Physikalische Medizin Rehabilitationsmedizin Kurortmedizin, Nov 14, 2005
Fragestellung: Das Symptom krebsassoziertes Fatiguesyndrom („Fatigue“) wird in der Literatur als ... more Fragestellung: Das Symptom krebsassoziertes Fatiguesyndrom („Fatigue“) wird in der Literatur als ein allgemeines, persistierendes und subjektives Gefuhl der Erschopfung beschrieben, welches in Zusammenhang mit der Krebserkrankung oder deren Behandlung steht und die betroffenen Patienten in ihrer Leistungsfahigkeit und ihren taglichen Verrichtungen behindert, was wiederum zu einer Einschrankung der Lebensqualitat (QOL) und der „Sozialen Partizipation“ fuhren kann. Die vorliegende Querschnittsuntersuchung hatte das Ziel, Zusammenhange zwischen dem Symptom „Fatigue“ mit der QOL und mit der „Sozialen Partizipation“ an Wiener Karzinompatienten unter ambulanter palliativer Chemotherapie zu untersuchen. Methode: 98 konsekutive Patienten (Durschnittsalter 56±8 Jahre) mit fortgeschrittener Karzinomerkrankung und infauster Prognose wurden in die Studie eingeschlossen. Alle Studienteilnehmer lebten zuhause und erhielten an der Abteilung fur Onkologie des Wiener Allgemeinen Krankenhauses als ambulante Patienten palliative Chemotherapien. Die Zielparameter „Fatigue“ und „Soziale Partizipation“ wurden anhand Visueller Analog-Skalen (VAS) registriert und dokumentiert. Die Erfassung der Lebensqualitat erfolgte mittels der deutschen Version des „SF-36 Health Survey“ (SF-36). Mittels statischer Analysen (Spearman-Korrelation) wurden Korrelationen zwischen „Fatigue“ und QOL sowie „Fatigue“ und „Sozialer Partizipation“ untersucht. Ergebnis: Es wurde keine signifikante Korrelation zwischen „Fatigue“ mit der QOL-Domane „Korperlicher Schmerz“ gefunden. Dagegen ergaben sich signifikante negative Korrelationen zwischen „Fatigue“ mit den QOL-Domanen „Korperliche Funktionsfahigkeit“ (p<0.0001, r=–0.56), „Korperliche Rollenfunktion“ (p<0.0001, r=–0.60), „Mentale Gesundheit“ (p=0.0003, r=–0.36), „Emotionelle Rollenfunktion“ (p<0.0001, r=–0.42), „Vitalitat“ (p<0.0001, r=–0.67), „Allgemeiner Gesundheitszustand“ (p=0.0016, r=–0.32) und „Soziale Kompetenz“ (p=0.0006, r=–0.34). Zusatzlich zeigte sich eine signifikante negative Korrelation zwischen dem Symptom „Fatigue“ mit der von den Patienten angegebenen „Sozialen Partizipation“ (p<0.0001, r=–0.44). Diskussion: Die Ergebnisse dieser Studie an ambulanten Wiener Patienten weisen auf einen negativen Einfluss des Symptoms „Fatigue“ auf die meisten Domanen der QOL und auf die „Soziale Partizipation“ bei Karzinompatienten unter palliativer Chemotherapie hin. Zusatzlich unterstreichen sie die klinische, Relevanz dem aktivitats- und funktionslimitierenden Symptom „Fatigue“ in der Rehabilitation solcher Patienten suffizient entgegenzuwirken.
A 48-year-old female patient suffering from advanced breast cancer with metastatic bone disease p... more A 48-year-old female patient suffering from advanced breast cancer with metastatic bone disease participated in an aerobic exercise program consisting of ergometer cycling three times a week for 1 year. Feasibility, safety and beneficial effects of the program were proven for the patient in this case study. VO(2)max (20.2% after 16 weeks, 52.7% after 12 months) and peak work capacity (15.5% after 16 weeks, 35.7% after 12 months) had increased. The patient experienced a marked improvement in physical performance and in quality of life. Aerobic exercise, initiated and executed with appropriate care, may serve as a useful additional means of palliative treatment in some cancer patients with bone metastases.
In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Sur... more In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&amp;amp;amp;amp;amp;amp;amp;amp;amp;R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&amp;amp;amp;amp;amp;amp;amp;amp;amp;R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.
We performed a pilot-study on pegylated liposomal doxorubicin (PLD) for advanced hepatocellular c... more We performed a pilot-study on pegylated liposomal doxorubicin (PLD) for advanced hepatocellular carcinoma. Seventeen patients received 40 mg/m 2 PLD intravenously every 4 weeks. A clinical benefit response was achieved in 50% (complete remission 7%, minor remission 7%, stable disease 36%). Toxicities were moderate. In view of these encouraging findings, further studies appear warranted.
With the increase in the number of patients who survive cancer, there is a growing need to attend... more With the increase in the number of patients who survive cancer, there is a growing need to attend to the physical and emotional effects of cancer and oncological treatment. Reduced physical performance, fatigue, nausea, weight gain, psychological distress, changes in body image, dependency, and reduced quality of life are some of the short-and long-term .sequelae of cancer. We describe data from the literature about firstly the effects of aerobic exercise as an additive treatment for cancer patients, and about the feasibility of aerobic exercise secondly during oncological treatment, and thirdly in patients suffering from terminal cancer. The data from the literature support that exercise as an additive treatment may help to attenuate the physical limitations caused by cancer and oncological treatment and there
Evidence Based Medicine in Physical Medicine and Rehabilitation In the last twenty years the term... more Evidence Based Medicine in Physical Medicine and Rehabilitation In the last twenty years the term "Evidence Based Medicine (EBM)" has spread into all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The definition of EBM is to use the physician's individual expertise, the patient's needs and the best external evidence for each individual patient. Today, however, the term EBM is often wrongly used as a synonym for best "external evidence". This leads not only to a misuse of evidence based medicine but suggests a fundamental misunderstanding of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions, public healthcare providers and politicians use external evidence alone as a main guideline for financing therapies in physical medicine and general rehabilitation without taking into account the physician's expertise and the patient's needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management). Absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in physical medicine and general rehabilitation will be analysed and discussed.
Muskelkraft und selbsteingeschätzte körperliche Leistungsfähigkeit bei österreichischen Glioblast... more Muskelkraft und selbsteingeschätzte körperliche Leistungsfähigkeit bei österreichischen Glioblastom-Patienten Zusammenfassung Grundlagen Die vorliegende Untersuchung hatte die Beschreibung der motorischen Grundeigenschaft "Kraft" (vor und nach Chemoradiatio) und deren Auswirkung auf die Leistungs-und Funktionsfähigkeit von Glioblastom (GBM)-Patienten zum Ziel. Methodik 24 Patienten (m:f = 19:5, 52 ± 14a, BMI = 26 ± 3 kg/m²) wurden in die vorliegende Pilot-Untersuchung eingeschlossen. Es wurden bei jedem Patienten eine "Handdynamometrie" mit Ermittlung der Faustschlusskraft (Jamar ®) sowie eine isokinetische Dynamometrie der Extensoren und Flexoren der Kniegelenke (Biodex ®-3) vor und nach Chemoradiatio (Abstand zwischen den Messungen = 14 ± 9 Wochen) durchgeführt. Die körperliche Leistungs-und Funktionsfähigkeit der Studienteilnehmer wurde mittels der Subskalen "Körperliche Funktionsfähigkeit" und "Körperliche Rollenfunktion" des SF-36 Health Survey erfragt. Ergebnisse Das maximale Drehmoment der Knieextensoren (maximales Drehmoment) lag deutlich unter den alters-und geschlechtsspezifischen Erwartungswerten (p < 0,0001). Verglichen mit alters-und geschlechtsspezifischen Referenzwerten konnten signifikante Defizite der selbsterfassten Leistungs-und Funktionsfähigkeit der Patienten ("Körperliche Rollenfunktion": p < 0,0001; "Körperliche Funktionsfähigkeit": p = 0,010) gefunden werden. Sowohl Faustschlusskraft als auch maximales Drehmoment zeigten signifikante (negative) Korrelationen mit der Subskala "Körperliche Funktionsfähigkeit" (maximales Drehmoment: p < 0,001; Faustschlusskraft: p < 0,001). Maximales Drehmoment (p = 0,337), Faustschlusskraft (p = 0,995), "Körperliche Funktionsfähigkeit" (p = 0,824), und "Körperliche Rollenfunktion" (0,594) änderten sich im Zeitverlauf (vor und nach Chemoradiatio) nicht signifikant. Schlussfolgerungen Im Rahmen der vorliegenden Studie an GBM-Patienten (vor und nach Chemoradiatio) konnten deutliche Defizite der Kraft der Knieextensoren und der selbsterfassten körperlichen Leistungs-und Funktionsfähigkeit gefunden werden. Da diese Defizite funktionell relevant für den Alltag der Patienten zu sein scheinen, sollte die Rehabilitation dieser Patienten Optionen zur Verbesserung der motorischen Grundeigenschaft Kraft inkludieren.
When thyroid and other cancers are &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more When thyroid and other cancers are &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;cured&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; it is often assumed that the patients are able to resume their normal lives. This was a cross-sectional study to evaluate health-related quality of life (HRQOL) and to identify rehabilitation needs of patients with non-metastatic thyroid cancer under thyroxine supplementation therapy. Included in the study were 150 consecutive patients with differentiated thyroid cancer (age 52 +/- 14 years, range 25-83 years; male/female 39/111). All patients had a history of total thyroidectomy followed by radioiodine ablation, were free of metastatic disease and under levothyroxine treatment. The mean period since the diagnosis of thyroid cancer was 5.5 +/- 6 years (range 0-23 years). Health-related quality of life was evaluated using the SF-36 Health Survey. The findings were compared with sex- and age-matched reference values. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Role-emotional&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Vitality&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; were significantly lower ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 and P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005, respectively) in the group as a whole ( n = 150). In the subgroup of patients with a recent (less than 1 year) diagnosis of thyroid cancer ( n = 51), however, the following subscales were significantly lower: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Mental Health&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Role-emotional&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Role-physical&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005),…
A 47-year-old female patient suffering from advanced lung cancer with metastatic bone and brain d... more A 47-year-old female patient suffering from advanced lung cancer with metastatic bone and brain disease participated in a passive exercise program, consisting of neuromuscular electrical stimulation (NMES) five times a week, carried out for 4 weeks. After the training period, the results of the 6-min walk (420 m before and 603 m after the training period) have improved by 44%, which demonstrates the increase of physical performance (mobility, endurance capacity). The results of the "Timed up and go" indicate an improvement of mobility and functional health of skeletal muscles. Furthermore, the quality of life (QOL)-scales (assessed by using the SF-36 health survey) "Physical functioning", "Role-physical", "Mental health", "Role-emotional", "Vitality", "Bodily pain", and "General health" showed improvements after the intervention period. Feasibility, safety, and beneficial effects of the NMES program were proven for the patient in this case study. These findings indicate that NMES, initiated and executed with appropriate care, may serve as a useful supportive means of palliative treatment in some patients with advanced cancer and metastatic disease, especially in cases of metastatic involvement of the brain and of the skeletal system with the risk of seizures and pathological fractures where volitional training is not allowed.
ABSTRACT Purpose: The present methodological observation aimed to compare assessment of pain and ... more ABSTRACT Purpose: The present methodological observation aimed to compare assessment of pain and of pain related disability when using different tools in Viennese outpatients suffering from advanced cancer during palliative chemotherapy. Materials and Methods: A total of 100 consecutive patients with a median age of 59 years (range 27.0-72.0 years) were included in this cross-sectional observation. All participants were suffering from metastatic cancer and, receiving palliative chemotherapy as outpatients at the Department of Oncology in the General Hospital of Vienna. Pain was registered on Visual analogue scale (VAS) and by using the SF-36 Health Survey subscale &quot;Bodily pain&quot;. The Pain Disability Index (PDI) was used to measure the degree of interference with normal role functioning caused by chronic pain. Associations between various outcome variables were quantified using Spearman&#39;s correlation coefficient. P-values &lt;= 0.05 were considered to be statistically significant. Results: &quot;Bodily pain&quot; showed a Spearman correlation coefficient of -0.87(p&lt;0.001)and -0.86 (p&lt;0.001) with VAS and PDI, respectively. PDI and VAS gave a Spearman correlation of 0.94 (p&lt;0.001). The various subscales of PDI showed moderate to high correlations with scores on &quot;Bodily pain&quot; (Spearman coefficients ranging from -0.55 for the subscale Life support activity to -0.84 for the subscale recreation, all p&lt;0.001) as well as with scores on VAS (Spearman coefficients ranging from 0.64 for the subscale Life support activity to 0.91 for the subscale recreation, all p&lt;0.001). Conclusions: The findings of the present investigation in Viennese Outpatients suffering from advanced cancer during palliative chemotherapy indicate high correlations between pain measured by VAS or by SF-36 subscale &quot;Bodily pain&quot;, with disability related to pain and its impact on QOL measured using PDI. All instruments seem to be adequate for pain assessment in this patient group. For clinical practice of pain assessment in patients with different advanced cancer we recommend the usage of VAS for simple assessing intensity of pain. SF-36 should be used, if assessment of QOL including &quot;Bodily pain&quot; is required. Assessment by PDI should be recommended as long as no ICF (International Classification of Functioning, Disability and Health) Core-sets are available, or to accomplish established Core sets for assessing disability related to pain in advanced cancer.
Ziel: Aerobes Bewegungstraining (ABT) hat positive Effekte auf die körperliche Leistungsfähigkeit... more Ziel: Aerobes Bewegungstraining (ABT) hat positive Effekte auf die körperliche Leistungsfähigkeit und auf die krankheitsbezogene Lebensqualität von Krebspatienten. Die Ergebnisse der ersten österreichischen ambulanten ABT-Gruppe für Brustkrebspatientinnen werden präsentiert, wobei als Zielparameter Machbarkeit und Praktikabilität in einem österreichischen Schwerpunktkrankenhaus sowie die Wirkungen eines ambulanten ABT-Programmes für Brustkrebspatientinnen evaluiert wurden. Methoden: Sieben Patientinnen (50 14 Jahre) nahmen an dem ABT-Programm während adjuvanter Chemo-und/oder Radiotherapie teil. Eine Patientin musste aufgrund eines Erysipels ausgeschlossen werden. Vor und nach der Intervention (aerobes Ausdauertraining auf einem Standfahrrad bei 60 % der maximalen Leistungsfähigkeit über 12 Wochen, dreimal wöchentlich eine Stunde) wurde die Ausdauerleistungsfähigkeit mittels Spiroergometrie bestimmt. Von den Patientinnen wurden Fragebogen ausgefüllt, womit ¾nderungen der Lebensqualität, die physischen Aktivitäten und der von den Patientinnen subjektiv erlebte Profit durch das ABT erhoben wurden. Ergebnisse: Trotz der adjuvanten onkologischen Therapien führten alle Patientinnen das ABT sicher und problemlos durch. Es ergab sich eine Steigerung der Ausdauerleistung von 17,2 % (10,19, peak VO 2-uptake) und von 25,5 % (16,18, VO 2-uptake an der anaeroben Schwelle). Das Quality-of-Life-Assessment ergab signifikante Verbesserungen für das psychische Wohlbefinden sowie tendenzielle Verbesserungen für beinahe alle Dimensionen der Lebensqualität. Die Patienten zeigten eine ausgezeichnete Compliance und gaben für das ABT und den Profit aus dieser Maûnahme ausgezeichnete Bewertungen. Schlussfolgerungen: Die Ergebnisse dieser ersten österreichischen Gruppe unterstreichen die Machbarkeit und Praktikabilität der Maûnahme in einem österreichischen Zent-Abstract Objective: Aerobic exercise has positive effects on physical performance and illness-related quality of life of cancer patients. Results of the first Austrian aerobic exercise group for breast cancer outpatients during adjuvant oncological therapy are presented. Aim was to evaluate effects and feasibility of an aerobic exercise programme for breast cancer outpatients during adjuvant chemo-and/or radiation therapy in an Austrian medical center. Methods: Seven female patients (50 14 years) participated in an aerobic exercise programme during adjuvant chemo-and/or radiation therapy. One patient had to be excluded due to erysipelas. Before and after intervention (cycle ergometry at 60 % of maximal heart rate, 12 weeks, 3x/week) endurance performance was determined by exercise testing and the patients filled in questionnaires to assess quality of life and to classify physical activity and subjective experienced benefit. Results: Despite adjuvant oncological therapies all patients performed the aerobic exercise with no adverse events and showed an improvement of endurance performance by 17.2 % (10.19, peak VO 2-uptake) and by 25.5 % (16.18, VO 2-uptake at treshold). Quality of life assessment revealed a significant improvement of emotional wellbeing. Patients showed excellent compliance and reported high experienced benefit due to the treatment. Conclusions: Present results of the first Austrian group underline the feasibility and indicate the benefit of aerobic exercise for breast cancer outpatients during adjuvant chemo-and/or radiation therapy in an Austrian medical center.
An increasing number of patients with glioblastoma multiforme live longer than 3 years after diag... more An increasing number of patients with glioblastoma multiforme live longer than 3 years after diagnosis (long-term survivors). Even so, little is known about their everyday performance and quality of life. We studied 17 glioblastoma patients surviving for longer than 3 years. We assessed all patients using the computerized neurocognitive assessment instrument NeuroCog FX test, the EORTC QLQ-C30, the EORTC QLQ-BN20, the Hospital Anxiety and Depression Scale, the Ten-Meter Walking Test, the Nine Hole Peg Test, the Boston Aphasia Severity Scale, and the Activities of Daily Living and Instrumental Activities of Daily Living forms. We included 9 female and 8 male glioblastoma long-term survivors with a median age of 51 years (24-71). The majority of the patients (10/ 17) scored normal in the NeuroCog FX test. However, financial difficulties, reduced social and cognitive functioning, and future uncertainty were frequently reported. Three patients showed conspicuous depression scores, two had noticeable anxiety results. Drowsiness and fatigue were the most often reported physical complaints. There were 12/17 patients who were fully independent concerning activities of daily living and 14 patients (82%) showed C90 points in the Barthel Index, but 6 patients (35%) were impaired in their manual dexterity, and 1 patient in mobility. Glioblastoma long-term survivors show moderate impairment in their cognitive functions and more often neurological symptoms. However, the majority of these patients are able to manage their daily routine independently. Nevertheless, future prospects remain poor and patients suffer from financial difficulties. Keywords Brain tumor Á Cognition Á Glioblastma multiforme Á Long-term survivor Á Neurocognitive outcome Á Quality of life Á Sociodemographic characteristics Electronic supplementary material The online version of this article (
The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (... more The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha)) of 61 advanced stage cancer patients receiving palliative chemotherapy as outpatients were determined with quantikine immunoassays. The values were correlated with body mass index (BMI), weight loss and appetite. Furthermore cytokine levels of patients who have died within one year were compared with those of patients who have survived more than a year. Serum levels of IL-6 (median: 1.93 pg/ml, range: 0.32-42.87) and of TNF-alpha (median: 2.55 pg/ml, range: 1.03-34.06) did not correlate with BMI, weight loss and appetite. Serum IL-6 levels of patients with survival time less than one year were significantly higher than the levels of patients who survived more than one year, no significant differences in TNF-alpha serum levels were evident. The data of this observation are consistent with current literature. Due to changes in serum levels of proinflammatory cytokines in response to chemotherapy and additional therapy, it is unlikely that IL-6 and TNF-alpha can be used as independent indicators for weight loss and appetite. Nevertheless, high serum levels of IL-6 correlate with short-time mortality.
Physikalische Medizin Rehabilitationsmedizin Kurortmedizin, Nov 14, 2005
Fragestellung: Das Symptom krebsassoziertes Fatiguesyndrom („Fatigue“) wird in der Literatur als ... more Fragestellung: Das Symptom krebsassoziertes Fatiguesyndrom („Fatigue“) wird in der Literatur als ein allgemeines, persistierendes und subjektives Gefuhl der Erschopfung beschrieben, welches in Zusammenhang mit der Krebserkrankung oder deren Behandlung steht und die betroffenen Patienten in ihrer Leistungsfahigkeit und ihren taglichen Verrichtungen behindert, was wiederum zu einer Einschrankung der Lebensqualitat (QOL) und der „Sozialen Partizipation“ fuhren kann. Die vorliegende Querschnittsuntersuchung hatte das Ziel, Zusammenhange zwischen dem Symptom „Fatigue“ mit der QOL und mit der „Sozialen Partizipation“ an Wiener Karzinompatienten unter ambulanter palliativer Chemotherapie zu untersuchen. Methode: 98 konsekutive Patienten (Durschnittsalter 56±8 Jahre) mit fortgeschrittener Karzinomerkrankung und infauster Prognose wurden in die Studie eingeschlossen. Alle Studienteilnehmer lebten zuhause und erhielten an der Abteilung fur Onkologie des Wiener Allgemeinen Krankenhauses als ambulante Patienten palliative Chemotherapien. Die Zielparameter „Fatigue“ und „Soziale Partizipation“ wurden anhand Visueller Analog-Skalen (VAS) registriert und dokumentiert. Die Erfassung der Lebensqualitat erfolgte mittels der deutschen Version des „SF-36 Health Survey“ (SF-36). Mittels statischer Analysen (Spearman-Korrelation) wurden Korrelationen zwischen „Fatigue“ und QOL sowie „Fatigue“ und „Sozialer Partizipation“ untersucht. Ergebnis: Es wurde keine signifikante Korrelation zwischen „Fatigue“ mit der QOL-Domane „Korperlicher Schmerz“ gefunden. Dagegen ergaben sich signifikante negative Korrelationen zwischen „Fatigue“ mit den QOL-Domanen „Korperliche Funktionsfahigkeit“ (p<0.0001, r=–0.56), „Korperliche Rollenfunktion“ (p<0.0001, r=–0.60), „Mentale Gesundheit“ (p=0.0003, r=–0.36), „Emotionelle Rollenfunktion“ (p<0.0001, r=–0.42), „Vitalitat“ (p<0.0001, r=–0.67), „Allgemeiner Gesundheitszustand“ (p=0.0016, r=–0.32) und „Soziale Kompetenz“ (p=0.0006, r=–0.34). Zusatzlich zeigte sich eine signifikante negative Korrelation zwischen dem Symptom „Fatigue“ mit der von den Patienten angegebenen „Sozialen Partizipation“ (p<0.0001, r=–0.44). Diskussion: Die Ergebnisse dieser Studie an ambulanten Wiener Patienten weisen auf einen negativen Einfluss des Symptoms „Fatigue“ auf die meisten Domanen der QOL und auf die „Soziale Partizipation“ bei Karzinompatienten unter palliativer Chemotherapie hin. Zusatzlich unterstreichen sie die klinische, Relevanz dem aktivitats- und funktionslimitierenden Symptom „Fatigue“ in der Rehabilitation solcher Patienten suffizient entgegenzuwirken.
A 48-year-old female patient suffering from advanced breast cancer with metastatic bone disease p... more A 48-year-old female patient suffering from advanced breast cancer with metastatic bone disease participated in an aerobic exercise program consisting of ergometer cycling three times a week for 1 year. Feasibility, safety and beneficial effects of the program were proven for the patient in this case study. VO(2)max (20.2% after 16 weeks, 52.7% after 12 months) and peak work capacity (15.5% after 16 weeks, 35.7% after 12 months) had increased. The patient experienced a marked improvement in physical performance and in quality of life. Aerobic exercise, initiated and executed with appropriate care, may serve as a useful additional means of palliative treatment in some cancer patients with bone metastases.
In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Sur... more In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&amp;amp;amp;amp;amp;amp;amp;amp;amp;R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&amp;amp;amp;amp;amp;amp;amp;amp;amp;R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.
We performed a pilot-study on pegylated liposomal doxorubicin (PLD) for advanced hepatocellular c... more We performed a pilot-study on pegylated liposomal doxorubicin (PLD) for advanced hepatocellular carcinoma. Seventeen patients received 40 mg/m 2 PLD intravenously every 4 weeks. A clinical benefit response was achieved in 50% (complete remission 7%, minor remission 7%, stable disease 36%). Toxicities were moderate. In view of these encouraging findings, further studies appear warranted.
With the increase in the number of patients who survive cancer, there is a growing need to attend... more With the increase in the number of patients who survive cancer, there is a growing need to attend to the physical and emotional effects of cancer and oncological treatment. Reduced physical performance, fatigue, nausea, weight gain, psychological distress, changes in body image, dependency, and reduced quality of life are some of the short-and long-term .sequelae of cancer. We describe data from the literature about firstly the effects of aerobic exercise as an additive treatment for cancer patients, and about the feasibility of aerobic exercise secondly during oncological treatment, and thirdly in patients suffering from terminal cancer. The data from the literature support that exercise as an additive treatment may help to attenuate the physical limitations caused by cancer and oncological treatment and there
Evidence Based Medicine in Physical Medicine and Rehabilitation In the last twenty years the term... more Evidence Based Medicine in Physical Medicine and Rehabilitation In the last twenty years the term "Evidence Based Medicine (EBM)" has spread into all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The definition of EBM is to use the physician's individual expertise, the patient's needs and the best external evidence for each individual patient. Today, however, the term EBM is often wrongly used as a synonym for best "external evidence". This leads not only to a misuse of evidence based medicine but suggests a fundamental misunderstanding of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions, public healthcare providers and politicians use external evidence alone as a main guideline for financing therapies in physical medicine and general rehabilitation without taking into account the physician's expertise and the patient's needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management). Absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in physical medicine and general rehabilitation will be analysed and discussed.
Muskelkraft und selbsteingeschätzte körperliche Leistungsfähigkeit bei österreichischen Glioblast... more Muskelkraft und selbsteingeschätzte körperliche Leistungsfähigkeit bei österreichischen Glioblastom-Patienten Zusammenfassung Grundlagen Die vorliegende Untersuchung hatte die Beschreibung der motorischen Grundeigenschaft "Kraft" (vor und nach Chemoradiatio) und deren Auswirkung auf die Leistungs-und Funktionsfähigkeit von Glioblastom (GBM)-Patienten zum Ziel. Methodik 24 Patienten (m:f = 19:5, 52 ± 14a, BMI = 26 ± 3 kg/m²) wurden in die vorliegende Pilot-Untersuchung eingeschlossen. Es wurden bei jedem Patienten eine "Handdynamometrie" mit Ermittlung der Faustschlusskraft (Jamar ®) sowie eine isokinetische Dynamometrie der Extensoren und Flexoren der Kniegelenke (Biodex ®-3) vor und nach Chemoradiatio (Abstand zwischen den Messungen = 14 ± 9 Wochen) durchgeführt. Die körperliche Leistungs-und Funktionsfähigkeit der Studienteilnehmer wurde mittels der Subskalen "Körperliche Funktionsfähigkeit" und "Körperliche Rollenfunktion" des SF-36 Health Survey erfragt. Ergebnisse Das maximale Drehmoment der Knieextensoren (maximales Drehmoment) lag deutlich unter den alters-und geschlechtsspezifischen Erwartungswerten (p < 0,0001). Verglichen mit alters-und geschlechtsspezifischen Referenzwerten konnten signifikante Defizite der selbsterfassten Leistungs-und Funktionsfähigkeit der Patienten ("Körperliche Rollenfunktion": p < 0,0001; "Körperliche Funktionsfähigkeit": p = 0,010) gefunden werden. Sowohl Faustschlusskraft als auch maximales Drehmoment zeigten signifikante (negative) Korrelationen mit der Subskala "Körperliche Funktionsfähigkeit" (maximales Drehmoment: p < 0,001; Faustschlusskraft: p < 0,001). Maximales Drehmoment (p = 0,337), Faustschlusskraft (p = 0,995), "Körperliche Funktionsfähigkeit" (p = 0,824), und "Körperliche Rollenfunktion" (0,594) änderten sich im Zeitverlauf (vor und nach Chemoradiatio) nicht signifikant. Schlussfolgerungen Im Rahmen der vorliegenden Studie an GBM-Patienten (vor und nach Chemoradiatio) konnten deutliche Defizite der Kraft der Knieextensoren und der selbsterfassten körperlichen Leistungs-und Funktionsfähigkeit gefunden werden. Da diese Defizite funktionell relevant für den Alltag der Patienten zu sein scheinen, sollte die Rehabilitation dieser Patienten Optionen zur Verbesserung der motorischen Grundeigenschaft Kraft inkludieren.
When thyroid and other cancers are &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more When thyroid and other cancers are &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;cured&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; it is often assumed that the patients are able to resume their normal lives. This was a cross-sectional study to evaluate health-related quality of life (HRQOL) and to identify rehabilitation needs of patients with non-metastatic thyroid cancer under thyroxine supplementation therapy. Included in the study were 150 consecutive patients with differentiated thyroid cancer (age 52 +/- 14 years, range 25-83 years; male/female 39/111). All patients had a history of total thyroidectomy followed by radioiodine ablation, were free of metastatic disease and under levothyroxine treatment. The mean period since the diagnosis of thyroid cancer was 5.5 +/- 6 years (range 0-23 years). Health-related quality of life was evaluated using the SF-36 Health Survey. The findings were compared with sex- and age-matched reference values. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Role-emotional&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Vitality&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; were significantly lower ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 and P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005, respectively) in the group as a whole ( n = 150). In the subgroup of patients with a recent (less than 1 year) diagnosis of thyroid cancer ( n = 51), however, the following subscales were significantly lower: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Mental Health&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Role-emotional&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Role-physical&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005),…
A 47-year-old female patient suffering from advanced lung cancer with metastatic bone and brain d... more A 47-year-old female patient suffering from advanced lung cancer with metastatic bone and brain disease participated in a passive exercise program, consisting of neuromuscular electrical stimulation (NMES) five times a week, carried out for 4 weeks. After the training period, the results of the 6-min walk (420 m before and 603 m after the training period) have improved by 44%, which demonstrates the increase of physical performance (mobility, endurance capacity). The results of the "Timed up and go" indicate an improvement of mobility and functional health of skeletal muscles. Furthermore, the quality of life (QOL)-scales (assessed by using the SF-36 health survey) "Physical functioning", "Role-physical", "Mental health", "Role-emotional", "Vitality", "Bodily pain", and "General health" showed improvements after the intervention period. Feasibility, safety, and beneficial effects of the NMES program were proven for the patient in this case study. These findings indicate that NMES, initiated and executed with appropriate care, may serve as a useful supportive means of palliative treatment in some patients with advanced cancer and metastatic disease, especially in cases of metastatic involvement of the brain and of the skeletal system with the risk of seizures and pathological fractures where volitional training is not allowed.
ABSTRACT Purpose: The present methodological observation aimed to compare assessment of pain and ... more ABSTRACT Purpose: The present methodological observation aimed to compare assessment of pain and of pain related disability when using different tools in Viennese outpatients suffering from advanced cancer during palliative chemotherapy. Materials and Methods: A total of 100 consecutive patients with a median age of 59 years (range 27.0-72.0 years) were included in this cross-sectional observation. All participants were suffering from metastatic cancer and, receiving palliative chemotherapy as outpatients at the Department of Oncology in the General Hospital of Vienna. Pain was registered on Visual analogue scale (VAS) and by using the SF-36 Health Survey subscale &quot;Bodily pain&quot;. The Pain Disability Index (PDI) was used to measure the degree of interference with normal role functioning caused by chronic pain. Associations between various outcome variables were quantified using Spearman&#39;s correlation coefficient. P-values &lt;= 0.05 were considered to be statistically significant. Results: &quot;Bodily pain&quot; showed a Spearman correlation coefficient of -0.87(p&lt;0.001)and -0.86 (p&lt;0.001) with VAS and PDI, respectively. PDI and VAS gave a Spearman correlation of 0.94 (p&lt;0.001). The various subscales of PDI showed moderate to high correlations with scores on &quot;Bodily pain&quot; (Spearman coefficients ranging from -0.55 for the subscale Life support activity to -0.84 for the subscale recreation, all p&lt;0.001) as well as with scores on VAS (Spearman coefficients ranging from 0.64 for the subscale Life support activity to 0.91 for the subscale recreation, all p&lt;0.001). Conclusions: The findings of the present investigation in Viennese Outpatients suffering from advanced cancer during palliative chemotherapy indicate high correlations between pain measured by VAS or by SF-36 subscale &quot;Bodily pain&quot;, with disability related to pain and its impact on QOL measured using PDI. All instruments seem to be adequate for pain assessment in this patient group. For clinical practice of pain assessment in patients with different advanced cancer we recommend the usage of VAS for simple assessing intensity of pain. SF-36 should be used, if assessment of QOL including &quot;Bodily pain&quot; is required. Assessment by PDI should be recommended as long as no ICF (International Classification of Functioning, Disability and Health) Core-sets are available, or to accomplish established Core sets for assessing disability related to pain in advanced cancer.
Ziel: Aerobes Bewegungstraining (ABT) hat positive Effekte auf die körperliche Leistungsfähigkeit... more Ziel: Aerobes Bewegungstraining (ABT) hat positive Effekte auf die körperliche Leistungsfähigkeit und auf die krankheitsbezogene Lebensqualität von Krebspatienten. Die Ergebnisse der ersten österreichischen ambulanten ABT-Gruppe für Brustkrebspatientinnen werden präsentiert, wobei als Zielparameter Machbarkeit und Praktikabilität in einem österreichischen Schwerpunktkrankenhaus sowie die Wirkungen eines ambulanten ABT-Programmes für Brustkrebspatientinnen evaluiert wurden. Methoden: Sieben Patientinnen (50 14 Jahre) nahmen an dem ABT-Programm während adjuvanter Chemo-und/oder Radiotherapie teil. Eine Patientin musste aufgrund eines Erysipels ausgeschlossen werden. Vor und nach der Intervention (aerobes Ausdauertraining auf einem Standfahrrad bei 60 % der maximalen Leistungsfähigkeit über 12 Wochen, dreimal wöchentlich eine Stunde) wurde die Ausdauerleistungsfähigkeit mittels Spiroergometrie bestimmt. Von den Patientinnen wurden Fragebogen ausgefüllt, womit ¾nderungen der Lebensqualität, die physischen Aktivitäten und der von den Patientinnen subjektiv erlebte Profit durch das ABT erhoben wurden. Ergebnisse: Trotz der adjuvanten onkologischen Therapien führten alle Patientinnen das ABT sicher und problemlos durch. Es ergab sich eine Steigerung der Ausdauerleistung von 17,2 % (10,19, peak VO 2-uptake) und von 25,5 % (16,18, VO 2-uptake an der anaeroben Schwelle). Das Quality-of-Life-Assessment ergab signifikante Verbesserungen für das psychische Wohlbefinden sowie tendenzielle Verbesserungen für beinahe alle Dimensionen der Lebensqualität. Die Patienten zeigten eine ausgezeichnete Compliance und gaben für das ABT und den Profit aus dieser Maûnahme ausgezeichnete Bewertungen. Schlussfolgerungen: Die Ergebnisse dieser ersten österreichischen Gruppe unterstreichen die Machbarkeit und Praktikabilität der Maûnahme in einem österreichischen Zent-Abstract Objective: Aerobic exercise has positive effects on physical performance and illness-related quality of life of cancer patients. Results of the first Austrian aerobic exercise group for breast cancer outpatients during adjuvant oncological therapy are presented. Aim was to evaluate effects and feasibility of an aerobic exercise programme for breast cancer outpatients during adjuvant chemo-and/or radiation therapy in an Austrian medical center. Methods: Seven female patients (50 14 years) participated in an aerobic exercise programme during adjuvant chemo-and/or radiation therapy. One patient had to be excluded due to erysipelas. Before and after intervention (cycle ergometry at 60 % of maximal heart rate, 12 weeks, 3x/week) endurance performance was determined by exercise testing and the patients filled in questionnaires to assess quality of life and to classify physical activity and subjective experienced benefit. Results: Despite adjuvant oncological therapies all patients performed the aerobic exercise with no adverse events and showed an improvement of endurance performance by 17.2 % (10.19, peak VO 2-uptake) and by 25.5 % (16.18, VO 2-uptake at treshold). Quality of life assessment revealed a significant improvement of emotional wellbeing. Patients showed excellent compliance and reported high experienced benefit due to the treatment. Conclusions: Present results of the first Austrian group underline the feasibility and indicate the benefit of aerobic exercise for breast cancer outpatients during adjuvant chemo-and/or radiation therapy in an Austrian medical center.
An increasing number of patients with glioblastoma multiforme live longer than 3 years after diag... more An increasing number of patients with glioblastoma multiforme live longer than 3 years after diagnosis (long-term survivors). Even so, little is known about their everyday performance and quality of life. We studied 17 glioblastoma patients surviving for longer than 3 years. We assessed all patients using the computerized neurocognitive assessment instrument NeuroCog FX test, the EORTC QLQ-C30, the EORTC QLQ-BN20, the Hospital Anxiety and Depression Scale, the Ten-Meter Walking Test, the Nine Hole Peg Test, the Boston Aphasia Severity Scale, and the Activities of Daily Living and Instrumental Activities of Daily Living forms. We included 9 female and 8 male glioblastoma long-term survivors with a median age of 51 years (24-71). The majority of the patients (10/ 17) scored normal in the NeuroCog FX test. However, financial difficulties, reduced social and cognitive functioning, and future uncertainty were frequently reported. Three patients showed conspicuous depression scores, two had noticeable anxiety results. Drowsiness and fatigue were the most often reported physical complaints. There were 12/17 patients who were fully independent concerning activities of daily living and 14 patients (82%) showed C90 points in the Barthel Index, but 6 patients (35%) were impaired in their manual dexterity, and 1 patient in mobility. Glioblastoma long-term survivors show moderate impairment in their cognitive functions and more often neurological symptoms. However, the majority of these patients are able to manage their daily routine independently. Nevertheless, future prospects remain poor and patients suffer from financial difficulties. Keywords Brain tumor Á Cognition Á Glioblastma multiforme Á Long-term survivor Á Neurocognitive outcome Á Quality of life Á Sociodemographic characteristics Electronic supplementary material The online version of this article (
The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (... more The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha)) of 61 advanced stage cancer patients receiving palliative chemotherapy as outpatients were determined with quantikine immunoassays. The values were correlated with body mass index (BMI), weight loss and appetite. Furthermore cytokine levels of patients who have died within one year were compared with those of patients who have survived more than a year. Serum levels of IL-6 (median: 1.93 pg/ml, range: 0.32-42.87) and of TNF-alpha (median: 2.55 pg/ml, range: 1.03-34.06) did not correlate with BMI, weight loss and appetite. Serum IL-6 levels of patients with survival time less than one year were significantly higher than the levels of patients who survived more than one year, no significant differences in TNF-alpha serum levels were evident. The data of this observation are consistent with current literature. Due to changes in serum levels of proinflammatory cytokines in response to chemotherapy and additional therapy, it is unlikely that IL-6 and TNF-alpha can be used as independent indicators for weight loss and appetite. Nevertheless, high serum levels of IL-6 correlate with short-time mortality.
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