p < 0.001) and ON thickness (14.3%, p = 0.004). The amount of ocular protrusion also showed a significant increase of approximately 14% after the treatment (14.0 [range, 12.0-16.0] mm vs. 16.0 [range, 14.0-17.2] mm, p < 0.001). DISCUSSION/CONCLUSION Our findings, for the first time in the literature, indicated that ADT causes a decrease in extraocular muscle mass and an increase in ROF with ocular protrusion. It can be asserted that these changes are similar to the changes in skeletal muscle and fat mass in other body parts. Further studies with a higher level of evidence are needed to clinically evaluate the increase in ocular protrusion and ON enlargement, which are likely to be caused by the increase in ROF.
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Affiliation(s)
- Hatice Kubra Sonmez
- Department of Ophthalmology, Division of Oculoplastic, Orbital, and Lacrimal Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
- Department of Ophthalmology, Kayseri State Hospital, Kayseri, Turkey
| | - Gokhan Sonmez
- Department of Urology, Division of Urooncology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Serap Dogan
- Department of Radiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Fatih Horozoglu
- Department of Ophthalmology, Division of Oculoplastic, Orbital, and Lacrimal Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Abdullah Demirtas
- Department of Urology, Division of Urooncology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Cem Evereklioglu
- Department of Ophthalmology, Division of Oculoplastic, Orbital, and Lacrimal Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
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Espinosa-Marrón A, Rubio-Blancas A, Quiñones-Capistran CA, Camacho-Zamora A, Salcedo-Grajales I, Bravo-García AP, Bourlon MT, Castillejos-Molina RA, Dias JA, Del Pilar Milke-García M. Muscle wasting assessment tools for prostate cancer. Sci Rep 2022; 12:4662. [PMID: 35304535 PMCID: PMC8933481 DOI: 10.1038/s41598-022-08501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/03/2022] [Indexed: 11/14/2022] Open
Abstract
Prostate cancer and its treatment may induce muscle wasting. Body composition and muscle functionality are rarely assessed in patients with prostate cancer from developing countries due to the limited availability of high-quality equipment for routine diagnosis. This cross-sectional study evaluated the association between several simplistic techniques for assessing muscle mass and function with a more complex standard of reference for muscle wasting among Mexican men with prostate cancer. Muscle wasting was highly prevalent, yet it was presumably associated with aging rather than cancer and its treatment itself. The restricted availability of specific equipment in clinical settings with technological limitations supports using unsophisticated techniques as surrogate measurements for muscle wasting. The left-arm handgrip dynamometry displayed the highest correlation with the standard of reference and exhibited an acceptable predicted probability for muscle estimation. Combining several simplistic techniques may be preferable. We also developed and internally validated a manageable model that helps to identify elderly patients with prostate cancer at risk of muscle depletion and impairment. These findings promote the early recognition and treatment of muscle wasting alterations occurring among older adults with prostate cancer.
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Affiliation(s)
- Alan Espinosa-Marrón
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Itzel Salcedo-Grajales
- Division of Nutrition, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Ana Paula Bravo-García
- Division of Nutrition, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Maria T Bourlon
- Department of Hematology and Oncology, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Ricardo A Castillejos-Molina
- Department of Urology, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Julie-Alexia Dias
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - María Del Pilar Milke-García
- Division of Nutrition, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico.
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11
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Lee J, Lin JB, Chen TC, Jan YT, Sun FJ, Chen YJ, Wu MH. Progressive Skeletal Muscle Loss After Surgery and Adjuvant Radiotherapy Impact Survival Outcomes in Patients With Early Stage Cervical Cancer. Front Nutr 2022; 8:773506. [PMID: 35127782 PMCID: PMC8810512 DOI: 10.3389/fnut.2021.773506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/06/2021] [Indexed: 12/23/2022] Open
Abstract
The effect of skeletal muscle loss associated with surgery and adjuvant radiotherapy on survival outcomes in patients with early-stage cervical cancer remains unclear. We analyzed the data of 133 patients with early-stage cervical cancer who underwent surgery and adjuvant radiotherapy between 2013 and 2018 at two tertiary centers. Skeletal muscle changes were measured using computed tomography scans at baseline, at simulation for radiotherapy, and at 3 months post-treatment. A decrease of ≥5% in the skeletal muscle was defined as “muscle loss.” The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was used to assess gastrointestinal toxicity. The Patient-Generated Subjective Global Assessment (PG-SGA) was used for nutritional assessment. Predictors of overall survival were identified using the Cox regression models. The median follow-up period was 3.7 years. After treatment, 32 patients (24.1%) experienced muscle loss. The rate of muscle loss was higher in patients with PRO-CTCAE score ≥3 or PG-SGA score ≥4 at the end of radiotherapy than in patients with PRO-CTCAE score ≤2 or PG-SGA score 0–3 (75.0 vs. 10.5%, p < 0.001; 71.4 vs. 2.2%, p < 0.001). The 3-year overall survival was significantly lower in patients with muscle loss than in those with muscle preserved (65.6 vs. 93.9%, p < 0.001). Multivariate analysis showed that muscle loss was independently associated with poor overall survival (hazard ratio, 4.55; 95% confidence interval: 1.63–12.72; p < 0.001). Muscle loss after surgery and adjuvant radiotherapy was associated with poor overall survival in patients with early-stage cervical cancer. Muscle loss is associated with patient-reported gastrointestinal toxicity and deterioration in nutritional status.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- *Correspondence: Jie Lee
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tze-Chien Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Meng-Hao Wu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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12
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Effect of Body Composition Change during Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma. J Clin Med 2022; 11:jcm11030508. [PMID: 35159960 PMCID: PMC8836597 DOI: 10.3390/jcm11030508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
Effects of changes in body composition during neoadjuvant chemotherapy (NAC) on perioperative complications and prognosis are unknown in patients with esophageal squamous cell carcinoma (ESCC). A total of 175 patients who underwent surgery for ESCC in our hospital between 2016 and 2019 were examined. The psoas muscle index (PMI) was calculated from the total psoas muscle area, and the visceral fat mass (VFM) at the umbilical level was measured. We defined body composition change (BCC) group as those with increased VFM of ≥ 3% and decreased PMI of ≥ 3% during NAC. Sarcopenia (S) was defined as PMI < 5.89 (male) and <4.06 (female). Nutritional assessment using the Subjective Global Assessment tool was performed upon admission. The percentages of BCC group, pre-NAC S, and post-NAC S was 32.5%, 79.4%, and 80.0%, respectively. BCC group had significantly more postoperative complications (p < 0.01) and longer hospital stays (p = 0.03) than groups pre-NAC S and post-NAC S. Overall survival (OS) analysis using the Cox hazard model showed that stage III (p < 0.01) and post-NAC S (p = 0.03) were poor prognostic factors. Changes in body composition during NAC affected perioperative complications and prognosis of patients with ESCC.
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