Physical activity, daily walking, and lower limb lymphedema associate with physical function among uterine cancer survivors.

PURPOSE: We sought to quantify the proportion of uterine cancer survivors who self-report poor physical function. We then sought to quantify the association of poor physical function with physical activity (PA), walking, and lower limb lymphedema (LLL), among women with a history of uterine cancer. METHODS: Physical function was quantified using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) questionnaire. PA, walking, and LLL were measured using self-report questionnaire. PA was calculated using metabolic equivalent hours per week (MET-h week(-1)), and walking was calculated using blocks per day (blocks day(-1)). Logistic regression estimated odds ratios (OR) and 95 % confidence intervals (95 % CI). RESULTS: Among the 213 uterine cancer survivors in our survey (43 % response rate), 35 % self-reported poor physical function. Compared to participants who reported <3.0 MET-h week(-1) of PA, participants who reported ≥18.0 MET-h week(-1) of PA were less likely to have poor physical function (OR 0.03, 95 % CI 0.01-0.10; P trend < 0.0001). Compared to participants who reported <4.0 blocks day(-1) of walking, participants who reported ≥12.0 blocks day(-1) of walking were less likely to have poor physical function (OR 0.07, 95 % CI 0.03-0.19; P trend < 0.0001). Compared to participants who did not have LLL, participants with LLL were more likely to have poor physical function (OR 5.25, 95 % CI 2.41-11.41; P < 0.0001). CONCLUSION: Higher levels of PA and walking associate with a lower likelihood of reporting poor physical function. The presence of LLL associates with a higher likelihood of reporting poor physical function. These findings are hypothesis-generating and should be evaluated in future prospective studies.

Quality of life, body mass index, and physical activity among uterine cancer patients.

OBJECTIVE: The purpose of this study was to assess the independent and joint effects of body mass index (BMI) and physical activity (PA) on overall quality of life (QoL) in survivors of uterine cancer. METHODS: We conducted a survey among uterine cancer patients who received curative therapy at the University of Pennsylvania between 2006 and 2010. Surveys assessed the weight, height, PA (college alumnus survey), and QoL (Functional Assessment of Cancer Therapy-Gynecologic Oncology Group). RESULTS: The response rate to the survey was 43%. Among 213 patients, the mean (SD) BMI was 31.1 (8.9) kg/m, and 48% reported greater than or equal to 150 min·wk of PA. Higher BMI was independently associated with poorer overall QoL (P = 0.050), including physical (P = 0.002) and functional well-being (P = 0.008). Higher min·wk of PA was not independently associated with any QoL outcome. However, among patients who engaged in greater than or equal to 150 min·wk of PA, the negative association between BMI and overall QoL was attenuated (P = 0.558), whereas among patients who engaged in less than 150 min·wk of PA, the negative association between BMI and overall QoL persisted (P = 0.025). Among patients who engaged in greater than or equal to 150 min·wk of PA, the negative association between BMI and physical and functional well-being was attenuated (P = 0.765 and P = 0.284), whereas among patients who engaged in less than 150 min·wk of PA, the negative association between BMI and physical and functional well-being persisted (P < 0.001 and P = 0.010), respectively. CONCLUSIONS: Body mass index is associated with poorer QoL among uterine cancer patients. The findings from this cross-sectional study are consistent with the hypothesis that endometrial cancer survivors who are able to perform 150 min/wk of PA may be protected from the negative effects of BMI on QoL.

Finding a new normal: a grounded theory study of rehabilitation after treatment for upper gastrointestinal or gynaecological cancers--the patient's perspective.

This paper reports on a study of perspectives of rehabilitation needs by 33 people treated for upper gastrointestinal and gynaecological cancers. This study used focus groups informed by grounded theory and involved adult participants who had completed radical treatment at a UK cancer centre. Patients were involved in the design. Findings indicate that these patients are likely to have ongoing rehabilitation needs and that there was poor awareness of possible treatment of symptoms and of rehabilitation services. Novel findings include distinct perspectives of adults who have completed treatment for upper gastrointestinal and gynaecological cancers regarding their rehabilitation needs. Patients on surgical pathways, or who had longer hospital stays, had a better understanding of the rehabilitation services available to them and they accessed them more easily to ameliorate their post-treatment symptoms. Furthermore rehabilitation services are not equally accessed by patients on different treatment pathways. A grounded theory of cancer rehabilitation was developed with core categories of: impacts on the person, adjustment after treatment, individualised tailored support and information sources. The overarching theme is 'seeking a new normal'. Individualised tailored support is integral to seeking and establishing a new normal. Routine assessment and referral for rehabilitation treatment warrants further evaluation in these groups.

Survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED): a randomized controlled trial.

OBJECTIVE: The majority of endometrial cancer survivors (ECS) are obese and at risk for premature death. The purpose of this study was to evaluate an intervention for ECS to promote weight loss and a healthy lifestyle. METHODS: Early stage overweight and obese (body mass index ≥ 25) ECS (N=75) were randomized to a 6-month lifestyle intervention (LI) or usual care (UC). The LI group received education and counseling for six months (10 weekly followed by 6 bi-weekly sessions). Weight change at 12 months was the primary endpoint. Secondary outcomes included fruit/vegetable servings/day and physical activity (PA). Multiple imputations were used for missing data and mixed models were used to analyze changes from baseline. RESULTS: Adherence was 84% and follow-up data were available from 92% of participants at 6 months and 79% at 12 months. Mean [95% CI] difference in weight change between LI and UC groups at 6 months was -4.4 kg [-5.3, -3.5], p<0.001 and at 12 months was -4.6 kg [-5.8, -3.5], p<0.001. Mean [95% CI] difference in PA minutes between groups at 6 months was 100 [6, 194], p=0.038 and at 12 months was 89 [14, 163], p=0.020. Mean difference in kilocalories consumed was -217.8 (p<0.001) at 6 months and -187.2 (p<0.001) at 12 months. Mean [95% CI] difference in fruit and vegetable servings was 0.91 servings/day at 6 months and 0.92 at 12 months (p<0.001). CONCLUSIONS: Behavior change and weight loss are achievable in overweight and obese ECS, however, the clinical implications of these changes are unknown and require a larger trial with longer follow-up.

Inpatient oncology rehabilitation in Toronto: a descriptive 18-month retrospective record review.

PURPOSE: The purpose was twofold: (1) to develop a comprehensive profile of patients discharged from an inpatient oncology rehabilitation unit and (2) to explore the relationships between patient characteristics and functional status. METHODS: A retrospective review of electronic data from all patients discharged from oncology rehabilitation between November 1, 2008, and March 31, 2010, was conducted. Data elements included age, sex, primary language, living arrangements, cancer diagnosis, comorbidities, and admission and discharge Functional Independence Measure (FIM(™)) scores. Descriptive statistics were compiled for all data elements. General linear regression was conducted to determine the descriptors independently associated with FIM(™) discharge and FIM(™) change scores. RESULTS: There were 153 eligible records. The patients' age ranged from 38 to 97 years (M = 72.6, SD = 12.9); 59.5% were women, and 39.3% lived alone prior to hospitalization. The most common diagnoses were colorectal cancer (n = 45, 28.8%), metastatic disease (n = 24, 15.7%), and cancer of the urinary organs (n = 14, 9.2%). Service goals were met for 77.1%. Patients improved an average of 17.1 (SD = 8.8) points on the FIM(™). Being older and having a diagnosis of brain or uterine cancer were associated with lower FIM™ change scores. CONCLUSIONS: In this sample, the majority of patients were older women, and many lived alone. While the group as a whole made significant functional gains, those who were younger improved more. Having a diagnosis of uterine or brain cancer was associated with lower functional change scores. This study was limited by a small sample size and the retrospective design; however, the results provide a foundation for future prospective research.

Are we underutilizing Palmer's point entry in gynecologic laparoscopy?

OBJECTIVE: To report our experience using Palmer's point entry in women undergoing gynecologic laparoscopic surgery. DESIGN: Retrospective observational study. SETTING: University teaching hospital, London, United Kingdom. PATIENT(S): We reviewed all patients who underwent laparoscopic gynecologic surgery under the care of the senior author between January 1, 2005, and December 31, 2008. INTERVENTION(S): Gynecologic laparoscopic surgery. MAIN OUTCOME MEASURE(S): Indications, incidence, success, and complications of using Palmer's entry. RESULT(S): Three hundred eighty-five patients underwent laparoscopic surgery. We used umbilical entry in 249 (64.6%) and Palmer's entry in 136 (35.4%). In almost three fourths of cases, the indications for using Palmer's point were previous laparotomy or the presence of large uterine fibroids. The next most common reasons for choosing Palmer's point were known documentation of intra-abdominal adhesions from prior laparoscopies, large ovarian cysts, and hernias or hernia repairs. Entry via Palmer's point was successful in all but two cases (98.5%), and there were no entry-related complications. CONCLUSION(S): Our experience shows that laparoscopic entry using the left upper quadrant is safe with a low failure rate. Because the vast majority of gynecologic laparoscopies are done using subumbilical entry, it seems that Palmer's entry is underused by many gynecologists, despite it being safer in patients at risk of underlying adhesions and more appropriate in the presence of a large pelvic mass or a nearby hernia.

New tool (Laparotenser) for gasless laparoscopic myomectomy: a multicenter-controlled study.

OBJECTIVE: To assess feasibility and safety of a new surgical instrument-Laparotenser-in the procedure of gasless laparoscopic myomectomy. DESIGN: Multicenter controlled study. SETTING: Academic departments of obstetrics and gynecology, Italy. PATIENT(S): Thirty patients scheduled for gasless laparoscopic myomectomy (experimental group) and another group of 30 patients from our historical records that have undergone traditional laparoscopic myomectomy, matched with the cases for number of fibroids and for size of the main fibroid (control group). INTERVENTION(S): Gasless laparoscopic myomectomy using Laparotenser. MAIN OUTCOME MEASURE(S): Surgical data. RESULT(S): No significant differences in total operative time, postoperative ileus, hospitalization, time to return to full activity/work, and complication rates were observed between groups. Intraoperative blood loss, hemoglobin level, and surgical difficulty were significantly higher in the experimental than in the control group. Postoperative pain and number of analgesic vials used were significantly lower in the experimental group than in the control group. CONCLUSION(S): Although performed during the learning curve period, the use of the Laparotenser instrument in gasless laparoscopic myomectomy is a safe procedure.

Laparoscopy versus minilaparotomy in women with symptomatic uterine myomas: short-term and fertility results.

OBJECTIVE: To retrospectively compare the feasibility, safety, morbidity, and pregnancy outcome of laparoscopy (LPS) and minilaparotomy (LPT) in the treatment of symptomatic uterine myomas. DESIGN: Retrospective, nonrandomized study. SETTING: Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy. PATIENT(S): 680 nonconsecutive patients with symptomatic uterine myomas. INTERVENTION(S): 350 women underwent LPS, and 330 underwent LPT myomectomy. MAIN OUTCOME MEASURE(S): Operative time, blood loss, hospital stay, pregnancy rate, and spontaneous abortion rate. RESULT(S): The mean operative time was 63 +/- 21 minutes (95% CI, 48-143) in the LPS group and 57 +/- 23 minutes (95% CI, 38-121) in the LPT group. The mean length of hospital stay was statistically significantly greater in the LPT group (3.1 +/- 0.5; 95% CI, 1-5) than the LPS group (2.1 +/- 0.8; 95% CI, 1-4). The overall spontaneous pregnancy rate after myomectomy was 53%; the pregnancy rate after LPS myomectomy (56%) was not statistically significantly higher than the rate for LPT (50%). CONCLUSION(S): Laparoscopy showed a lower morbidity than reported for the open approach and was characterized by less blood loss and a shorter postoperative hospitalization with an higher pregnancy rate. The operating time was not much longer in the laparoscopic group, and the intraoperative and postoperative complications appeared acceptable and not more than what is traditionally expected with the open approach.

A reappraisal on the management of lumbosacral plexopathies in gynecological malignancies: where do the physiatrists stand?

Two patients are reported here with gynecological malignancies--an ovarian and a cervical carcinoma--who had suffered from lumbar plexopathies during their follow-up. Their management is discussed with an emphasis on the collaboration of the gynecologists and the rehabilitation physicians.

[The effect of transcerebral electrical impulse exposures on regional hemodynamics after the surgical treatment of uterine myoma]. / Vliianie transtserebral'nykh élektroimpul'snykh vozdeistvii na regionarnuiu gemodinamiku posle khirurgicheskogo lecheniia miomy matki.

After surgical treatment of uterine myoma 28 patients with cardiovascular diseases experienced disturbances of cerebral, upper limb and small pelvis circulation. The course of transcerebral electrotherapy (short bipolar nonsymmetrical impulses with large amplitude of the negative part) relieved the symptoms as a results of better cerebral and upper limb hemodynamics.

[Quality of life of cancer patients: a method for evaluating physical, social and psychological adaptation of women with cancer of the breast and uterine body]. / Kachestvo zhizni onkologicheskikh bol'nykh: metodika izucheniia fizicheskoi, sotsial'noi, i psikhologicheskoi adaptatsii zhenshchin pri rake molochnoi zhelezy i tela matki.

The paper describes a procedure for evaluating quality of life of patients with breast and uterine cancer and discusses the rationale for its use. The method was used in 161 cases. A correlation was established between the results provided by the procedure and those of psychologic tests.

[The rank value of sports and movement therapy in patients with breast or pelvic cancer]. / Zum Stellenwert der Sport- und Bewegungstherapie bei Patientinnen mit Brust- oder Unterleibskrebs.

In the summer of 1980 fifty women with breast or uterine cancer participating in a health resort measure for cancer aftercare took part in an extended sports and movement therapy programme, which included hiking, swimming, play and dance activities, as well as specific gymnastic exercises to improve shoulder joint function. Only 38 percent of the women had previously received physical therapy during primary clinical treatment. On the basis of a standardized questionnaire submitted at the beginning and at the end of the aftercare measure, information was obtained from 42 women on their holiday and leisure behaviour, on the expected aftercare measure outcome, as well as their attitudes towards sports. In a follow-up interview some six months later 71 percent reported continued sports activities. Exercise programmes must be simple, their effectiveness explained, and they must be felt to be beneficial. As had been the case with the coronary sports groups, the establishment of local "cancer sports groups" needs to be actively pursued.