1
|
Wagoner CW, Daun JT, Danyluk J, Twomey R, Murphy L, Peterson M, Gentleman E, Capozzi LC, Francis GJ, Chandarana SP, Hart RD, Matthews TW, McKenzie D, Matthews J, Nakoneshny SC, Schrag C, Sauro KM, Dort JC, Manaloto V, Burnett L, Chisholm A, Lau H, Culos-Reed SN. Multiphasic exercise prehabilitation for patients undergoing surgery for head and neck cancer: a hybrid effectiveness-implementation study protocol. Support Care Cancer 2023; 31:726. [PMID: 38012345 DOI: 10.1007/s00520-023-08164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Head and neck cancer (HNC) treatment often consists of major surgery followed by adjuvant therapy, which can result in treatment-related side effects, decreased physical function, and diminished quality of life. Perioperative nutrition interventions and early mobilization improve recovery after HNC treatment. However, there are few studies on prehabilitation that include exercise within the HNC surgical care pathway. We have designed a multiphasic exercise prehabilitation intervention for HNC patients undergoing surgical resection with free flap reconstruction. We will use a hybrid effectiveness-implementation study design guided by the RE-AIM framework to address the following objectives: (1) to evaluate intervention benefits through physical function and patient-reported outcome assessments; (2) to determine the safety and feasibility of the prehabilitation intervention; (3) to evaluate the implementation of exercise within the HNC surgical care pathway; and (4) to establish a post-operative screening and referral pathway to exercise oncology resources. The results of this study will provide evidence for the benefits and costs of a multiphasic exercise prehabilitation intervention embedded within the HNC surgical care pathway. This paper describes the study protocol design, multiphasic exercise prehabilitation intervention, planned analyses, and dissemination of findings. Trial registration: https://clinicaltrials.gov/NCT04598087.
Collapse
Affiliation(s)
- Chad W Wagoner
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N IN4, Calgary, Alberta, Canada.
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N IN4, Calgary, Alberta, Canada
| | - Jessica Danyluk
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N IN4, Calgary, Alberta, Canada
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N IN4, Calgary, Alberta, Canada
| | - Lisa Murphy
- Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Megan Peterson
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Gentleman
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N IN4, Calgary, Alberta, Canada
| | - Lauren C Capozzi
- Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - George J Francis
- Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shamir P Chandarana
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert D Hart
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - T Wayne Matthews
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David McKenzie
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Matthews
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christiaan Schrag
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Khara M Sauro
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph C Dort
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vida Manaloto
- Acute Care, Alberta Health Services, Calgary, Canada
| | | | - Alex Chisholm
- Acute Care, Alberta Health Services, Calgary, Canada
| | - Harold Lau
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N IN4, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
2
|
Capozzi LC, Daun JT, Francis GJ, de Guzman Wilding M, Urgoiti GR, Langelier D, Culos-Reed N. Feasibility and Implementation of an Oncology Rehabilitation Triage Clinic: Assessing Rehabilitation, Exercise Need, and Triage Pathways within the Alberta Cancer Exercise-Neuro-Oncology Study. Curr Oncol 2023; 30:6220-6245. [PMID: 37504321 PMCID: PMC10377964 DOI: 10.3390/curroncol30070461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Individuals living with and beyond cancer face physical impairment and inactivity in survivorship. Neuro-oncology populations have especially high rates of sedentary behaviour and functional deficits, including impaired balance, motor skills, and cognition. Our purpose was to assess the rehabilitation and exercise needs of patients with brain tumours while examining the feasibility of a rehabilitation triage clinic as a part of the Alberta Cancer Exercise-Neuro-Oncology study, where patients were referred to a triage clinic, where health, neurologic, and functional status was assessed, followed by a referral to one or multiple resources, including exercise, physiotherapy, occupational therapy, or physiatry. Qualitative perception of the triage clinic was collected. Overall, the triage clinic was feasible and safe for participants, facilitating referral into rehabilitation and exercise resources. Pre-determined enrollment and attendance rates were met, but referral rates to the triage clinic were not met. Oncology clinic staff reported forgetting to refer patients or uncertainty of who was appropriate for rehabilitation as barriers. Oncology clinic-based screening may improve the identification of patients who are sedentary or have a physical impairment. A proposed screening tool, the Cancer Rehabilitation and Exercise Screening Tool (CREST), is presented within our Cancer Rehabilitation and Exercise Pathways Model. The CREST can identify patients who are sedentary or have a functional impairment, facilitating referral to appropriate rehabilitation resources and ultimately improving patient recovery and functioning.
Collapse
Affiliation(s)
- Lauren C Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - George J Francis
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie de Guzman Wilding
- Supportive Care: Psychosocial and Rehabilitation Oncology, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Gloria Roldan Urgoiti
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - David Langelier
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Supportive Care, Cancer Rehabilitation and Survivorship, Princess Margaret Hospital, Toronto, ON M5G 2C1, Canada
| | - Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Supportive Care: Psychosocial and Rehabilitation Oncology, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
| |
Collapse
|
3
|
Wagoner CW, Dreger J, Keats MR, Santa Mina D, McNeely ML, Cuthbert C, Capozzi LC, Francis GJ, Trinh L, Sibley D, Langley J, Chiekwe J, Ester M, Foucaut AM, Culos-Reed SN. First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources. Int J Environ Res Public Health 2023; 20:ijerph20031930. [PMID: 36767296 PMCID: PMC9915392 DOI: 10.3390/ijerph20031930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 05/27/2023]
Abstract
Barriers to exercise-oncology programs remain for those living with and beyond cancer in rural and remote communities, including geographic isolation and access to programs. The EXercise for Cancer to Enhance Living Well (EXCEL) study was designed to support exercise-oncology implementation in rural and remote communities across Canada. The purpose of this analysis was to evaluate the first-year reach, adoption, and implementation of the EXCEL study. Reach outcomes included participant characteristics, study enrolment, and referral type (self vs. healthcare-provider [HCP] referral). Adoption outcomes included the number of clinical contacts, trained qualified exercise professionals (QEPs), and QEPs delivering EXCEL exercise classes. Implementation outcomes included retention, adherence, assessment completion rates, and adverse-event reporting. A total of 290 individuals living with cancer enrolled in EXCEL in year one, with an 81.4% retention to the study intervention. Most participants self-referred to EXCEL (75.8%). EXCEL's HCP network consisted of 163 clinical contacts, and the QEP network included 45 trained QEPs, 22 of whom delivered EXCEL classes. Adherence to the exercise intervention was 78.2%, and only one adverse event (mild) was reported. Fitness assessment and patient-reported outcome completion rates were above 85% pre- and post-intervention. EXCEL has developed HCP and QEP networks supporting exercise referral and online delivery, and the intervention is meeting feasibility markers. These implementation findings will inform the continued gathering of feedback across stakeholders to ensure that best evidence informs best practices.
Collapse
Affiliation(s)
- Chad W. Wagoner
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Julianna Dreger
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Melanie R. Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Medicine, Division of Medical Oncology, Nova Scotia Health, Halifax, NS B3H 2Y9, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada
| | - Margaret L. McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Supportive Care Services, Cancer Care Alberta, Edmonton, AB T5J 3E4, Canada
| | - Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada
| | - Lauren C. Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - George J. Francis
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada
| | - Daniel Sibley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada
| | - Jodi Langley
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Joy Chiekwe
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Manuel Ester
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Aude-Marie Foucaut
- Health Educations and Promotion Laboratory, UR 3412, University Sorbonne Paris North, F-93000 Bobigny, France
| | | |
Collapse
|
4
|
Culos-Reed N, Wagoner CW, Dreger J, McNeely ML, Keats M, Santa Mina D, Cuthbert C, Capozzi LC, Francis GJ, Chen G, Ester M, McLaughlin E, Eisele M, Sibley D, Langley J, Chiekwe J, Christensen T. Implementing an exercise oncology model to reach rural and remote individuals living with and beyond cancer: a hybrid effectiveness-implementation protocol for project EXCEL (EXercise for Cancer to Enhance Living Well). BMJ Open 2022; 12:e063953. [PMID: 36581419 PMCID: PMC9806055 DOI: 10.1136/bmjopen-2022-063953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Individuals living with and beyond cancer from rural and remote areas lack accessibility to supportive cancer care resources compared with those in urban areas. Exercise is an evidence-based intervention that is a safe and effective supportive cancer care resource, improving physical fitness and function, well-being and quality of life. Thus, it is imperative that exercise oncology programs are accessible for all individuals living with cancer, regardless of geographical location. To improve accessibility to exercise oncology programs, we have designed the EXercise for Cancer to Enhance Living Well (EXCEL) study. METHODS AND ANALYSIS EXCEL is a hybrid effectiveness-implementation study. Exercise-based oncology knowledge from clinical exercise physiologists supports healthcare professionals and community-based qualified exercise professionals, facilitating exercise oncology education, referrals and programming. Recruitment began in September 2020 and will continue for 5 years with the goal to enroll ~1500 individuals from rural and remote areas. All tumour groups are eligible, and participants must be 18 years or older. Participants take part in a 12-week multimodal progressive exercise intervention currently being delivered online. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework is used to determine the impact of EXCEL at participant and institutional levels. Physical activity, functional fitness and patient-reported outcomes are assessed at baseline and 12-week time points of the EXCEL exercise intervention. ETHICS AND DISSEMINATION The study was approved by the Health Research Ethics Board of Alberta. Our team will disseminate EXCEL information through quarterly newsletters to stakeholders, including participants, qualified exercise professionals, healthcare professionals and community networks. Ongoing outreach includes community presentations (eg, support groups, fitness companies) that provide study updates and exercise resources. Our team will publish manuscripts and present at conferences on EXCEL's ongoing implementation efforts across the 5-year study. TRIAL REGISTRATION NUMBER NCT04478851.
Collapse
Affiliation(s)
- Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Chad W Wagoner
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Julianna Dreger
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Margaret L McNeely
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Supportive Care Services, Cancer Care Alberta, Edmonton, Alberta, Canada
| | - Melanie Keats
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Division of Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Cancer Rehabilitation and Survivorship, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Lauren C Capozzi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - George J Francis
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Guanmin Chen
- Data and Analytics, Alberta Health Services Board, Calgary, Alberta, Canada
| | - Manuel Ester
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Emma McLaughlin
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Max Eisele
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Sibley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Jodi Langley
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joy Chiekwe
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Thomas Christensen
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
5
|
Daun JT, Twomey R, Capozzi LC, Crump T, Francis GJ, Matthews TW, Chandarana S, Hart RD, Schrag C, Matthews J, McKenzie CD, Lau H, Dort JC, Culos-Reed SN. The feasibility of patient-reported outcomes, physical function, and mobilization in the care pathway for head and neck cancer surgical patients. Pilot Feasibility Stud 2022; 8:114. [PMID: 35624523 PMCID: PMC9136202 DOI: 10.1186/s40814-022-01074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/19/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Head and neck cancer (HNC) patients are an understudied population whose treatment often includes surgery, causing a wide range of side effects. Exercise prehabilitation is a promising tool to optimize patient outcomes and may confer additional benefits as a prehabilitation tool. The primary objective of this study was to assess the feasibility of measuring patient-reported outcomes (PROs), physical function, and in-hospital mobilization across the HNC surgical timeline in advance of a future prehabilitation trial. The secondary objective was to examine potential changes in these outcomes across the surgical timeline. METHODS HNC patients scheduled to undergo oncologic resection with free-flap reconstruction completed assessments of PROs and physical function at three timepoints across the surgical timeline (baseline, in-hospital, and postsurgical/outpatient). Mobilization was measured during the in-hospital period. The feasibility of recruitment and measurement completion was tracked, as were changes in both PROs and physical function. RESULTS Of 48 eligible patients, 16 enrolled (recruitment rate of 33%). The baseline and in-hospital PROs were completed by 88% of participants, while the outpatient assessments were completed by 81% of participants. The baseline and in-hospital assessment of physical function were completed by 56% of participants, and 38% completed the outpatient assessment. Measuring in-hospital mobilization was completed for 63% of participants. CONCLUSION Measuring PROs and in-hospital mobilization is feasible across the surgical timeline in HNC; however, the in-person assessment of physical function prior to surgery was not feasible. A multidisciplinary collaboration between exercise specialists and clinicians supported the development of new clinical workflows in HNC surgical care that will aid in the implementation of a future prehabilitation trial for this patient population.
Collapse
Grants
- N/A Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, AB, Canada.
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, AB, Canada.
Collapse
Affiliation(s)
- Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - Rosie Twomey
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lauren C Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Trafford Crump
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - George J Francis
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - T Wayne Matthews
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Shamir Chandarana
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Robert D Hart
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Christiaan Schrag
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jennifer Matthews
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - C David McKenzie
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Harold Lau
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph C Dort
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
6
|
Daun JT, Capozzi LC, Roldan Urgoiti G, McDonough MH, Easaw JC, McNeely ML, Francis GJ, Williamson T, Danyluk J, McLaughlin E, Ospina PA, de Guzman Wilding M, Radke L, Driga A, Lesiuk C, Culos-Reed SN. ACE-Neuro: A tailored exercise oncology program for neuro-oncology patients – Study protocol. Contemp Clin Trials Commun 2022; 28:100925. [PMID: 35720248 PMCID: PMC9198374 DOI: 10.1016/j.conctc.2022.100925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/17/2022] [Accepted: 05/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Methods Conclusion Neuro-oncology patients require access to tailored exercise oncology programs. The feasibility of a tailored neuro-oncology exercise program is being examined. Patients are referred and triaged via the electronic medical record. Intervention includes tailored exercise, an activity tracker, and health coaching. This work supports the implementation of exercise within neuro-oncology care.
Collapse
Affiliation(s)
- Julia T. Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Corresponding author. University of Calgary, Faculty of Kinesiology, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Lauren C. Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Gloria Roldan Urgoiti
- Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| | | | - Jacob C. Easaw
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Margaret L. McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - George J. Francis
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tanya Williamson
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Jessica Danyluk
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Emma McLaughlin
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Paula A. Ospina
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Marie de Guzman Wilding
- Supportive Care: Rehabilitation Oncology, Cancer Care Alberta, Alberta Health Services, AB, Canada
| | - Lori Radke
- Supportive Care: Rehabilitation Oncology, Cancer Care Alberta, Alberta Health Services, AB, Canada
| | - Amy Driga
- Rehabilitation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Christine Lesiuk
- Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, AB, Canada
| |
Collapse
|
7
|
Capozzi LC, Daun JT, Ester M, Mosca S, Langelier D, Francis GJ, Chang E, Mina DS, Fu JB, Culos-Reed SN. Physical Activity for Individuals Living with Advanced Cancer: Evidence and Recommendations. Semin Oncol Nurs 2021; 37:151170. [PMID: 34281734 DOI: 10.1016/j.soncn.2021.151170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To provide health and fitness professionals with screening, triage, prescription, and physical activity recommendations to better serve individuals living with advanced cancer. A call to action regarding next steps to improve research and knowledge translation is also outlined, ensuring the growing number of those with advanced cancers are supported in their efforts to adopt and adhere to active lifestyles. DATA SOURCES Sources include published literature, physical activity guidelines, and expert opinion from physical medicine and rehabilitation physicians, exercise physiologists, and health and exercise psychology researchers. CONCLUSION Individuals with advanced cancer who engage in regular physical activity report improved function, fatigue management, and quality of life, while objective testing shows improvements in fitness and physical function. Although there are no clear activity guidelines or recommendations for this population, patients must avoid inactivity to gain health benefits and minimize deconditioning. For most patients with advanced cancer, physical activity prescriptions should focus on maintaining fitness and functional independence, and specific modifications based on common comorbidities must be considered. IMPLICATIONS FOR NURSING PRACTICE Evidence supports the use of physical activity for the management of symptoms experienced by those with advanced cancers. Understanding the benefits of physical activity for patients with advanced cancer is important because health care providers play a key role in the adoption and adherence of physical activity among patients.
Collapse
Affiliation(s)
- Lauren C Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, Alb, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alb, Canada
| | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, Alb, Canada
| | - Manuel Ester
- Faculty of Kinesiology, University of Calgary, Calgary, Alb, Canada
| | - Stephen Mosca
- Division of Palliative Care, Cumming School of Medicine, University of Calgary, Calgary, Alb, Canada
| | - David Langelier
- Cancer Rehabilitation and Survivorship, Princess Margaret Hospital, Toronto, Ont, Canada; Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ont, Canada
| | - George J Francis
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alb, Canada
| | - Eugene Chang
- Cancer Rehabilitation and Survivorship, Princess Margaret Hospital, Toronto, Ont, Canada; Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ont, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ont, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, Ont, Canada
| | - Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, Tex, USA
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Alb, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alb, Canada; Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, Alb, Canada.
| |
Collapse
|
8
|
Francis GJ, Ngo-Huang A, Rhines LD, Bruera E. The challenges of providing rehabilitation for patients undergoing sacrectomy: two case reports. Eur J Phys Rehabil Med 2018; 55:526-529. [PMID: 29898586 DOI: 10.23736/s1973-9087.18.05112-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sacral neoplasms often present as large masses that often require sacrectomy. Multiple sacral nerve roots may be compromised post-sacrectomy and postoperative complications may result in impaired mobility, pain, orthostasis, and neurogenic bowel and bladder. CASE SERIES Case 1, 58 year-old female with a sacral solitary fibrous tumor underwent a high-level sacrectomy and bilateral gluteal muscle flaps. Her rehabilitation course included management of pain, orthostasis, and neurogenic bowel and bladder. Case 2, 67 year-old male with sacral chordoma underwent high-level sacrectomy and bilateral gluteal muscle flaps. His rehabilitation course was complicated by refractory orthostatic hypotension, pain, and wound impairment, which resulted in slow rehabilitation progression and bowel and bladder training. Progression of activity in both cases was limited by surgical restrictions to support wound healing. CLINICAL REHABILITATION IMPACT Multidisciplinary efforts after a sacrectomy are vital to successful rehabilitation. Highly functional outcomes are seen, including independent bowel and bladder management and return to preoperative ambulatory status.
Collapse
Affiliation(s)
- George J Francis
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA -
| | - Laurence D Rhines
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
9
|
Francis GJ, Cook AE, Morrish DW, Chan KM, Acharya HJ. What is the Fracture Risk in Patients at a Multidisciplinary Neuromuscular Clinic? J Neuromuscul Dis 2018; 5:93-98. [PMID: 29480212 DOI: 10.3233/jnd-170247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many neuromuscular diseases (NMD) result in muscle weakness, immobility and greater fracture risk. The objective of this study is to determine the fracture risk of adult patients at a multidisciplinary NMD clinic. Fracture risk was calculated using the Fracture Risk Assessment Tool, the presence of osteoporosis was quantified using bone densitometry and contributing co-morbidities were screened through serum markers. Of the 36 patients studied, 47% were found to be of moderate and high fracture risk. Two thirds of these patients had not been previously screened or treated for osteoporosis. These findings suggest that NMD patients warrant routine screening for osteoporosis and early treatment to reduce fragility fracture.
Collapse
Affiliation(s)
- George J Francis
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Amy E Cook
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Donald W Morrish
- Division of Endocrinology, University of Alberta, Edmonton, AB, Canada
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Hernish J Acharya
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
10
|
Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. In Brief. Curr Probl Surg 2017. [DOI: 10.1067/j.cpsurg.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
11
|
Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
12
|
Ng AH, Francis GJ, Sumler PA. Poster 34: Massage Therapy in Cancer Patients with Venous Thromboembolism: A Case Series. PM R 2017. [DOI: 10.1016/j.pmrj.2017.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amy H. Ng
- University of Texas, MD Anderson Cancer Center
| | | | | |
Collapse
|
13
|
Abstract
Cluster headache (CH) is a rare and disabling primary headache disorder. CH attacks are unilateral, short, severe headaches associated with ipsilateral autonomic symptoms that occur in a periodic fashion. We provide a systematic review and meta-analysis of existing trials of pharmacotherapy for CH and evidence-based suggestions for acute abortive treatment and preventive therapy for cluster headache. Prospective, double-blind, randomized controlled trials of any pharmacologic agent for the symptomatic relief or prevention of CH were included in this evidence-based review. The main outcomes considered were headache response and pain-free response at 15 and 30 minutes for acute treatment trials, and the cessation of CH attacks within a specific time period or the number of days on which CH attacks occurred for preventive trials. Twenty-seven trials were included in the analysis. The American Academy of Neurology quality criteria were used to assess trial quality and to grade advisements. Based on the evidence, for acute treatment of CH, Level A advice can be given for subcutaneous sumatriptan 6 mg, zolmitriptan nasal spray 5 mg and 10 mg, and 100% oxygen 6-12 L/min. Level B advice can be given for sumatriptan nasal spray 20 mg and oral zolmitriptan 5 mg and 10 mg. For the prevention of CH, Level B advice can be given for intranasal civamide 100 microg daily and suboccipital steroid injections, and Level C advice can be given for verapamil 360 mg, lithium 900 mg, and melatonin 10 mg.
Collapse
Affiliation(s)
- George J Francis
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, T3B 6A8, Canada
| | | | | |
Collapse
|
14
|
|
15
|
Marsden HS, McLean GW, Barnard EC, Francis GJ, MacEachran K, Murphy M, McVey G, Cross A, Abbotts AP, Stow ND. The catalytic subunit of the DNA polymerase of herpes simplex virus type 1 interacts specifically with the C terminus of the UL8 component of the viral helicase-primase complex. J Virol 1997; 71:6390-7. [PMID: 9261356 PMCID: PMC191912 DOI: 10.1128/jvi.71.9.6390-6397.1997] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The herpes simplex virus type 1 (HSV-1) UL8 DNA replication protein is a component of a trimeric helicase-primase complex. Sixteen UL8-specific monoclonal antibodies (MAbs) were isolated and characterized. In initial immunoprecipitation experiments, one of these, MAb 804, was shown to coprecipitate POL, the catalytic subunit of the HSV-1 DNA polymerase, from extracts of insect cells infected with recombinant baculoviruses expressing the POL and UL8 proteins. Coprecipitation of POL was dependent on the presence of UL8 protein. Rapid enzyme-linked immunosorbent assays (ELISAs), in which one protein was bound to microtiter wells and binding of the other protein was detected with a UL8- or POL-specific MAb, were developed to investigate further the interaction between the two proteins. When tested in the ELISAs, five of the UL8-specific MAbs consistently inhibited the interaction, raising the possibility that these antibodies act by binding to epitopes at or near a site(s) on UL8 involved in its interaction with POL. The epitopes recognized by four of the inhibitory MAbs were approximately located by using a series of truncated UL8 proteins expressed in mammalian cells. Three of these MAbs recognized an epitope near the C terminus of UL8, which was subjected to fine mapping with a series of overlapping peptides. The C-terminal peptides were then tested in the ELISA for their ability to inhibit the POL-UL8 interaction: the most potent exhibited a 50% inhibitory concentration of approximately 5 microM. Our findings suggest that the UL8 protein may be involved in recruiting HSV-1 DNA polymerase into the viral DNA replication complex and also identify a potential new target for antiviral therapy.
Collapse
Affiliation(s)
- H S Marsden
- MRC Virology Unit, University of Glasgow, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Marsden HS, Cross AM, Francis GJ, Patel AH, MacEachran K, Murphy M, McVey G, Haydon D, Abbotts A, Stow ND. The herpes simplex virus type 1 UL8 protein influences the intracellular localization of the UL52 but not the ICP8 or POL replication proteins in virus-infected cells. J Gen Virol 1996; 77 ( Pt 9):2241-9. [PMID: 8811024 DOI: 10.1099/0022-1317-77-9-2241] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We have developed a panel of 14 monoclonal antibodies (MAbs) to POL, the catalytic subunit of herpes simplex virus type 1 (HSV-1) DNA polymerase encoded by gene UL30, and one MAb to the UL52 protein, another of the seven proteins essential for replication of HSV DNA. The approximate locations of the epitopes of the polymerase-specific MAbs were identified using truncated polymerase molecules, and the antibodies were characterized in a number of immunological assays allowing eight different specificities to be recognized. These MAbs, together with a polyclonal antibody raised in rabbits against a third DNA replication protein, ICP8, were used to localize the respective proteins by immunofluorescence in cells infected with wild-type HSV-1 or the DNA replication-defective mutants ambUL8 or 2-2. In BHK cells infected with ambUL8, a mutant with an amber termination codon within the coding region of gene UL8, the UL52 protein did not enter the nucleus, although ICP8 and POL entered the nucleus in a normal fashion. The failure of the UL52 protein to be correctly transported to the nucleus was also observed in both HFL and Vero cells infected with ambUL8. In contrast, UL52 protein was transported to the nucleus in BHK cells infected with wild-type HSV-1 or with 2-2, a mutant lacking a functional UL9 protein.
Collapse
Affiliation(s)
- H S Marsden
- MRC Virology Unit, Church Street, Glasgow, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Marshall BJ, Warren JR, Francis GJ, Langton SR, Goodwin CS, Blincow ED. Rapid urease test in the management of Campylobacter pyloridis-associated gastritis. Am J Gastroenterol 1987; 82:200-10. [PMID: 3548326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Campylobacter pyloridis colonization of the stomach may be an etiological factor in gastritis and peptic ulceration. Campylobacter pyloridis produces large amounts of urease, and the presence of this enzyme in gastric mucosa usually indicates infection with the organism. In this paper we describe the use of a rapid urease test (CLOtest) to detect C. pyloridis infection in gastric mucosal biopsies. In 141 consecutive endoscopy cases, antral biopsies were taken for culture and histology, and an extra biopsy was inserted into the CLOtest gel. There were 79 patients infected with C. pyloridis, 78 of whom were detected by CLOtest: 75% were positive at 20 min, 92% at 3 h, and 98% at 24 h. There were no false positive results. Eighteen infected patients were rebiopsied after a course of amoxycillin and bismuth subcitrate. Active chronic gastritis resolved in eight of nine who were cleared of the organism, but histological gastritis was unchanged in nine patients who were still infected. CLOtest is a simple, sensitive, and highly specific test that enables the endoscopist to diagnose C. pyloridis infection in the endoscopy room. A negative test after antibiotic therapy correlates with clearance of the bacteria and healing of active gastritis.
Collapse
|
18
|
Marshall BJ, Armstrong JA, Francis GJ, Nokes NT, Wee SH. Antibacterial action of bismuth in relation to Campylobacter pyloridis colonization and gastritis. Digestion 1987; 37 Suppl 2:16-30. [PMID: 3622946 DOI: 10.1159/000199555] [Citation(s) in RCA: 141] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colloidal bismuth subcitrate (CBS, De-Nol) heals duodenal ulcers but with a lower relapse rate than cimetidine, perhaps due to inhibition of Campylobacter pyloridis (CP) organisms. To test this hypothesis we studied gastric mucosal histology in three groups of ulcer patients treated with either cimetidine, CBS, or CBS in combination with an antibiotic. Cimetidine had no effect on CP or gastric mucosal histology but with CBS therapy there was a significant reduction in the number of bacteria (p less than 0.0001). However, relapse of both CP infection and gastritis usually occurred once CBS was withdrawn. When CBS was combined with amoxycillin or tinidazole, long-term disappearance of both CP bacteria and gastritis was achieved (p less than 0.0001). In ultrastructural studies 30-90 min after single oral doses of CBS or bismuth subsalicylate, CP had detached from the gastric epithelial cells and exhibited structural degradation associated with the selective deposition of a particulate bismuth complex within and upon the surface of the organisms. In vitro, CP and other campylobacters were inhibited by bismuth compounds at 25 mg/l but they were resistant to cimetidine and ranitidine. CBS has a powerful antibacterial effect against CP but relapse of infection is common after CBS alone. In combination with antibiotics however, eradication of CP and long-term healing of gastritis occurs. In such cases the gastroduodenal mucosa is intact, and less likely to ulcerate.
Collapse
|
19
|
|