Physical behavior and associations with health outcomes in operable NSCLC patients: A prospective study.

OBJECTIVES: Our objectives were to 1) characterize daily physical behavior of operable non-small cell lung cancer (NSCLC) patients, from preoperative to six months postoperative using accelerometry, and explore if physical behavior preoperative or one month postoperative is associated with better health outcomes at six months postoperative. METHODS: A prospective study with 23 patients (13 female) diagnosed with primary NSCLC and scheduled for curative lung resection was performed. Outcome measures were assessed two weeks preoperative, and one, three and six months postoperative, and included accelerometer-derived physical behavior measures and the following health outcomes: six minute walking distance (6MWD), questionnaires concerning health-related quality of life (HRQOL), fatigue and distress. RESULTS: On group average, physical behavior showed significant changes over time. Physical behavior worsened following surgery, but improved between one and six months postoperative, almost reaching preoperative levels. However, physical behavior showed high variability between patients in both amount as well as change over time. More time in moderate-to-vigorous physical activity in bouts of 10 min or longer in the first month postoperative was significantly associated with better 6MWD, HRQOL, distress, and fatigue at six months postoperative. CONCLUSION: As expected, curative lung resection impacts physical behavior. Patients who were more active in the first month following surgery reported better health outcome six months postoperative. The large variability in activity patterns over time observed between patients, suggests that physical behavior 'profiling' through detailed monitoring of physical behavior could facilitate tailored goal setting in interventions that target change in physical behavior.

[The Tobacco-Free Generation]. / De Rookvrije Generatie.

In the Netherlands, every day some 100 adolescents become addicted to cigarettes. These new smokers fill the gap left by the 25% of smokers who die before reaching retirement age. The State Secretary for Health, Welfare and Sport in the Netherlands, the Royal Dutch Medical Association (KNMG), and the Dutch Cancer Society, Lung Foundation and Heart Foundation all support the concept of a tobacco-free generation. The concept is that, by applying public health interventions and restriction of tobacco accessibility through price hikes, in the near future none of the children in the Netherlands born in 2017 and beyond will take up smoking. This appealing plan can be phased in gradually, reaching full implementation by 2035. That gives politicians time to take evidence-based measures. The roadmap for this 'tobacco endgame' starts today with tobacco-free conception and pregnancy, and will follow the life of a child from then on. In this comment, I discuss the concept of a tobacco-free generation and focus on the responsibility of the government to take effective measures.

Assessment of sleep complaints and sleep-disordered breathing in a consecutive series of obese patients.

BACKGROUND/OBJECTIVE: The prevalence of sleep-related complaints (SRC) and the frequency of sleep-disordered breathing (SDB) in obese patients has not been studied extensively. We investigated SRC and SDB in a group of obese persons as part of a preoperative workup for weight reduction (bariatric) surgery. METHODS: All consecutive patients attending a weight-loss clinic for evaluation for bariatric surgery were asked to complete a questionnaire. The questionnaire consisted of a section on SRC and a validated general sleep questionnaire (Sleep Wake Experience List). The patients underwent sleep studies in which an Edentrace recorder registered heart rate, chest wall movements by impedance, airflow and oxygen saturation. RESULTS: Fifty-one patients (14 men, 37 women) were evaluated. Mean body mass index (BMI) was 45 kg/m2 (range 33-61). Eighteen patients (35%) demonstrated SDB, defined as (a) an apnea/hypopnea index 5, and/or (b) more than 2% of registration time with an oxygen saturation below 90%. There was no difference between these 18 patients and patients who did not exhibit SDB in age, sex, BMI or SRC. Seven patients had SDB of a severity warranting closer investigation and perioperative monitoring. CONCLUSION: Both SRC and SDB are common in obese patients. Limited nocturnal respiratory monitoring is indicated as part of the preoperative workup for weight reduction surgery.