Dynapenia in digestive cancer outpatients: association with markers of functional and nutritional status (the FIGHTDIGO study).

BACKGROUND: The FIGHTDIGO study determined the feasibility and acceptability of handgrip strength (HGS) measurement in digestive cancer outpatients. PURPOSE: To assess the relationship between muscle strength and markers of functional and nutritional status in this population. DESIGN: In this prospective study, a total of 201 patients were followed during 6 months and were asked to perform HGS measurement at each hospitalization. Anthropometric measurements, laboratory tests, and performance status (PS) evaluation were collected. The modified Glasgow Prognostic Score (mGPS) was calculated using CRP and albumin levels. Severe malnutrition was defined as body mass index (BMI) < 18 kg/m2 in patients > 70 years old, and BMI < 16 kg/m2 in those < 70 years old. Dynapenia was defined as HGS < 30 kg (men) and < 20 kg (women). Mixed logistic regressions and mixed linear regressions were performed to study factors associated with dynapenia and HGS value, respectively. RESULTS: A total of 879 HGS measurements were analyzed. Dynapenia occurred in 177 measurements (20.1%). BMI and HGS were significantly associated in univariate analysis (p = 0.001). In multivariate analysis, mGPS score (ß = - 0.54 ± 0.31; p = 0.06) and severe malnutrition (ß = - 2.8 ± 1.4; p = 0.08) tended to be associated with HGS. Dynapenia was only associated with functional status impairment in univariate analysis (n = 140/803, 17.4% in ECOG 0 and 1 versus n = 37/76, 58.7% in ECOG 2 and 3; p = 0.002). CONCLUSIONS: Identification of dynapenia using HGS measurement may be useful to predict nutritional vulnerability in digestive cancer outpatients undergoing chemotherapy. Patients could then benefit from nutritional support, adapted physical activity programs, and early therapeutic adjustments. Trial registration ClinicalTrials.gov, NCT02797197.

Impact of multi-task on symptomatic patient affected by chronical vestibular disorders.

PURPOSE: After a vestibular deficit some patients may be affected by chronical postural instability. The aim of this study was to identify the emotional and cognitive factors of these symptomatic patients. In particular, the double cognitive task and the anxiety disorder were identified by our patients. Through a retrospective study, 14 patients (65.4 ± 18 years) participated in the experiment. METHOD: The experimentation consists in the study of the standing position of our patients through the aggregate of the trajectories of the center of pressure (COP) using a force plate device. With the aim of isolating the emotional and cognitive influence, this experimentation was defined in two conditions. In the first one, the patients were asked to maintain their balance without additional tasks. In the second one, the patients were submitted to an additional cognitive arithmetic task. The stabilogram surface, length (the forward and backward displacement distance during deviations in COP), lateral and the antero-posterior deviations were assessed. RESULTS: Our results showed an increase of postural instability of patients affected by chronical vestibular disorders when submitted to the double task. The patients submitted to the cognitive task present a larger surface of activity in comparison with the free-task one (Wilcoxon test p-value equals p = 0.0453). In addition, their displacements inside this area are more important (p = 0.0338). The COP of all our patients deviated forward in the presence of the double task. CONCLUSION: The increase in instability during the double cognitive task could be explained by an additional stress caused by the desire to make a success of the cognitive task.