Abstract Emerging evidence that cancers survivors may experience premature aging has prompted epidemiology research aimed at the characterization of key premature aging phenotypes. Physical functioning data relevant for premature aging phenotype classification in cancer survivors, however, remain scarce. We assessed the burden of dynapenia, a key sarcopenia indicator, and muscle strength loss in the understudied population of bone marrow transplant (BMT) patients. This study involved secondary analyses of data from patients who underwent bone marrow transplant (BMT) in a cancer Institute in South Florida (June 2018-April 2019) with traditional hematopoietic cell transplantation specific comorbidity index (HCT-CI) scores and other relevant information. T-tests for paired data assessed pre- vs. post-BMT changes in grip strength (GS) (n=9). Prevalence of dynapenia (GS<27Kg and <16Kg) in pre-BMT (n=20) and post-BMT (n=9) periods were calculated. Median age [25th-75th percentiles] age was 61 [55-68] years old. Fifty-percent were females. GS and HCT-CI scores were not correlated. Mean GS loss after BMT was 6.4 Kg (95% confidential interval: 2.5-10.4 Kg, p-value=.003) in post-BMT (median-time-after-BMT: 90 days) minus pre-BMT (median-time-before-BMT: 62 days) comparison. Proportion with dynapenia increased from 10% (1/10) to 20% (1/5) in women, and 10% (1/2) to 75% (3/4) in men. We observed substantial muscle strength loss and dynapenia burden in patients who underwent BMT. Considering that dynapenia is a major, potentially modifiable risk factor for frailty, which is not captured by HCT-TI, we speculated that dynapenia-related targeted assessments and interventions – preventive and/or rehabilitative – could offer complementary approaches for treatment enhancement in BMT patients.
Abstract Cancer patients are recommended to exercise at all stages of disease given the multiple health and functional benefits of physical activity. Certain safety precautions, including a preparticipation medical evaluation and periodic re-evaluations, should be undertaken before creating an exercise program based on individual cancer and treatment history. When designing an exercise program, physiatrists should use similar principles of frequency, intensity, timing, and type for cancer patients that are used for noncancer patients. Special attention to risks of cardiac and pulmonary disease along with risks of sarcopenia, thrombocytopenia, anemia, neutropenia, fracture risk, neurotoxicity, lymphedema, and metastases should be made. This article will outline these specific risks and necessary modifications to the exercise prescription for cancer patients that can be used to enable safe participation in recommended exercise.
Introduction Impaired physical function, fatigue and frailty are commonly seen in patients undergoing cancer treatment as well as in cancer survivors. These can have a significant adverse effect on the quality of life of the affected individuals. Objectives To compare the prevalence of impairment of physical function, fatigue and frailty in three populations of cancer patients-malignant hematology, patients with malignant hematology (MH) selected to undergo bone marrow transplant (pre-BMT) and patients with solid tumors (ST). Methods Retrospective chart review of patients referred to a cancer rehabilitation clinic in a cancer institute. The medical charts of 355 patients with ST (Breast-264; prostate-20; lung- 34 and GI- 37), 48 patients with MH (AML/ALL-5, Lymphoma-23, Myeloma-18, other:2) and 29 patients pre-BMT (AML/ALL-4, Lymphoma-11 and myeloma 14) were reviewed. Mean age: ST-67, MH-67 and Pre-BMT-55. Gender: ST-305 female; 50male; MH-25 female and 23 male; Pre-BMT-12 female and 17 male. Information reviewed: a) Patient Reported Outcome Measure Information System (PROMIS) Physical Function short form and Fatigue short form b) Timed Up and Go (TUG) test c) Sit to stand in 30 seconds test d) Grip Strength (in Kg), e) weight loss. Frailty or pre-frailty was determined by using modified Fried frailty criteria. Elements included: a) exhaustion (PROMIS-Fatigue score) b) low physical activity (PROMIS-Physical Function score) c) slowness (TUG) d) weakness (Grip strength) and e) weight loss. If person had 3/5 elements present, they were considered and if 1-2/5 elements were present, they were considered pre-frail. Results Impaired physical function: 198/348 of ST patients (57% ), 35/48 of MH patients (72.9% ) and 9/28 pre-BMT ( 32% ). Significant Fatigue: 122/349 ST patients (35%), 24/46 of MH patients (52%) and 6/28 pre-BMT patients (21%). Frail and Pre-frail: 137/315 (44%) of ST patients met pre-frail criteria and 143/315 (45%) ST patients met frail criteria. 14/43 (33%) of MH patients were pre-frail and 27/43 (63%) MH patients were frail. 16/28 ( 57% ) of pre-BMT patients were pre-frail and 7/28 ( 25% ) pre-BMT patients were frail. Conclusion Malignant hematology patients are more likely to have impaired self-reported physical function, significant fatigue and be frail compared to patients selected to undergo BMT and those with solid tumors at time of initial presentation to a cancer rehabilitation clinic. Physical impairments, fatigue and frailty should be identified early at time of diagnosis, during active treatment and during survivorship period and appropriate rehabilitation interventions initiated to maximize function and quality of life.
This paper emphasizes the social (both medical and legal) usefulness of human body’s autopsy and dissection, revealing the specific forms in which the body of the deceased person can be used for teaching and scientific purposes. A distinct section deals with the moral-ethical value we place on the cadaver, pointing out the reasons for which a respectful attitude towards the dead human body is required. We also analyze on one hand, the potential ethical conflict between the need of invasive maneuvers like autopsy/dissection and, on the other hand, the right to physical integrity of each individual (including the deceased person). In this respect, we also address the legal and deontological aspects of autopsy (legal compulsoriness, confidentiality, professional secret, breach of confidentiality, ethical implications of related teaching activities) and those of dissection (legal ways of body procurement - with emphasis on autonomy and substitute decision-making in this domain, the fact that voluntary bequest of one’s body is morally preferable to the use of unclaimed bodies, respectful treatment of the cadaver during dissection, the need to show final respect towards the body remains - in the form of appropriate funeral services).
