Reduced fitness and physical functioning are long-term sequelae after curative treatment for esophageal cancer: a matched control study.

Reduced physical functioning is common following resections for esophageal cancer; however, objective data on physical performance outcomes in this cohort are rare. The aim of this study was to assess the physical performance and health related quality of life (HRQOL) of disease free survivors and compare findings in a case matched noncancer control group. Twenty-five males (mean (±SD) aged 63 (±6) years) who were over 6 months postesophagectomy and disease-free were compared with 25 controls (60 ± 6 years). Physical functioning was assessed through hand grip strength (dynamometry), exercise capacity (incremental shuttle walk test), physical activity levels (RT3 accelerometer), and body composition (bio-electrical impedance analysis). Health-related quality of life was measured using the EORTC QLQ-C30 questionnaire. Esophageal cancer survivors demonstrated significantly lower fitness (P < 0.001) and time spent in moderate (P < 0.001) and vigorous (P < 0.001) intensity physical activity compared with controls. Global health status and quality of life were similar in both groups (P = 0.245); however, physical and role functioning domains were lower in the cancer survivors (P < 0.001, and P = 0.001, respectively). These data show that disease-free survivors of curative esophageal cancer treatment demonstrate a significant compromise in physical functioning compared with controls, thus highlighting the multiple, complex rehabilitative needs of this cohort.

Level dependent signal flow in the light pupil reflex. II. Phase velocity of responses to sinusoidal light stimuli.

Pupillary responses to sinusoidal light stimuli were measured over a range of light levels and frequencies. The phase lag and equivalent time delay of these responses were reduced in an approximately log-linear fashion with increasing mean light level (slope = -60 ms/log unit). The magnitude of this level dependence is reduced at higher frequencies, and at higher light levels. This nonlinear level dependent signal flow (LDSF) effect is shown to be essentially independent of target distance (accommodative stimulus) which influences pupil size, and of pupil size itself. Thus most of the level dependence probably resides in the afferent path of the light-pupil reflex arc, before the accommodation signal joins the light signal in the Edinger-West-phal nucleus. A systems model is presented to the LDSF effect described here and in the companion papers (Myers and Stark 1993a, b). When parameters of the model are adjusted to fit pupillary responses to transient light stimuli over a range of light levels, the model simulates reduced phase lag in response to increased mean light level, and the reduction in this LDSF effect with increased mean light level or increasing stimulus frequency without further changes in parameters. This latter reduction explains the relatively small level dependence seen in latency data (-34 ms/log unit). These data will be shown (Myers and Stark 1990b) to be commensurate with reduction in pupil cycle time (increased frequency of oscillation) observed in high gain oscillation experiments as mean brightness increases.(ABSTRACT TRUNCATED AT 250 WORDS)