Perspective: Towards Personalised Metabolic Coaching in Cancer.

Although cancer survivorship has improved over the last decades, numbers of cancer incidence and prevalence are rising. Evidence is growing that lifestyle factors, such as physical activity, a healthy weight management and -diet, play an important role in first- and second line preventive strategies. When implementing a healthy lifestyle, the maintenance of the energy balance should be taken into account. The energy equilibrium is achieved when the energy intake (Ei) for one day is equal to the total daily energy expenditure (TEE). The latter is, among others, made up of the resting energy expenditure, its largest contributor (60-80% of TEE), and can be assessed by indirect calorimetry (i.e. the gold standard). The resting energy expenditure reflects the individual's minimal caloric need in 24h to support basal functions. In cancer patients, energy imbalances, expressed as a positive (Ei > TEE) or negative (Ei & TEE) energy balance, may occur and are characterised by weight gain or -loss respectively. As a corollary, shifts in fatmass and fatfree mass are reported. Adequate nutritional follow-up is necessary in order to meet the energy needs, since both positive and negative energy balances are known to have deteriorating effects on cancer prognosis and mortality. In the clinical setting, predictive formulas (e.g. Harris-Benedict equation) are often used to estimate the caloric need. However, both under- and overfeeding are reported when using equations. Therefore, we advise to use indirect calorimetry in the standard assessment of a patient's energy need in order to provide adequate metabolic coaching and -follow up.

Cross-cultural Psychometric Evaluation of the Dutch McGill-QoL Questionnaire for Breast Cancer Patients.

AIM OF THE STUDY: Assessing the cross-cultural psychometric properties of the Dutch-MQoL for breast cancer patients. METHODS: 26 patients were recruited at the Antwerp University Hospital. Eligible patients filled in the MQoL on different moments in time in order to evaluate clinimetric properties. To determine the validity; MQoL was correlated to the EORTC QLQ-C30. Internal consistency was analysed using Cronbach's and test-retest reliability was determined by ICC. For statistical responsiveness, S.E.M and MDC were calculated. RESULTS: A strong correlation was found between the 'QoL score' of the MQoL and the domain 'existential well- being' of the EORTC QLQ-C30 (r = 0.72). An excellent test-retest reliability (ICC (1,1)) was demonstrated with intraclass coefficients ranging from 0.82 to 0.92. A MDC in total score of only 1.22 (12%) was seen, needed to detect a factual change within a patients' QoL. Psychometric properties of the Dutch MQoL were found comparable to the properties of the original questionnaire. CONCLUSION: The Dutch version of the MQoL is a valid and reliable questionnaire for breast cancer patients and shows statistical responsiveness. Due to the strong to excellent reliability, this version of the MQoL is useful in clinical as well as scientific setting.

Actigraphic measurement of motor deficits in acute ischemic stroke.

BACKGROUND: This study aimed to investigate the use of actigraphy (accelerometry) to measure disuse of the impaired arm in acute stroke patients. We correlated the National Institute of Health Stroke Scale (NIHSS) and the Fugl-Meyer Assessment arm section (FMA) findings with actigraphic data as a measure of validity. METHODS: Thirty-nine acute ischemic stroke patients were included within 1 week after stroke onset. At inclusion, motor deficits were assessed by the NIHSS, FMA and 48-hour actigraphic recordings of both wrists were performed. RESULTS: Moderate but highly significant correlations (Spearman's rho) between actigraphic recordings and total NIHSS (ratio r = -0.59 and activity of impaired arm r = -0.75; p < 0.001) and FMA (ratio r = 0.54 and activity of impaired arm r = 0.69; p < 0.001) scores were found. Based on actigraphic motor activity scores, ROC curves were calculated following dichotomization of the population based on NIHSS = 7 and FMA = 45, showing good sensitivity and specificity, with negative predictive value of 100% and positive predictive value of 91% for the ratio variable. CONCLUSIONS: Moderate but highly significant correlations were found between actigraphy and the stroke scales NIHSS and FMA. Actigraphy was able to reliably discriminate less impaired from more impaired stroke patients with excellent sensitivity and specificity values. Actigraphy is a simple, valid, objective and reliable clinical research tool that can be used to determine motor impairment of the upper limb in stroke patients.

Volumetric evaluation of upper extremities in 250 healthy persons.

BACKGROUND AND PURPOSE: Upper extremity oedema frequently occurs as a complication of several diseases. The aim of this study was to establish normative data for upper extremity volumes with a modified water displacement method. These data were used to develop predictive formulas helpful in detecting abnormal swelling. SUBJECTS AND METHODS: Upper extremities of 250 healthy subjects (138 men and 112 women) were measured by water displacement. RESULTS: A mean difference of 3.0% (3.2%) between right and left arm (forearm) was found. Intra-class correlation coefficients were 0.99 for intra-rater and inter-rater reliabilities. Coefficient of variation was 0.23%. To predict the premorbid volume of an oedematous arm, prediction formulas were constructed. DISCUSSION AND CONCLUSION: Water displacement as used in this study is a highly reliable technique for volume measurement of upper extremities. This technique was applied to gather normative data for upper extremity volumes. We suggest that this technique can be used in daily clinical practice for the evaluation of upper extremity oedema or atrophy caused by various diseases as well as for volume monitoring. Prediction formulas can be used to define abnormal swelling.