Effects of supervised aerobic exercise on cardiorespiratory fitness and patient-reported health outcomes in colorectal cancer patients undergoing adjuvant chemotherapy-a pilot study.

PURPOSE: Colorectal cancer and its treatment are associated with debilitating side effects. Exercise may improve the physical and psychological wellbeing of cancer patients; however, evidence in colorectal cancer patients undergoing adjuvant chemotherapy is limited. This pilot study aimed to explore the effects of supervised aerobic exercise on cardiorespiratory fitness and patient-reported health outcomes in colorectal cancer patients undergoing adjuvant chemotherapy. METHODS: Patients who had undergone curative resection for colorectal cancer (stages II-III) and were scheduled to receive adjuvant chemotherapy were enrolled into this non-randomized controlled trial. Patients in the intervention group (IG) took part in a 6-month supervised aerobic exercise program, while the control group (CG) received usual care. Cardiorespiratory fitness (measured by peak oxygen consumption) was assessed at baseline and 6 months. Fatigue, quality of life, and physical activity levels were additionally assessed at 3 months. RESULTS: In total, 59 patients (33 in IG vs. 26 in CG) were enrolled into this study. Eighteen patients (9 in IG vs. 9 in CG) dropped out of the study prior to the 6-month follow-up. Significant improvements in cardiorespiratory fitness (p = .002) and selected patient-reported health outcomes, such as reduced motivation (p = .015) and mental fatigue (p = .018), were observed in the IG when compared to the CG. CONCLUSION: To our knowledge, this is the first study to investigate the effects of a supervised aerobic exercise program in colorectal cancer patients undergoing adjuvant chemotherapy. The significant and clinically meaningful improvements in CRF warrant further randomized controlled trials to confirm these findings. TRIALS REGISTRATION: German Clinical Trials Register Identifier: DRKS00005793, 11/03/2014, retrospectively registered.

Gastrointestinal Quality of Life in Gastroesophageal Reflux Disease: A Systematic Review.

BACKGROUND: The Gastrointestinal Quality of Life Index (GIQLI) is a well-established instrument for the assessment of quality of life (QOL) in gastrointestinal (GI) diseases. The purpose of this literature review was to investigate QOL by means of GIQLI in patients with gastroesophageal reflux disease (GERD) prior to any interventional therapy. There are several reports on GIQLI data; however, comparisons from different countries and/or different GERD cohorts assessing the same disease have to date not been conducted. METHODS: The GIQLI uses 36 items around 5 dimensions (GI symptoms [19 items], emotional dimension [5 items], physical dimension [7 items], social dimension [4 items], and therapeutic influences [1 item]). A literature search was conducted on the application of GIQLI in GERD patients prior to interventional therapy using reports in PubMed. Data on the mean GIQLI as well as index data for the 5 dimensions as originally validated were extracted from the published patient cohorts. A comparison with the normal healthy control group from the original publication of the GIQLI validation conducted by Eypasch was performed. Data are presented descriptively as GIQLI points as well as a reduction from 100% maximum possible index points (max 144 index points = highest QOL). RESULTS: In total, 77 abstracts from studies using the GIQLI on patients with GERD were identified. After screening for content, 21 publications were considered for further analysis. Ten studies in GERD patients comprised complete calculations of all dimensions and were included in the analysis. Data from 1,682 study patients were evaluated with sample sizes ranging from 33 to 568 patients (median age of 789 females and 858 males: 51.8 years). The median overall GIQLI for the patient group was 91.7 (range 86-102.4), corresponding to 63.68% of the maximum GIQLI. The dimensions with the largest deviation from the respective maximum score were the physical dimension (55% of maximum) followed by the emotional dimension (60% of maximum). In summary, the GIQLI level in GERD cohorts was reduced to 55-75% of the maximum possible index. CONCLUSIONS: Severe GERD causes substantial reductions in the patient's QOL. The level of GIQLI can carry between different studied GERD cohorts from different departments and countries. GIQLI can be used as an established tool to assess the patient's condition in various dimensions.

Laparoscopic versus open appendectomy: between evidence and common sense.

BACKGROUND: Laparoscopic surgery has been proposed to have diagnostic and therapeutic advantages over conventional surgery. The purpose of this article is to present a recently completed Cochrane review on laparoscopic surgery for suspected appendicitis on the background of daily surgical practice and the developments in the last decade. METHODS: Within the Cochrane review, various medical databases (Medline, Embase, Cochrane, SciSearch) were searched electronically until October 2001. Congress proceedings were searched by hand. Randomized controlled trials were included that assessed the therapeutic effects of laparoscopic appendectomy (LA) versus open appendectomy (OA) in adults and children, the diagnostic effects of laparoscopy followed by LA or OA if necessary versus immediate OA, and the therapeutic effects of diagnostic laparoscopy followed by OA if necessary versus immediate OA. RESULTS: Based on 45 studies, wound infection was half as likely while intra-abdominal abscesses were three times more frequent after LA. Return to normal activity showed a uniform tendency in favor of LA. Pain was also reduced, but data vary and most primary studies were not blinded. Obvious diagnostic advantages concerned the negative appendectomy rate and the rate of patients without established diagnosis, both being reduced to 0.2-0.3 (RR). CONCLUSION: The review finds that laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages as compared to conventional surgery--a fact which is in full agreement with the daily practice of surgeons interested in endoscopic surgery.