Background Brain metastasis represents a major complication with a significantly shorter overall survival of many oncological diseases, in particular of lung cancer, breast cancer and malignant melanoma patients. However, despite the poor prognosis, sometimes clinical decision-making, between on the one hand not to harm the patient and on the other hand not withholding a potential therapeutic option, is very challenging. Thus the aim of this retrospective study was to compare various scores, including scores for activities of daily living (ADL) before resection of brain metastases and to analyse their impact on survival. Methods Our single institution retrospective patient cohort (N = 100) with a median age of 63.6 years, which had all undergone resection of one or more brain metastases, was categorized using the original patient files. The cohort includes 52 patients with lung cancer, 27 patients with breast cancer, 8 patients with colorectal carcinoma and 13 patients with kidney cancer. To categorize, we used different score systems which were capable to evaluate the patient in relation to self-sufficiency, activity and self-determination as part of ADL. The retrospective analysis includes the ECOG-Status, Karnofsky-Index, Barthel-Index, ASA-Classification and Katz-Index. Pre-processing and the analysis of the data was implemented using KNIME, where we used the R-plugin nodes to perform the final statistical tests with R. Results Our analysis reveals that most of the ADL scores we tested are able to give a reliable prediction on overall survival after brain metastasis surgery. The survival rates decrease significantly with a lower score in all tested score systems, with the exception of the ASA-Risk score. In particular, the Katz Index < 6 was identified to have a significant correlation with a lower cancer specific survival (CSS) (HR 3.33, 95%-CI [2.17–5.00]; p-Value = 9.6*10− 9), which is easy to use and has reproducible measurements. Conclusions Pre-operative independence assessment by indices of ADL represents a predictor for overall survival after resection of brain metastases. Especially the easily, objectively and rapidly applicable Katz-Score is a very helpful tool to assess the pre-operative status, which could be additionally included in clinical decision making in daily practice.

It is widely accepted that physical activity is important for physical functioning and well-being, and as such the promotion of active lifestyles is becoming increasingly significant in public health policy both in the UK and worldwide. Sedentary lifestyles have been associated with increased risk of obesity and preventable disease including diabetes, coronary heart disease and some cancers. With regards cancer specifically, this chapter will provide a brief overview on current opinions on the link between physical activity and cancer prevention.The published evidence focuses both on primary and secondary prevention. More recent evidence has investigated the use of physical activity in secondary prevention for those who have been diagnosed with cancer and proposed a link between physical activity, morbidity and mortality in those with cancer. The evidence-base for secondary prevention is more limited. Nevertheless, studies to date have indicated that physical activity can improve both physical functioning and psychological outcomes in cancer survivors, and significantly improve quality of life.The exact nature of those interventions which confer the most positive effects is less well-established, and there is a current lack of consensus on the most appropriate type, intensity and duration of activity for people with cancer. It has not yet been wellestablished as to which stage of the treatment programme physical activity should be encouraged (during or following treatment) or the most appropriate length of time during which structured physical activity interventions should be delivered to achieve beneficial results.These factors will be discussed in this chapter, and barriers to engaging in physical activity for those with a diagnosis of cancer will be considered. The chapter will conclude with a summary of key findings and the potential for further research.