ABSTRACT
PURPOSE: This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA). METHODS: A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours. RESULTS: A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046). CONCLUSION: This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.
ABSTRACT
BACKGROUND: The psychological burden of cutaneous malignant melanoma (CM) is all-encompassing, affecting treatment adherence, recurrence, and mortality. Yet, the prevalence and risk factors of anxiety and depression (A&D) in CM remain unclear. OBJECTIVES: To establish a benchmark pooled prevalence of A&D in CM, provide magnitudes of association for clinical, therapeutic, and demographic correlates, and elucidate temporal trends in A&D from the time of diagnosis. METHODS: This review was reported in line with MOOSE guidance. MEDLINE, Embase, PsychINFO, Web of Science, and the Cochrane Library were queried from database inception through August 24th, 2023. Study selection, data extraction, and quality assessment were performed by two independent authors, utilising both the JBI and NIH risk of bias (ROB) tools for the latter. The GRADE approach was used to rate the certainty of evidence. Prevalence rates, 95% Confidence (CI), and Prediction (PI) Intervals were derived using a random-effects model, and estimating between- and within-study variance. RESULTS: Nine longitudinal and 29 cross-sectional studies were included (n = 7,995). Quality assessment revealed 20/17 low, 12/15 moderate, and six/five high ROB studies, based on JBI/NIH tools, respectively. The prevalence of A (30.6% [95% CI, 24.6-37.0%; PI, 18-47%]) and D (18.4% [95% CI, 13.4-23.9%; PI, 10-33%]) peaked during treatment, declining to pre-treatment levels after one year (A: 48% vs 20%, p = 0.005; D: 28% vs 13%, p = 0.03). Female gender (OR 1.8; 95% CI, 1.4-2.3; p < 0.001), age <60â years (OR 1.5; 95% CI, 1.2-2.0; p = 0.002), and low educational level (OR 1.5; 95% CI, 1.2-2.0; p < 0.001) were likely to result in a large increase in the odds of anxiety. Depression was 12.3% higher in stage IV vs I CM (p = 0.048). Relative to immune checkpoint inhibition, the rates of depression were 22% (p = 0.002) and 34% (p < 0.001) higher among advanced-stage patients receiving interferon-α and chemotherapy, respectively. A significant diminution in self-reported depression scores was demonstrated over time (p = 0.003). CONCLUSIONS: A&D in CM notably affects women, under-60â s, and the less educated, with up to 80% higher odds of anxiety in these groups. A&D surge during CT & IFN treatment, especially in advanced CM. Our findings facilitate risk stratification and underscore the need for multi-disciplinary vigilance.
ABSTRACT
BACKGROUND: The role of perioperative radiotherapy in the management of resectable extremity soft tissue sarcoma (ESTS) is widely recognised for local tumour control, wound complications (WC) and long-term function. However, debate continues regarding its implications on long-term survival. This study aimed to determine whether the timing of perioperative radiotherapy affects long-term survival outcomes in adults with ESTS. METHODS: A systematic literature search of MEDLINE, EMBASE, Web of Science and Cochrane was performed. The primary outcome measure was the pooled hazard ratio (HR) at 95% confidence intervals. Secondary outcomes and subgroup analyses were presented as cumulative odds ratios (OR). A random-effects, generic inverse variance method and sensitivity analysis were performed to minimise heterogeneity. RESULTS: Six studies (nâ¯=â¯4192 patients) were identified. Time-to-event analysis demonstrated a statistically significant advantage in post-operative radiotherapy for overall survival (HR 1.15 and pâ¯=â¯0.05). Combined HRs for disease-free (1.25 and pâ¯=â¯0.22) and disease-specific (1.06 and pâ¯=â¯0.43) survival also favoured post-operative radiotherapy but did not achieve statistical significance. Post-operative radiotherapy was shown to confer an overall (OR 1.19 and pâ¯=â¯0.01), disease-free (OR 1.19 and pâ¯=â¯0.01) and disease-specific (OR 1.19 and pâ¯=â¯0.01) survival advantage on subgroup analysis. This survival benefit was best observed at three years in the disease-free survival comparison (OR 1.55 and pâ¯=â¯0.003). Preoperative radiotherapy was associated with more WC (OR 2.74 and p<0.00001). CONCLUSIONS: Pooled analysis of published literature suggests that post-operative radiotherapy confers a significant long-term survival advantage with fewer WC. Further large multicentre randomised controlled trials with long-term follow-up are required to determine the optimal perioperative radiotherapy regime in adult ESTS.
