Robert D. Kilgour’s research while affiliated with Concordia University and other places

This study aimed to (i) explore determinants of health-related quality of life (HRQoL) in patients with cancer awaiting liver resection and entering a prehabilitation program, and (ii) examine the effect of prehabilitation on HRQoL in both the pre- and postoperative period. We randomized patients to prehabilitation or rehabilitation. Prehabilitation began an exercise, nutrition, and relaxation intervention 4 weeks preoperatively; rehabilitation began the same intervention postoperatively. We measured the following at baseline, preoperatively, 4 weeks and 8 weeks postoperatively: HRQoL [Functional Assessment of Cancer Therapy-General (FACT-G)], nutritional status [abridged Patient-Generated Subjective Global Assessment (aPG-SGA)], cancer symptom burden [revised Edmonton Symptom Assessment System (ESAS-r)], fatigue [Brief Fatigue Inventory (BFI)] and anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], 6 min walking distance, handgrip strength, and body composition. At baseline (n = 35, prehabilitation = 17), there were significant negative associations between FACT-G and ESAS-r total score (r = −0.675, p < 0.001), HADS depression (r = −0.618, p < 0.001), BFI (r = −0.612, p < 0.001), aPG-SGA (r = −0.432, p < 0.05), and HADS anxiety (r = −0.397, p < 0.05). There were no associations between FACT-G and strength/function tests or body composition. Robust multivariate regression analysis revealed ESAS-r was the only variable to consistently remain significant and predictive of baseline FACT-G (β = −0.67 to −0.83, p < 0.05, R2 = 36%–41%). There were no differences in FACT-G within or between groups at any timepoint. Cancer symptom burden was predictive of poor HRQoL in patients entering a prehabilitation program prior to liver resection. Future prehabilitation studies in this patient population should test whether the addition of supportive care measures to relieve cancer-related symptoms will lead to significant improvements in HRQoL. Clinicaltrials.gov registration NCT03475966. Take home message Cancer symptoms negatively affect health-related quality of life (HRQoL) in patients with cancer awaiting liver resection. Prehabilitation maintained HRQoL after surgery. Future studies should test whether relieving cancer symptoms can improve HRQoL.

Objective: Breast cancer treatment often causes the removal of or damage to lymph nodes of the patient's lymphatic drainage system. This side effect is the origin of Breast Cancer-Related Lymphedema (BCRL), referring to a noticeable increase in excess arm volume. Ultrasound imaging is a preferred modality for the diagnosis and progression monitoring of BCRL because of its low cost, safety, and portability. As the affected and unaffected arms have similar appearances in B-mode ultrasound images, the thickness of the skin, subcutaneous fat, and muscle have been shown to be important biomarkers for this task. The segmentation masks are also helpful in monitoring the longitudinal changes in morphology and mechanical properties of each tissue layer. Methods: For the first time, a publicly available ultrasound dataset containing the Radio-Frequency (RF) data of 39 subjects as well as manual segmentation masks by two experts, are provided. Inter- and intra-observer reproducibility studies performed on the segmentation maps show a high Dice Score Coefficient (DSC) of $0.94\pm 0.08$ and $0.92\pm 0.06$ , respectively. Gated Shape Convolutional Neural Network (GSCNN) is modified for precise automatic segmentation of tissue layers, and its generalization performance is improved by the CutMix augmentation strategy. Results: We got an average DSC of $0.87\pm 0.11$ on the test set, which confirms the high performance of the method. Conclusion: Automatic segmentation methods can pave the way for convenient and accessible staging of BCRL, and our dataset can facilitate development and validation of those methods. Significance: Timely diagnosis and treatment of BCRL are of crucial importance to prevent irreversible damage.

We examined the effectiveness of dietary counseling performed within a trimodal prehabilitation study for patients with cancer awaiting hepato-pancreato-biliary (HPB) surgery. Additionally, we explored relationships between nutritional status and health-related quality of life (HRQoL). The dietary intervention aimed to achieve a protein intake of 1.5 g/kg/day and reduce nutrition-impact symptoms. Patients received dietary counseling 4 weeks prior to surgery (prehabilitation group); the rehabilitation group just before surgery. We used 3-day food journals to calculate protein intake and the abridged Patient-generated Subjective Global Assessment questionnaire (aPG-SGA) to determine nutritional status. We utilized the Functional Assessment of Cancer Therapy-General questionnaire to measure HRQoL. Sixty-one patients participated in the study (30 = prehabilitation). Dietary counseling achieved a significant increase in preoperative protein intake (+0.3 ± 0.1 g/kg/day, P = 0.007), with no change in the rehabilitation group. Dietary counseling did not mitigate a significant increase in aPG-SGA postoperatively (prehabilitation: +5.8 ± 1.0; rehabilitation: +3.3 ± 1.0; P < 0.05). aPG-SGA was predictive of HRQoL (β = -1.77, P < 0.0001). HRQoL remained unchanged in both groups over the study period. Dietary counseling within a HPB prehabilitation program improves preoperative protein intake, but not aPG-SGA, which is predictive of HRQoL. Future studies should examine whether specialized medical management of nutrition-impact symptoms would improve HRQoL outcomes within a prehabilitation model.

Diet and exercise interventions may help reverse malnutrition and muscle wasting common in pancreatic cancer. We performed a scoping review to identify the knowledge gaps surrounding diet and exercise interventions. We searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest Theses and Dissertations, and Google Scholar using the umbrella terms of "pancreatic cancer," "diet/nutrition," and "exercise." Included were articles reporting on ambulatory adults with diagnosed pancreatic cancer. Excluded were studies examining prevention and/or risk, animal, or cell lines. Of the 15,708 articles identified, only 62 met the final inclusion criteria. Almost half of the articles were randomized controlled studies (n = 27). Most studies were from the United States (n = 20). The majority examined dietary interventions (n = 41), with 20 assessing the use of omega-3 fatty acids. Exercise interventions were reported in 13 studies, with 8 examining a diet and exercise intervention. Most studies were small and varied greatly in terms of study design, intervention, and outcomes. We identified 7 research gaps that should be addressed in future studies. This scoping review highlights the limited research examining the effect of diet and exercise interventions in ambulatory patients with pancreatic cancer.

Background Weight loss increases survivorship following breast cancer diagnosis. However, most breast cancer survivors (BCS) do not meet diet and exercise recommendations. Aim The purpose of this study was to explore the barriers and facilitators of BCS who had lymphedema and who participated in a 22‐week weight loss lifestyle intervention. Methods and results Participants completed semi‐structured interviews about barriers and facilitators to intervention adherence. Interviews were transcribed verbatim and a thematic analysis was conducted. Participants (n = 17) were 62 ± 8.0 years of age with a mean body mass index of 34.0 ± 7.1 kg/m². Four themes emerged: (1) facilitators of intervention adherence, (2) barriers of intervention adherence, (3) continuation of healthy habits post intervention, and (4) recommendations for intervention improvements. Facilitators of intervention adherence were education, social support, routine, motivation, goal‐setting, meal‐provisioning, self‐awareness, and supervised exercise. Barriers to intervention adherence were personal life, health, meal dissatisfaction, seasonality, unchallenging exercises, and exercising alone. All women planned to continue the acquired healthy habits post intervention. Recommendations to improve the study included addressing the exercise regime, meal‐provisioning, and dietary intake monitoring methods. Conclusion Future strategies to engage BCS in weight loss interventions should promote group exercise, offer individualized meal‐provisioning and exercise regimes, provide transition tools, and allow participants to choose their self‐monitoring method.

Background and Objectives: Fatigue is one of the characteristics defining frailty. However, the mechanisms leading to fatigue are still poorly understood. Our objectives were to assess the efficacy of energy utilization (EU) during walking in frail older persons and their level of fatigue. Research Design and Methods: Clinical study of a convenient sample of frail older women. 10 healthy (H; 77±4y, BMI: 25±3 kg/m2, MMSE: 29±1) and 10 frail elderly women (F; 83±6y, 26±5 kg/m2, 27±3) were compared for their usual level of fatigue and changes in perceived fatigue and EU before and after walking. A 10 cm Visual Analogue Scale (VAS) prior to and following a 6-Minute Walk Test (6MWT) served to measure fatigue. EU was based on VO2 consumption adjusted for walking distance and measured using a portable Cosmed K4b2 indirect calorimeter. Participants underwent body composition measurements by DXA and venous blood sampling. Results: Groups had similar body composition and blood parameters. At rest, there were no differences in VO2 or energy expenditure but the frail group had a lower heart rate. During 6MWT, between group differences were found for distance VO2, HR and EU. There were VAS changes in fatigue and a moderate correlation between the VAS of general fatigue and hsCRP. Discussion and Implications: Compared with their healthy counterparts, frail older women exhibited lower physical performance, efficacy of EU, and perceived more fatigue with activity. Inflammation was significantly correlated with subjective fatigue but did not characterize frailty. Key Words: frailty, fatigue, metabolism, physical performance, energy expenditure, six-minute walk test.

Breast cancer-related lymphedema is a consequence of a malfunctioning lymphatic drainage system resulting from surgery or some other form of treatment. In the initial stages, minor and reversible increases in the fluid volume of the arm are evident. As the stages progress over time, the underlying pathophysiology dramatically changes with an irreversible increase in arm volume most likely due to a chronic local inflammation leading to adipose tissue hypertrophy and fibrosis. Clinicians have subjective ways to stage the degree and severity such as the pitting test which entails manually comparing the elasticity of the affected and unaffected arms. Several imaging modalities can be used but ultrasound appears to be the most preferred because it is affordable, safe, and portable. Unfortunately, ultrasonography is not typically used for staging lymphedema, because the appearance of the affected and unaffected arms is similar in B-mode ultrasound images. However, novel ultrasound techniques have emerged, such as elastography, which may be able to identify changes in mechanical properties of the tissue related to detection and staging of lymphedema. This paper presents a novel technique to compare the mechanical properties of the affected and unaffected arms using quasi-static ultrasound elastography to provide an objective alternative to the current subjective assessment. Elastography is based on time delay estimation (TDE) from ultrasound images to infer displacement and mechanical properties of the tissue. We further introduce a novel method for TDE by incorporating higher order derivatives of the ultrasound data into a cost function and propose a novel optimization approach to efficiently minimize the cost function. This method works reliably with our challenging patient data. We collected radio frequency ultrasound data from both arms of seven patients with stage 2 lymphedema, at six different locations in each arm. The ratio of strain in skin, subcutaneous fat, and skeletal muscle divided by strain in the standoff gel pad was calculated in the unaffected and affected arms. The p-values using a Wilcoxon sign-rank test for the skin, subcutaneous fat, and skeletal muscle were 1.24 × 10 ^-5 , 1.77 × 10 ^-8 , and 8.11 × 10 ^-7 respectively, showing differences between the unaffected and affected arms with a very high level of significance.

Background Maximal voluntary rate (MVR) performance tasks can provide important age-related information to the limiting factors associated with movement and the development of fatigue. AimTo determine whether kinematic and muscle activation patterns during an MVR task differ between young and older adults. Methods We continuously measured frequency, amplitude, peak velocity, index of co-contraction and median frequencies of the index finger flexors and extensors during a 20-s MVR task in 10 young and 10 older subjects. ResultsIndex finger amplitude and peak velocity in flexion and extension were significantly lower in the older group. During the MVR, amplitude was maintained in the old (1–4 s, 53.2° ± 2.8° vs. 15–19 s, 48.6° ± 3.2°, ns) but not in the younger group (1–4 s, 64.9° ± 4.9° vs. 15–19 s, 59.4° ± 3.3°; p = 0.001). Frequency declined in the young (1–4 s, 5.2 ± 0.24 Hz vs. 15–19 s, 4.4 ± 0.25 Hz; p = 0.001) and old (1–4 s, 4.6 ± 0.17 Hz vs. 15–19 s, 4.0 ± 0.15 Hz; p = 0.01). Similarly, peak flexion velocity of the young (1–4 s, 1.77 ± 0.07 × 103 °/s vs. 15–19 s, 1.01 ± 0.07 × 103 °/s, p = 0.01) and older groups (1–4 s, 1.04 ± 0.07 × 103 °/s vs. 15–19 s, 0.78 ± 0.06 × 103 °/s; p = 0.016) as well as peak extension velocity of the young (1–4 s, 1.01 ± 0.053 × 103 °/s vs. 15–19 s, 0.78 ± 0.06 × 103 °/s, p = 0.01) and older groups (1–4 s, 0.72 ± 0.04 × 103 °/s vs. 15–19 s, 0.58 ± 0.05 × 103 °/s, p = 0.012) significantly decreased throughout the MVR. Median frequency of the flexors and extensors were maintained and were not different between groups. Only the older group experienced an increase in the index of co-contraction. Conclusion The changes in kinematics over time are not a result of a decrease in pre-post test force or velocity, but rather central factors affecting movement coordination.