Background: Age-related sarcopenia is a serious global health issue in elderly individuals and for the community as it induces disability and significant economic burden. The purpose of the study is to understand the factors associated with sarcopenia and the role of growth hormone (GH) and insulin-like growth factor (IGF-1) in the occurrence of sarcopenia. Methods: Elderly patients (n = 3276) were included in this cross-sectional study. Survey and measurement of body composition (bioelectrical impedance), grip strength, and step speed were performed according to the Asian Working Group on Sarcopenia (AWGS) diagnostic criteria. Hematological and hormonal indicators were compared between patients with and without sarcopenia in order to identify the associated factors. Results: There were significant differences in the demographic parameters between the sarcopenia and nonsarcopenia groups (all P < 0.05). There were significant differences between the two groups regarding the blood levels of GH, IGF-1, testosterone (T), and mechanical growth factor (MGF) (all P < 0.001). Correlation analyses showed that the appendicular skeletal muscle mass (ASMI) was positively associated with gender and BMI, and with GH, T, IGF-1, MGF, BUN, Cr, and Hb levels, but negatively associated with HDL-C (all P < 0.05). Logistic multivariable regression analysis showed that IGF-1, MGF, BMI, and gender were independently associated with appendicular skeletal muscle mass (ASMI) (all P < 0.05). Conclusions: GH and IGF-1 are associated with sarcopenia in the elderly. IGF-1 and MGF are independently associated with the reduction of skeletal muscle mass, along with BMI and gender.

Objectives Chemotherapy-induced peripheral neuropathy is frequently a dose-limiting factor in cancer treatment and may cause pain and irreversible function loss in cancer survivors. We tested whether alpha-lipoic acid (ALA) could decrease the severity of peripheral neuropathy symptoms in patients undergoing platinum-based chemotherapy. Methods Cancer patients 18 years or older were randomly selected to receive either 600 mg ALA or a placebo three times a day orally for 24 weeks while receiving chemotherapy regimens including cisplatin or oxaliplatin. Neuropathy was measured by the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) scale and the NCI Common Toxicity Criteria for Adverse Events neurotoxicity grades. Results from timed functional tests and the Brief Pain Inventory (BPI) were secondary endpoints. Results 70 of 243 (29%) patients completed the study (24 weeks). Both the ALA and the placebo arms had a comparable drop-out rate. No statistically significant differences were found between the ALA and the placebo groups for FACT/GOG-Ntx scores, BPI scores, and patients’ functional outcomes.. Conclusion This strategy of oral ALA administration was ineffective at preventing neurotoxicity caused by oxaliplatin or cisplatin. High attrition rates due to poor patient compliance and manner of dosage administration in this trial demonstrated a lack of feasibility for this intervention. Future studies to explore ALA as a neuroprotective agent should take heed of the barriers confronted in this study.

Transferring back to the acute oncology service is 35% among patients undergoing acute cancer rehabilitation.

BackgroundThis single-arm study evaluated feasibility, safety, and initial efficacy of electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy (PN) in cancer patients with multiple myeloma.MethodsPatients with neuropathy ≥ grade 2 received 20 acupuncture treatments over 9 weeks.ResultsFor the 19 evaluable patients, Functional Assessment of Cancer Therapy/Gynecological Oncology Group-Neurotoxicity (FACT/GOG/NTX) mean (SD) scores improved significantly between baseline and week 13 (20.8 [9.6] vs 13.2 [8.5], p = 0.0002). Moderate effect size differences began on week 4, with the largest effect size differences found at week 9 for FACT/GOG/NTX scores, worst pain in the last 24 hours, and pain severity (Cohen’s d = 1.43, 1.19, and 1.08, respectively) and continuing through week 13 (Cohen’s d = 0.86, 0.88, and 0.90, respectively). From baseline to week 13, additional significant improvements were seen as follows: postural stability (1.0 [0.6] vs 0.8 [0.4], p = 0.02); coin test (10.0 [7.4] vs 5.6 [1.9], p < 0.0001); button test (96.1 [144.4] vs 54.9 [47.3], p < 0.0001); and walking test (21.6 [10.0] vs 17.2 [7.7], p = 0.0003). No significant changes were seen with NCS.ConclusionsAcupuncture may help patients experiencing thalidomide- or bortezomib-induced PN. Larger, randomized, clinical trials are needed.Trial registrationClinicalTrials.gov Identifier: NCT00891618.

AD is associated with shorter survival in male patients with advanced cancer. Further longitudinal research in a large cohort is justified based on.

Compared with patients with low-grade astrocytoma, patients with high-grade astrocytoma had higher total functional independence measure gain but also longer lengths of stay. Functional independence measure efficiencies were comparable between the two groups. Our results parallel those of previous rehabilitation outcome studies comparing patients with brain tumors with patients with brain injuries of other etiologies. Larger matched studies are needed for this patient population.

Objective To assess rehabilitation inpatient risk of return to primary service in bone marrow transplant patients. Design Retrospective review. Setting Inpatient rehabilitation unit within a tertiary referral based cancer center Participants All bone marrow transplant patients (131) who were admitted a total of 147 times to inpatient rehabilitation between January 1, 2002, and April 30, 2010. Interventions None. Main Outcome Measures We analyzed return to primary service and demographic information, cancer characteristics, medications, hospital admission characteristics, and laboratory values. Results 41% (61/147) of bone marrow transplant admissions were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 38% (23/61) died after being transferred back to the primary service. Significant or near significant relationships were found for a platelet count < 43,000 per microliter (p<.01), a creatinine level > 0.9 milligrams/deciliter (p<.01), the presence of an antiviral agent (p=.0501), the presence of an antibacterial agent (p=.0519), the presence of an antifungal agent (p<.05) and leukemia, lymphoma or multiple myeloma diagnosis (p<.05). Using five of these factors the Return to Primary-Bone Marrow Transplant (RTP-BMT) index was formulated to determine the likelihood of return to the primary team. Conclusion Bone marrow transplant patients have a high rate of transfer from the inpatient rehabilitation unit back to the primary service. The RTP-BMT score can be a useful tool to help clinicians predict the likelihood of return to the primary acute care service.

Context Survival predictions for advanced cancer patients impact many aspects of care, but the accuracy of clinician prediction of survival (CPS) is low. Prognostic tools such as the Palliative Prognostic Index (PPI) have been proposed to improve accuracy of predictions. However, it is not known if PPI is better than CPS at discriminating survival. Objective We compared the prognostic accuracy of CPS to PPI in patients with advanced cancer. Methods This was a prospective study in which palliative care physicians at our tertiary care cancer center documented both the PPI and CPS in hospitalized patients with advanced cancer. We compared the discrimination of CPS and PPI using concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index (NRI) and integrated discrimination improvement for 30-day survival and 100-day survival. Results 215 patients were enrolled with a median survival of 109 days and a median follow up of 239 days. The AUC for 30-day survival was 0.76 (95% confidence interval [CI] 0.66–0.85) for PPI and 0.58 (95% CI 0.47–0.68) for CPS (P<0.0001). Using the NRI, 67% of patients were correctly reclassified using PPI instead of CPS for 30-day survival (P=0.0005). CPS and PPI had similar accuracy for 100-day survival (AUC 0.62 vs. 0.64; P=0.58). Conclusion We found that PPI was more accurate than CPS when used to discriminate survival at 30 days, but not at 100 days. This study highlights the reason and timing for using PPI to facilitate survival predictions.