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Analysis of physical function, muscle strength, and pulmonary function in surgical cancer patients: a prospective cohort study

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Abstract

The aim of this study was to investigate mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength and pulmonary function in surgical cancer patients admitted to an intensive care unit (ICU). We conducted a prospective cohort study with 85 patients. Mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength, and pulmonary function were assessed using the following tests: ICU Mobility Scale (IMS); Chelsea Critical Care Physical Assessment (CPAx); handgrip strength and Medical Research Council Sum-Score (MRC-SS); maximal inspiratory pressure (MIP) and S-Index; and peak inspiratory flow, respectively. The assessments were undertaken at ICU admission and discharge. The data were analyzed using the Shapiro–Wilk and Wilcoxon tests and Spearman’s correlation coefficient. Significant differences in inspiratory muscle strength, CPAx, grip strength, MRC-SS, MIP, S-Index, and peak inspiratory flow scores were observed between ICU admission and discharge. Grip strength showed a moderate correlation with MIP at admission and discharge. The findings also show a moderate correlation between S-Index scores and both MIP and peak inspiratory flow scores at admission and a strong correlation at discharge. Patients showed a gradual improvement in mobility, physical functioning, peripheral and inspiratory muscle strength, and inspiratory flow during their stay in the ICU.

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References

  1. Staudinger T, Stoiser B, Müllner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28(5):1322–1328. https://doi.org/10.1097/00003246-200005000-00011

    Article  CAS  PubMed  Google Scholar 

  2. Mokart D, Etienne A, Esterni B, Brun JP, Chow-Chine L, Sannini A, Faucher M, Blache JL (2012) Critically ill cancer patients in the intensive care unit: short-term outcome and 1-year mortality. Acta Anaesthesiol Scand 56(2):178–189. https://doi.org/10.1111/j.1399-6576.2011.02579.x

    Article  CAS  PubMed  Google Scholar 

  3. Azoulay E, Afessa B (2006) The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med 32(1):3–5. https://doi.org/10.1007/s00134-005-2835-6

    Article  PubMed  Google Scholar 

  4. Martos-Benítez FD, Soto-García A, Gutiérrez-Noyola A (2018) Clinical characteristics and outcomes of cancer patients requiring intensive care unit admission: a prospective study. J Cancer Res Clin Oncol 144(4):717–723. https://doi.org/10.1007/s00432-018-2581-0

    Article  PubMed  Google Scholar 

  5. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, Hicks DG, Lester S, Love R, Mangu PB, McShane L, Miller K, Osborne CK, Paik S, Perlmutter J, Rhodes A, Sasano H, Schwartz JN, Sweep FC, Taube S, Torlakovic EE, Valenstein P, Viale G, Visscher D, Wheeler T, Williams RB, Wittliff JL, Wolff AC; American Society of Clinical Oncology; College of American Pathologists (2010) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med 134(7):e48–72. https://doi.org/10.5858/134.7.e48

  6. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M (2014) Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys 88(3):553–564. https://doi.org/10.1016/j.ijrobp.2013.11.012

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sledge GW, Mamounas EP, Hortobagyi GN, Burstein HJ, Goodwin PJ, Wolff AC (2014) Past, present, and future challenges in breast cancer treatment. J Clin Oncol 32(19):1979–86. https://doi.org/10.1200/JCO.2014.55.4139

  8. Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G, Dal Pizzol F, Mello PV, Bozza FA, Silva UV, Torelly AP, Knibel MF, Rezende E, Netto JJ, Piras C, Castro A, Ferreira BS, Réa-Neto A, Olmedo PB, Salluh JI; Brazilian Research in Intensive Care Network (BRICNet) (2010) Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 38(1):9–15. https://doi.org/10.1097/CCM.0b013e3181c0349e

  9. Rosolem MM, Rabello LS, Lisboa T, Caruso P, Costa RT, Leal JV, Salluh JI, Soares M (2012) Critically ill patients with cancer and sepsis: clinical course and prognostic factors. J Crit Care 27(3):301–307. https://doi.org/10.1016/j.jcrc.2011.06.014

    Article  PubMed  Google Scholar 

  10. Puxty K, McLoone P, Quasim T, Kinsella J, Morrison D (2014) Survival in solid cancer patients following intensive care unit admission. Intensive Care Med 40(10):1409–1428. https://doi.org/10.1007/s00134-014-3471-9

    Article  PubMed  Google Scholar 

  11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008

  12. Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M, Young P, Zanni J, Buhr H, Higgins A, Presneill J, Berney S (2014) Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart Lung 43(1):19–24. https://doi.org/10.1016/j.hrtlng.2013.11.003. Epub 2013 Nov 19. Erratum in: Heart Lung. 2014 Jul-Aug;43(4):388

  13. Kawaguchi, Yurika Maria Fogaça et al (2016) "Perme IntensiveCare Unit Mobility Score e UTI Mobility Scale: tradução e adaptação cultural para a língua portuguesa falada no Brasil." J Bras Pneumol 42:429–434

  14. Faria LM (2018) Adaptação transcultural e validação do instrumento Chelsea Critical Care Physical Assessment (CPAx) para língua portuguesa. Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis

  15. Corner EJ, Wood H, Englebretsen C, Thomas A, Grant RL, Nikoletou D, Soni N (2013) The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy 99(1):33–41. https://doi.org/10.1016/j.physio.2012.01.003

    Article  CAS  PubMed  Google Scholar 

  16. Corner EJ, Soni N, Handy JM, Brett SJ (2014) Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness. Crit Care 18(2):R55. https://doi.org/10.1186/cc13801.PMID:24669784;PMCID:PMC4056321

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vaz M, Thangam S, Prabhu A, Shetty PS (1996) Maximal voluntary contraction as a functional indicator of adult chronic undernutrition. Br J Nutr 76:9–15

    Article  CAS  PubMed  Google Scholar 

  18. Günther CM, Bürger A, Rickert M, Crispin A, Schulz CU (2008) Grip strength in healthy Caucasian adults: reference values. J Hand Surg Am 33:558–565

    Article  PubMed  Google Scholar 

  19. Lopes J, Grams ST, da Silva EF, de Medeiros LA, de Brito CMM, Yamaguti WP (2018) Reference equations for handgrip strength: normative values in young adult and middle-aged subjects. Clin Nutr 37(3):914–918. https://doi.org/10.1016/j.clnu.2017.03.018

    Article  PubMed  Google Scholar 

  20. Reis NFD, Biscaro RRM, Figueiredo FCXS, Lunardelli ECB, Silva RMD (2021) Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit. Rev Bras Ter Intensiva 33(3):353–61. https://doi.org/10.5935/0103-507X.20210051

  21. De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, Outin H, Sharshar T, Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation (2007) Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med 35(9):2007–15. https://doi.org/10.1097/01.ccm.0000281450.01881.d8

  22. Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C, Casaer MP, Wouters P, Gosselink R, Van Den Berghe G (2012) Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve 45(1):18–25. https://doi.org/10.1002/mus.22219

    Article  PubMed  Google Scholar 

  23. American Thoracic Society/European Respiratory Society (2002) Statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518–524

    Article  Google Scholar 

  24. Neder JA, Andreoni S, Lerario MC, Nery LE (1999) Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res 32(6):719–727

  25. Silva PE, Carvalho KL, Frazão M, Maldaner V, Daniel CR, Gomes-Neto M (2018) Assessment of maximum dynamic inspiratory pressure. Respir Care 63(10):1231–1238

    Article  PubMed  Google Scholar 

  26. da Silva FMF, Cipriano G, Lima ACGB, Andrade JML, Nakano EY, Chiappa GR, Cahalin LP, Cipriano GFB (2020) Maximal dynamic inspiratory pressure evaluation in heart failure: a comprehensive reliability and agreement study. Phys Ther 100(12):2246–2253. https://doi.org/10.1093/ptj/pzaa165

    Article  PubMed  Google Scholar 

  27. Langer D, Jacome C, Charususin N, Scheers H, McConnell A, Decramer M, Gosselink R (2013) Measurement validity of an electronic inspiratory loading device during a loaded breathing task in patients with COPD. Respir Med 107(4):633–635. https://doi.org/10.1016/j.rmed.2013.01.020

    Article  CAS  PubMed  Google Scholar 

  28. Whelan M, van Aswegen H, Corner E (2018) Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgical and trauma patients in an intensive care unit: an experimental study. S Afr J Physiother 74(1):450. https://doi.org/10.4102/sajp.v74i1.450.PMID:30214949;PMCID:PMC6131696

    Article  PubMed  PubMed Central  Google Scholar 

  29. White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ (2014) Age and cancer risk: a potentially modifiable relationship. Am J Prev Med 46(3 Suppl 1):S7-15. https://doi.org/10.1016/j.amepre.2013.10.029

    Article  PubMed  PubMed Central  Google Scholar 

  30. DePinho RA (2000) The age of cancer. Nature 408(6809):248–254. https://doi.org/10.1038/35041694

    Article  CAS  PubMed  Google Scholar 

  31. Bos MM, de Keizer NF, Meynaar IA, Bakhshi-Raiez F, de Jonge E (2012) Outcomes of cancer patients after unplanned admission to general intensive care units. Acta Oncol 51(7):897–905. https://doi.org/10.3109/0284186X.2012.679311

    Article  PubMed  Google Scholar 

  32. Caruso P, Ferreira AC, Laurienzo CE, Titton LN, Terabe DS, Carnieli DS, Deheinzelin D (2010) Short- and long-term survival of patients with metastatic solid cancer admitted to the intensive care unit: prognostic factors. Eur J Cancer Care (Engl) 19(2):260–266. https://doi.org/10.1111/j.1365-2354.2008.01031.x

    Article  CAS  PubMed  Google Scholar 

  33. Cense HA, Hulscher JB, de Boer AG, Dongelmans DA, Tilanus HW, Obertop H, Sprangers MA, van Lanschot JJ (2006) Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection. Crit Care Med 34(2):354–362. https://doi.org/10.1097/01.ccm.0000195016.55516.3e

    Article  CAS  PubMed  Google Scholar 

  34. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2020) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492. Epub 2018 Sep 12. Erratum in: CA Cancer J Clin 70(4):313

  35. Martos-Benítez FD, Soto-García A, Gutiérrez-Noyola A (2018) Clinical characteristics and outcomes of cancer patients requiring intensive care unit admission: a prospective study. J Cancer Res Clin Oncol 144:717–723

  36. García A, Gutiérrez-Noyola A (2018) Clinical characteristics and outcomes of cancer patients requiring intensive care unit admission: a prospective study. J Cancer Res Clin Oncol 144:717–723

  37. Cata JP, Hernandez M, Lewis VO, Kurz A (2014) Can regional anesthesia and analgesia prolong cancer survival after orthopaedic oncologic surgery? Clin Orthop Relat Res 472(5):1434–1441

    Article  PubMed  Google Scholar 

  38. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E (2008) Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 36(8):2238–2243. https://doi.org/10.1097/CCM.0b013e318180b90e

    Article  PubMed  Google Scholar 

  39. Montagnani G, Vagheggini G, Panait Vlad E, Berrighi D, Pantani L, Ambrosino N (2011) Use of the Functional Independence Measure in people for whom weaning from mechanical ventilation is difficult. Phys Ther 91(7):1109–1115

    Article  PubMed  Google Scholar 

  40. Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL (2015) Functional outcomes in ICU - what should we be using?? - an observational study. Crit Care 19:127. https://doi.org/10.1186/s13054-015-0829-5

    Article  PubMed  PubMed Central  Google Scholar 

  41. Schnipper LE, Smith TJ, Raghavan D, Blayney DW, Ganz PA, Mulvey TM, Wollins DS (2012) American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 30(14):1715–1724. https://doi.org/10.1200/JCO.2012.42.8375

    Article  PubMed  Google Scholar 

  42. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E (2007) The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35(3):808–814. https://doi.org/10.1097/01.CCM.0000256846.27192.7A

    Article  PubMed  Google Scholar 

  43. Norman K, Stobäus N, Smoliner C, Zocher D, Scheufele R, Valentini L, Lochs H, Pirlich M (2010) Determinants of hand grip strength, knee extension strength and functional status in cancer patients. Clin Nutr 29(5):586–591. https://doi.org/10.1016/j.clnu.2010.02.007

    Article  PubMed  Google Scholar 

  44. Ryan AM, Power DG, Daly L, Cushen SJ, NíBhuachalla Ē, Prado CM (2016) Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc 75(2):199–211. https://doi.org/10.1017/S002966511500419X

    Article  PubMed  Google Scholar 

  45. O’Donnell et al. O’Donnell DE, Webb KA, Langer D, Elbehairy AF, Neder JA, Dudgeon DJ (2016) Respiratory factors contributing to exercise intolerance in breast cancer survivors: a case-control study. J Pain Symptom Manage 52(1):54–63. https://doi.org/10.1016/j.jpainsymman.2016.01.004

  46. Parry SM, Granger CL, Berney S, Jones J, Beach L, El-Ansary D, Koopman R, Denehy L (2015) Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med 41(5):744–762. https://doi.org/10.1007/s00134-015-3672-x

    Article  PubMed  Google Scholar 

  47. Silva VZMD, Araújo JA Neto, Cipriano G Jr, Pinedo M, Needham DM, Zanni JM, Guimarães FS (2017) Brazilian version of the Functional Status Score for the ICU: translation and cross-cultural adaptation. Rev Bras Ter Intensiva 29(1):34–38. https://doi.org/10.5935/0103-507X.20170006

  48. Namendys-Silva SA, González-Herrera MO, Herrera-Gómez A (2011) Critical care for patients with cancer. Am J Hosp Palliat Care 28(7):461–462

    Article  PubMed  Google Scholar 

  49. Rick O, Dauelsberg T, Kalusche-Bontemps EM (2017) Oncological Rehabilitation. Oncol Res Treat 40(12):772–777

    Article  PubMed  Google Scholar 

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Author notes

  1. Lara Patrícia Bastos Rocha

    Present address: Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil

Authors and Affiliations

  1. Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil

    Gerson Cipriano Jr & Graziella França Bernardelli Cipriano

  2. Institute of Strategic Health Management of the Federal District Brasília, Brasília, Brazil

    Lara Patrícia Bastos Rocha, Fernanda da Rocha Medeiros, Hilana Nóbrega de Oliveira & Renato Valduga

  3. Science and Technology in Health Program, University of Brasília, DF, Brasília, Brazil

    Gerson Cipriano Jr

  4. University of Brasília, QNN 14 Área Especial, Ceilândia Sul., DF, CEP: 72220-140, Brasília, Brazil

    Graziella França Bernardelli Cipriano

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Contributions

LPBR, FRM, and HNO had full access to all of the data in the study and takes responsibility for the integrity of the data, including any adverse effects. GCJr and GFBC contributed with data analysis and interpretation. LPBR, RV, and GFBC contributed with analysis and interpretation of data, and the writing of manuscript. GCJr revised it critically for important intellectual content; GFB has made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data, and the writing of manuscript.

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Correspondence to Graziella França Bernardelli Cipriano.

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Ethical approval

The study protocol was approved by the research ethics committees at the University of Brasilia (CAAE: 31665120.0.0000.8093) and Federal District Strategic Management Institute (CAAE: 31665120.0.3001.8153). All participants signed an informed consent form.

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Rocha, L.P.B., da Rocha Medeiros, F., de Oliveira, H.N. et al. Analysis of physical function, muscle strength, and pulmonary function in surgical cancer patients: a prospective cohort study. Support Care Cancer 31, 105 (2023). https://doi.org/10.1007/s00520-022-07507-3

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