Gait Speed and Survival in Patients With Brain Metastases

Dulaney, Caleb; McDonald, Andrew M.; Wallace, Audrey S.; Fiveash, John B.

doi:10.1016/j.jpainsymman.2017.03.013

Cited by 18 publications

(9 citation statements)

References 11 publications

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“…Similar to our results, a previous multinational study performed a pooled analysis of nine cohorts, finding that gait speed was a risk factor for mortality, independently of confounders [37]. Likewise, other studies have evaluated the survival of older adults with cancer who had slow gait speed, but only included patients with brain and hematological cancer, respectively [11,38]. This is important to take into account since while the incidence of these types of cancer is not high, the mortality is [2], and thus, these studies reported a greater magnitude of association.…”

Section: Comparison With Literaturesupporting

confidence: 87%

Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru

Salazar

Barrueto-Deza

Urrunaga-Pastor

et al. 2022

Heliyon

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Background: Given the increase in incidence and mortality from cancer in recent years in Latin America and Peru, it is necessary to identify frailty older adults at higher risk of disability, hospitalizations and mortality. However, its measure is complex and requires time. For this reason, it has been proposed that frailty can be evaluated by a single measure, as gait speed. We aimed to evaluate the role of gait speed as a predictor of mortality in older men with cancer in Peru. Methods: A prospective cohort study was carried out that included military veterans (aged 60 years and older) with an oncological diagnosis evaluated at the Centro M edico Naval in Peru during the period 2013-2015. Slow gait speed was defined as <0.8 m/s. All-cause mortality was recorded during a 2-year follow-up. Sociodemographic characteristics, medical and personal history, and functional assessment measures were collected. We performed Cox regression analysis to calculate hazard ratios with their respective 95% confidence intervals. Results: 922 older men were analyzed from 2013 to 2015, 56.9% (n ¼ 525) of whom were >70 years of age. 41.3% (n ¼ 381) had slow gait speed with a mortality incidence of 22.9% (n ¼ 211) at the end of follow-up. The most frequent types of cancer in the participants who died were of the lung and airways (26.1%), liver and bile ducts (23.2%), and lymphomas and leukemias (16.6%). In the adjusted Cox regression analysis, we found that slow gait speed was a risk factor for mortality in older men with cancer (adjusted hazard ratio ¼ 1.55; 95% confidence interval: 1.21-2.23). Conclusions: Slow gait speed was associated with an increased risk of mortality in older men with cancer. Gait speed could represent a simple, useful, inexpensive, rapidly applicable marker of frailty for the identification of older men at higher risk of mortality. Gait speed could be useful in low-and middle-income countries, and in rural areas with limited access to health services.

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Section: Comparison With Literaturesupporting

confidence: 87%

Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru

Salazar

Barrueto-Deza

Urrunaga-Pastor

et al. 2022

Heliyon

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“…The third level of performance assessed, independent standing, greatly increases participation in ADL [ 23 , 56 ], and the fourth level of motor skill, independent gait, not only determines participation in an active life and provides a sense of self-confidence but is also important for social and mental health. Gait efficiency, especially speed of gait, is a known survival factor in patients with brain tumors [ 57 ]. We found that gait efficiency was worst in the VS group, both before and after surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle Tumor Surgery

Krajewski

Furtak²,

Zawadka‐Kunikowska

et al. 2022

IJERPH

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Brain tumor location is an important factor determining the functional state after brain tumor surgery. We assessed the functional state and course of rehabilitation of patients undergoing surgery for brain tumors and assessed the location-dependent risk of loss of basic motor skills and the time needed for improvement after surgery. There were 835 patients who underwent operations, and 139 (16.6%) required rehabilitation during the inpatient stay. Karnofsky Performance Scale, Barthel Index, and the modified Rankin scale were used to assess functional status, whereas Gait Index was used to assess gait efficiency. Motor skills, overall length of stay (LOS) in hospital, and LOS after surgery were recorded. Patients were classified into four groups: cerebral hemisphere (CH), ventricular system (VS), and cerebellopontine angle (CPA) tumors; and a control group not requiring rehabilitation. VS tumor patients had the lowest scores in all domains compared with the other groups before surgery (p < 0.001). Their performance further deteriorated after surgery and by the day of discharge. They most often required long-lasting postoperative rehabilitation and had the longest LOS (35 days). Operation was most often required for CH tumors (77.7%), and all metrics and LOS parameters were better in these patients (p < 0.001). Patients with CPA tumors had the best outcomes (p < 0.001). Most patients (83.4%) with brain tumors did not require specialized rehabilitation, and LOS after surgery in the control group was on average 5.1 days after surgery. VS tumor patients represent a rehabilitation challenge. Postoperative rehabilitation planning must take the tumor site and preoperative condition into account.

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“…At discharge, the condition of patients in both groups significantly improved relative to the scores after surgery but did not return to preoperative levels. Other authors have emphasized the effectiveness of postoperative rehabilitation as well as the need to continue rehabilitation in the post-hospital period [ 24 , 34 , 43 , 59 , 67 , 71 , 72 , 73 , 74 ]. Despite improvements, only half of the repeat surgery group were able to walk independently, as assessed by the GI scale, while in the first surgery group, 60.2% of participants were able to walk independently with orthopedic aids.…”

Section: Discussionmentioning

confidence: 99%

“…Independent gait not only determines participation in an active life but also provides a sense of self-confidence important for social and mental health. Speed of gait is a known survival factor in patients with brain tumors [ 72 ]. Average LOS values did not differ significantly between groups 18 days in the repeat surgery group and 16.5 days in the first surgery group, over three times longer than LOS after surgery in patients not requiring rehabilitation (5.1 days) [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation Outcomes for Patients with Motor Deficits after Initial and Repeat Brain Tumor Surgery

Krajewski

Furtak²,

Zawadka‐Kunikowska

et al. 2022

IJERPH

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Repeat surgery is often required to treat brain tumor recurrences. Here, we compared the functional state and rehabilitation of patients undergoing initial and repeat surgery for brain tumors to establish their individual risks that might impact management. In total, 835 patients underwent operations, and 139 (16.6%) required rehabilitation during the inpatient stay. The Karnofsky performance status, Barthel index, and the modified Rankin scale were used to assess functional status, and the gait index was used to assess gait efficiency. Motor skills, postoperative complications, and length of hospital stay were recorded. Patients were classified into two groups: first surgery (n = 103) and repeat surgery (n = 30). Eighteen percent of patients required reoperations, and these patients required prolonged postoperative rehabilitation as often as those operated on for the first time. Rehabilitation was more often complicated in the repeat surgery group (p = 0.047), and the complications were more severe and persistent. Reoperated patients had significantly worse motor function and independence in activities of daily living before surgery and at discharge, but the deterioration after surgery affected patients in the first surgery group to a greater extent according to all metrics (p < 0.001). The length of hospital stay was similar in both groups. These results will be useful for tailoring postoperative rehabilitation during a hospital stay on the neurosurgical ward as well as planning discharge requirements after leaving the hospital.

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Gait Speed and Survival in Patients With Brain Metastases

Abstract: Gait speed is associated with overall survival in patients with newly diagnosed brain metastases. Gait speed assessment is simple, objective, and may provide additional prognostic information to improve life expectancy estimation and management decisions.

Cited by 18 publications

References 11 publications

Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru

Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru

Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle Tumor Surgery

Rehabilitation Outcomes for Patients with Motor Deficits after Initial and Repeat Brain Tumor Surgery

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