The purpose of this study was to evaluate novel inflammatory and nutritional prognostic factors in patients with advanced colorectal cancer (ACRC). All ACRC patients attending the clinic for palliative treatment were eligible for study. Demographics, including performance status (PS), C-reactive protein (CRP), albumin (Alb), Glasgow prognostic score (GPS), weight, weight history, body mass index (BMI), and nutritional status using the patient-generated subjective global assessment (PGSGA), were collected and correlated with survival. At a median follow-up of 29.8 mo, with a minimum follow-up of 15.7 mo, the median survival was 9.9 mo (0.8-21.8 mo). Fifteen (29%) patients were newly diagnosed (stage IV colorectal cancer), and 36 (71%) had received prior chemotherapy. Although the median BMI was 27 kg/m2 (range = 17-41 kg/m2), 28 of 50 (56%) were nutritionally at risk. In fact, 19 patients (38%) were critically in need of nutrition intervention (PGSGA score of > or =9). Thirty-three of 48 patients (69%) had an elevated CRP (>10 mg/l with a median of 21.1 mg/L), and 7 patients (15%) had both a CRP of >10 mg/l and hypoalbuminemia (< 35 g/l). A significant positive correlation was found between PGSGA score and CRP (P = 0.003; r = 0.430). Using univariate analysis, significantly worse survival was found for patients with poorer PS (P = 0.001), high GPS (P = 0.04), low Alb (P = 0.017), elevated serum alkaline phosphatase (SAP; P = 0.018), PGSGA score of > 9 (P = 0.001), and PGSGA group B/C (P = 0.02). Using the Cox proportional hazard model for multivariate survival analysis, type of treatment (hazard ratio, HR = 1.48; 95% confidence interval, CI = 1.11-1.79; P = 0.005), PS (HR = 2.37; 95% CI = 1.11-5.09; P = 0.026), GPS (HR = 2.27; 95% CI = 1.09-4.73; P = 0.028), and SAP (HR = 0.44; 95% CI = 0.18-1.07; P =0.069) remained significant predictors of survival. These preliminary data suggest that the type of treatment, PS, GPS, and SAP are important predictors of survival in ACRC.

The evaluation of nutritional status in cancer patients is often neglected in spite of the fact that poor nutritional status may adversely affect prognosis and treatment tolerance. In day-to-day oncology practice, a sensitive but simply applied nutritional assessment tool is needed to identify at-risk patients. Several tools exist; however, none has been universally accepted. The aim of this study was to compare two potential tools, the Mini-Nutritional Assessment (MNA) and the scored Patient Generated Subjective Global Assessment (PGSGA). The MNA is more simply applied and does not require a trained dietitian. The PGSGA has been previously validated in cancer patients. One hundred fifty-seven newly diagnosed cancer patients were assessed using both tools. Of these, 126 were reassessed at 4-6 wk, and 104 were reassessed at Weeks 8-12 after initial assessment. A significant negative correlation was found between the tools at all three time periods (at baseline r = -0.76; P < 0.001). Taking the PGSGA as the most accepted nutritional assessment tool, at baseline the MNA demonstrated a sensitivity of 97% and specificity of 54%. At 4-6 wk MNA sensitivity was 79% and specificity was 69%. At 8-12 wk MNA sensitivity was 93% and specificity was 82%. When comparing the tools in elderly patients alone (>65 yr), similar results were obtained. Both tools were able to correctly classify patients as malnourished, although the MNA lacks specificity. Therefore, the PGSGA should be the tool of choice for nutritional assessment in cancer patients.

Aims• To determine whether a basic set of Pilates exercises improves the efficiency of load transfer through the pelvis • To compare the effects on chronic, mild low back pain (LBP) symptoms of three slightly different Pilates based regimes MethodsA between subjects equivalent group experimental design was used -Independent variable: type of exercise training (three groups) -Dependent variables: efficient load transfer through the pelvis as measured by the stork test in weight bearing; low back pain symptoms At entry, to establish baseline values, subjects completed an Oswestry DisabilityQuestionnaire and recorded the frequency, intensity and duration of their back pain in an average week. Also, a Stork test was recorded.Thirty-nine volunteers with mild chronic low back pain (CLBP) were taught four Pilates based exercises before being randomly allocated to one of three groups for the addition of other interventions.• Groups A received four basic exercises• Groups B and C received an additional relaxation posture using a specific spinal support • Group C received an additional postural training exercise Exercises were performed three times per week for six weeks and recording was done once per week for eight weeks. For each of the eight weeks, subjects recorded frequency, intensity and duration of back pain ii At the final assessment, subjects completed another Oswestry Disability Questionnaire, returned their recording sheets, had a stork test recorded and their exercises checked. Results Oswestry Disability QuestionnairePre and post comparison of answers showed only one statistically significant improvement among subject groups. This was for question one, 'Do you have back pain at present?' where Group B reported significantly less pain post program compared with pre program (Wilcoxon, z=-2.496, p=0.013). Number of days of painGroup B experienced a statistically significant reduction in the number of days of pain between Week 1 and Weeks 6 to 8 (F 7,84 =6.4, p=0.0001). Post hoc analysis using Scheffé showed significant differences between Week 1 and Weeks 6, 7 and 8 and between Week 2 and Week 8 (p<0.05). There were statistically significant differences by week within Group C (F 7,77 =3.29, p=0.0041), but they only show up with Fisher (p<0.05) and they were between Week 1 and Weeks 6, 7 and 8, Week 2 and Weeks 6, 7 and 8, Week 3 and Weeks 6 and 7 and between Week 4 and Week 7.Some of the improvements were lost once exercising ceased at the end of week 6 Duration of back pain episodesAll groups experienced a reduction in the mean length of the shortest, longest and average pain episodes. At week eight all groups had subjects who were pain free (Group A: 7.7%, Group B: 30.8%, Group C: 25%) and in Group B, no subjects reported pain episodes longer than six hours. However, differences were not statistically significant for the duration of this study.Some of the improvements were lost once exercising ceased at the end of week 6iii Intensity of pain across all lengths of pain episodes While, all groups exper...

Background:The aim of the study was to assess the nutritional status of cancer patients attending the medical oncology outpatient setting for the first time. Methods: One-hundred and forty-one patients (87 males, 54 females) were assessed by a dietitian, using the nutrition assessment tool, the Patient-Generated Subjective Global Assessment (PG-SGA). Tumor types included colorectal, head and neck, lung, pancreatic, gastric or esophageal cancer. No patient had previously received chemotherapy. Results: Forty-eight (34%) patients were well nourished (PG-SGA rating A), 79 (56%) patients were at risk of malnutrition (B), and 14 (10%) patients were malnourished (C). The median PG-SGA score was 7. There were no significant differences in nutritional status between those >65 years and those ≤65 years. The highest PG-SGA scores (indicating a greater nutritional risk) were found in patients with gastric, pancreatic and oesophageal cancers. There were significant differences found between certain cancer groups using the PG-SGA, however, these were not detected using other more commonly used criteria, such as the body mass index (BMI). Conclusion: This study confirms that the majority of new patients with cancer presenting to a medical oncologist are at risk of malnutrition or malnourished. It calls for better screening, and adequate nutrition intervention in patients who are about to be considered for systemic treatment.