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The purpose of this paper is to review the evidence for the role of physical rehabilitation in stem cell transplantation patients. We will also review the literature and discuss professional experiences on how rehabilitation can play a role in stem cell transplant care and survivorship. Hematopoietic stem cell transplantation (HCT) is a procedure that has evolved substantially over the years to help treat multiple conditions, particularly hematologic malignancies. HCT can be very stressful on the body and can leave patients weakened and sometimes quite debilitated. Supportive care measures have advanced to improve the quality of life and overall survival of HCT survivors. One key component of improved supportive care is gaining increased attention, and that is physical medicine and rehabilitation. Its role in HCT survivorship care is expanding, and new insight and research within the discipline have focused on fatigue, inflammation, exercise, and the development of structured rehabilitation programs to improve the musculoskeletal sequelae of transplantation. This literature review has demonstrated the utility of physical rehabilitation in HCT, its impact on cancer-related fatigue, and to outline the current state of the literature on these topics. The paper delves into a background of HCT. Cancer-related fatigue in HCT is then discussed and summarized, and the role that exercise plays in modifying such fatigue is outlined. We then outline the models and the impact that physical rehabilitation may play in HCT recipients.

Breast cancer (BC) is a major global health issue and remains the second leading cause of cancer-related death in women, contributing to approximately 41,760 deaths annually. BC is caused by a combination of genetic and environmental factors. Although various molecular diagnostic tools have been developed to improve diagnosis of BC in the clinical setting, better detection tools for earlier diagnosis can improve survival rates. Given that altered metabolism is a characteristic feature of BC, we aimed to understand the comparative metabolic differences between BC and healthy controls. Metabolomics, the study of metabolism, can provide incredible insight and create useful tools for identifying potential BC biomarkers. In this study, we applied two analytical mass spectrometry (MS) platforms, including hydrophilic interaction chromatography (HILIC) and gas chromatography (GC), to generate BC-associated metabolic profiles using breast tissue from BC patients. These metabolites were further analyzed to identify differentially expressed metabolites in BC and their associated metabolic networks. Additionally, Chemical Similarity Enrichment Analysis (ChemRICH), MetaMapp, and Metabolite Set Enrichment Analysis (MSEA) identified significantly enriched clusters and networks in BC tissues. Since metabolomic signatures hold significant promise in the clinical setting, more effort should be placed on validating potential BC biomarkers based on identifying altered metabolomes.

Introduction Discrimination exacerbates disparities among breast cancer survivors (BCS), yet how different reasons for experiencing perceived discrimination (e.g., race, age) influence health remains understudied. We explored the association between self-reported discrimination, psychosocial health, and quality of life (QOL), identified clusters based on reasons for perceived discrimination, and examined differences in QOL and psychosocial outcomes between these clusters. Methods In this cross-sectional study, we examined correlations between reasons for perceived discrimination (Everyday Discrimination Scale; EDS), QOL domains (cognitive, physical, social, emotional, and functional QOL measured with FACT-G), social dysfunction (Social Difficulties Inventory), and a psychological distress composite score (included measures of stress [Perceived Stress Scale], anxiety [PROMIS Anxiety], and depression [PROMIS Depression]), among 174 breast cancer survivors (stage 0-IV; ≥21 years). We used k-modes clustering to identify discrimination groups. Differences in demographics, clinical characteristics, and outcomes across clusters were assessed using Chi-square, analysis of variance, covariance, or non-parametric tests, followed by post hoc analyses. Results Overall, experiences of discrimination were associated with poorer QOL and psychosocial health (|0.306| 0.05). Conclusion QOL and psychosocial health scores varied between clusters based on reasons for perceived discrimination. Future interventions to improve QOL for breast cancer survivors should consider addressing stigma related to gender, physical appearance, and other forms of discrimination.

IntroductionPhysical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation.Methods and analysisThe trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes.Ethics and disseminationThis study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations.Trial registration numberNCT04896580.

Contemporary breast cancer surgical procedures vary greatly by the amount of tissue removed, anesthesia time, and reconstruction. Despite historical literature comparing the health-related quality of life (HRQOL) after lumpectomy and mastectomy, HRQOL data are limited regarding contemporary surgical procedures. Further, biological processes (e.g., inflammation) associated with HRQOL outcomes have not been described. We conducted two studies to examine differences in post-operative physical and mental functioning, pain, fatigue, and systemic inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) in women with early-stage breast cancer. Study 1 assessed women before and after surgery (n = 27) and Study 2 used a large cross-sectional sample (n = 240) to confirm findings from Study 1 and included a no-surgery comparison group. In Study 1, women who received mastectomy had lower physical functioning than lumpectomy (ps < 0.05), and those who received bilateral mastectomy had worse pain (p < 0.01) and fatigue (p = 0.029) than lumpectomy. Results were replicated in Study 2: mastectomy groups exhibited poorer physical functioning (ps < 0.01) and greater pain (ps < 0.001) than lumpectomy, and bilateral mastectomy was associated with worse fatigue (p < 0.05). Women who received bilateral mastectomy had higher levels of CRP than lumpectomy (p < 0.01) and higher TNF-α than the no-surgery group (p < 0.05). All surgery groups exhibited higher IL-6 than no-surgery (ps < 0.05). More extensive surgery is associated with poorer postoperative HRQOL. As compared to lumpectomy and no-surgery, mastectomy is associated with higher concentrations of systemic inflammatory markers.

Background: Despite the known benefits of physical activity in cancer survivors, adherence to exercise guidelines remains low. Known barriers to adhering to guidelines include a lack of time and an unwillingness to return to treatment facilities. Virtual exercise programming could assist in mitigating these barriers. This protocol presents a single arm pilot study exploring the feasibility of personalized Zoom-delivered exercise training for breast and prostate cancer survivors. A secondary objective is to determine the preliminary efficacy of participation on body composition, estimated VO2max, hand grip, one repetition maximum leg press, resting heart rate, resting blood pressure, exercise self-efficacy, and intentions to remain active. Methods: Breast (n = 10) and prostate (n = 10) cancer survivors will participate in a 24-week feasibility study, including (1) 12 weeks of one-on-one virtual personal training with an exercise physiologist (EP) via Zoom, and (2) individual exercise for a 12-week follow-up period using recordings of Zoom sessions for guidance. Physical assessments and surveys will be implemented at baseline, 12 weeks, and at the end of the study (24 weeks from baseline). Conclusions: While virtual exercise programming became popularized during the pandemic, evidence is still required to understand whether it can successfully address barriers and promote participation.

Purpose: The pilot study purpose was to demonstrate feasibility for the use of a mobile digital application (MindCap-app) designed to objectively assess cognitive function for cancer survivors. Significance: Cancer and cancer treatment-related cognitive impairment (CRCI) incidence estimates range up to 75% during treatment and persists for years in about 30% of cancer survivors. Accessible, feasible, sensitive objective measures to longitudinally assess cognitive function and evaluate the cognitive intervention effectiveness in this population are critically needed. MindCap was developed to provide neurocognitive testing sensitive to CRCI-affected cognitive domains (psychomotor, attention, working memory, verbal abilities, visual-spatial search, and executive function). Preliminary research indicated potential sensitivity to cognitive decline during chemotherapy for breast cancer. This research was conducted to assess sensitivity to cognitive improvement in conjunction CRCI interventions. Methods: Adult participants (n=57) with stage I-III solid tumors, Hodgkin or Non-Hodgkin lymphoma, (>6-months-to-<5-years post-chemotherapy), were recruited from a 3-arm, randomized, wait-list controlled parent study (N=90) investigating two telehealth-delivered formats of a cognitive rehabilitation intervention (Emerging from the Haze). Weekly responses to Patient Reported Outcomes Management Information System (PROMIS) cognitive function abilities-8a and participant satisfaction ratings were collected. Mind- Cap has three phases, practice (two trials with <2 errors), individualized baseline-determination (3 times/ day), and testing (3 times/week). Feasibility measures included: time to complete each phase and participant feedback/satisfaction. MindCap detection algorithms comprise 12 neurocognitive performance metrics from two tests (NovaScan and Trail Making). Correlations between MindCap metrics and PROMIS scores were assessed along with sensitivity to change over time. Findings and Interpretations: Median time for practice-phase completion was 5.82 minutes (n=50). Median time for baseline-determination was twenty-four MindCap tests over 9.13 days (n=36). Fifty-four percent (n=31) completed sufficient tests (39-162) for longitudinal analyses. Survey respondents (80%) indicated satisfaction with testing frequency. MindCap improvement preceded PROMIS improvement for 60%. Cap-PROMIS (>0.5) were demonstrated for 33.33%. Duration of detected improvement episodes ranged from 18-222 days for MindCap and 1-99 days for PROMIS. No improvement difference was noted between parent study groups. Discussion /Conclusions: Feasibility was demonstrated for MindCap practice, individualized baseline determination, and testing phases. Mindcap captured changes in cognitive function over time. Testing frequency was acceptable to most participants. Moderate correlation with PROMIS was demonstrated. Further research is needed to assess MindCap sensitivity using comparisons to validated objective neurocognitive measures and to capture individual CRCI-specific cognitive domain profiles.

Purpose of Review This article aims to expand on the role of rehabilitation clinicians in providing whole-person care to the dying cancer patient. We identify symptoms common at the end of life in patients with cancer and demonstrate how rehabilitation specialists can use medications and interventions to ease the dying process. Recent Findings Achieving adequate pain and symptom control can be done through a collaborative, multidisciplinary model with physiatrists, nurses, and therapists in all disciplines. Addressing anxiety, depression, and existential distress can and must be part of the whole-person rehabilitation care. Summary Achieving a “good death” is a collaborative process and one that is unique to each individual. Research has revealed that people want to be as symptom-free as possible, remain as functional and clear-thinking as possible, and contribute to those around them. The rehabilitation team is well-poised to help individuals meet these goals.

Abstract Background Prognosis has a vital role for patients with cancer undergoing palliative rehabilitation in acute inpatient rehabilitation. This study aimed to identify the proportion of patients who survived <2 months after discharge and the associated prognostic factors. Materials and Methods This was a secondary analysis of a retrospective study of 163 consecutive patients admitted to acute inpatient rehabilitation from September 1, 2017, to February 28, 2018 at a cancer center. Baseline demographics, clinical characteristics, and putative prognostic factors, including Activity Measure for Post-Acute Care (AM-PAC) functional scores, were analyzed. Results Of 163 patients, 27 (17%; 95% CI, 11-23) died within 60 days of discharge. These patients were more likely to be male (OR = 2.83; 95% CI, 1.16-6.92; P = .017); have longer hospital stays (OR = 1.02; 95% CI, 1-1.04; P = .015); receive ≥ weekly packed red blood cell (OR = 5.31; 95% CI, 1.86-15.1; P = .003) or platelet (OR = 4.57; 95% CI, 1.44-14.5; P = .014) transfusions; have lower AM-PAC daily activity scores upon discharge (OR = 0.90; 95% CI, 0.83-0.97; P = .006); and have lower AM-PAC basic mobility scores upon admission (OR = 0.91; 95% CI, 0.85-0.98; P = .018) and discharge (OR = 0.88; 95% CI, 0.82-0.94; P = <.001). Multivariate analysis showed that the male sex (OR = 2.71; 95% CI, 1.03-7.15; P = .037) was independently associated with ≤2 months survival, whereas AM-PAC basic mobility score at admission of >33 (OR = 0.24, 95% CI, 0.07-0.79; P = .022) was less likely. Conclusion Approximately 1 in 6 patients who completed acute inpatient rehabilitation died within 2 months of discharge, had poorer baseline functional status, and were less likely to regain function than those who lived longer. This article reports on the prognostic factors for early mortality after acute inpatient rehabilitation among patients with cancer.

Effective, evidence-based, disseminatable interventions for cancer-related cognitive impairment (GRGI) are urgently needed to promote cancer survivors' quality of life. Research indicates innovative interventions targeting improvements in physical activity, sleep disturbance, mindfulness, and loneliness reduction may improve cognitive function. Virtually delivered standardized cognitive rehabilitation programs integrating these strategies may represent safe, low-cost, broadly disseminatable, efficacious treatments. Emerging from the HazeTM (HAZE) is a multi-dimensional cognitive rehabilitation intervention that includes psychoeducational and experiential content. The pilot study purpose was to gather feasibility and preliminary data comparing two virtual delivery methods for providing HAZE to cancer survivors compared to wait-list control (WEG). A 3-arm randomized design was used to determine feasibility for comparing virtual \"live\" group presentation of HAZE sessions, to virtual \"pre-recorded\" group presentation sessions, or WEG. Feasibility was measured by percent recruitment and retention for the three groups. Eligible participants reported GRGI following chemotherapy for stage I-III solid tumors, Hodgkin or Non-Hodgkin Lymphoma. Self-report pre/post data were electronically captured. Between- and within- group differences for change in perceived cognitive function were assessed (perceived cognitive function/PGF; perceived cognitive abilities/ PGA). Study power was 80% for detection of large between-group effect sizes. Health behavior changes (physical activity, sleep, mindfulness), psychosocial outcomes (mood, loneliness), a determinant of behavior change (intentions), and health-related quality of life (HRQOL) were explored. Target enrollment was exceeded (n=93/90). Complete data were collected for 92.4% with 11.9% overall attrition (\"Live\"-19%, \"Pre-recorded\"-i6%, WLC-0%). Mean virtual session attendance for both intervention groups was 80% (8/10). Participant satisfaction ratings were high (2 or higher on a 0-4 scalc=90-100%, 3 or highcr=64-90%). Significant PCF improvement was reported for the \"live\" group versus WEG (PGA- p=0.010, 6=707) at week 10. PCF improvement reported for the \"pre-recorded\" group versus WEG was clinically meaningful with a moderate effect size (PGI-p=0.10, d=0.443) at week 10. No significant between-group difference for PCF was seen between the two intervention groups. The \"pre-recorded\" group reported significant improvement in physical activity and HRQOL at week 14 (p<0.01) without control for multiple exploratory outcomes. Feasibility for two virtual group HAZE delivery methods was confirmed. \"Pre-recorded\" HAZE group delivery has great potential for broad dissemination and scalability. Preliminary results suggest potential efficacy for \"pre-recorded\" group delivery. Study results justify future multi-site research powered to detect moderate effect sizes to demonstrate efficacy for \"pre-recorded\" group delivery.