51
|
Harrington SE, Stout NL, Hile E, Fisher MI, Eden M, Marchese V, Pfalzer LA. Cancer Rehabilitation Publications (2008-2018) With a Focus on Physical Function: A Scoping Review. Phys Ther 2020; 100:363-415. [PMID: 32043151 PMCID: PMC8204886 DOI: 10.1093/ptj/pzz184] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. PURPOSE This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. DATA SOURCES PubMed and CINAHL were searched up to September 2018. STUDY SELECTION Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. DATA EXTRACTION Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. DATA SYNTHESIS Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). LIMITATIONS Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. CONCLUSIONS This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.
Collapse
Affiliation(s)
- Shana E Harrington
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Blatt PE Center, 101G, Columbia, SC 29208 (USA)
| | - Nicole L Stout
- Office of Strategic Research, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland; Cancer Prevention and Control, Department of Hematology/Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Elizabeth Hile
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mary Insana Fisher
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, Ohio
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Lucinda A Pfalzer
- Physical Therapy Department, University of Michigan–Flint, Flint, Michigan
| |
Collapse
|
52
|
Meneses-Echávez JF, Loaiza-Betancur AF, Díaz-López V, Echavarría-Rodríguez AM. Prehabilitation programs for cancer patients: a systematic review of randomized controlled trials (protocol). Syst Rev 2020; 9:34. [PMID: 32054520 PMCID: PMC7020348 DOI: 10.1186/s13643-020-1282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Around twenty million new cases and ten million of deaths were attributed to cancer in 2018. Physical exercise, as main component of prehabilitation programs, has been associated with clinical improvements in aerobic capacity, muscular strength, gait speed, and fewer postoperative complications. This systematic review aims to determine the benefits and harms of prehabilitation programs, mainly composed of physical exercise, compared with standard care for cancer patients. METHODS/DESIGN A librarian will systematically search for randomized controlled trials in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), and EMBASE. Two independent reviewers will independently screen the retrieved references, appraise the methodological quality of the included studies, and extract data. If possible, we will pool the data. We will evaluate the completeness of reporting of prehabilitation programs by using the CERT checklist, and the GRADE approach will be used to evaluate the quality of the evidence. DISCUSSION This systematic review will determine the benefits and harms of prehabilitation programs for cancer patients. We will provide a complete appraisal of the quality of the evidence, our confidence in the results, and completeness of reporting of the exercise interventions evaluated in the prehabilitation programs. Findings from this review will assist health care providers, patients, decision-makers, and international organizations to make informed decisions in this field. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019125658.
Collapse
Affiliation(s)
- Jose F. Meneses-Echávez
- Division for Health Services, Norwegian Institute of Public Health, Sandakerveien 24C, Building D11, 4th Floor, Office 434, Oslo, Norway
- Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia
| | | | | | | |
Collapse
|
53
|
Kachur AK, Yaduta RT, Lyadov VK. [Application of the standardized protocol for fast track recovery after lung cancer surgery]. Khirurgiia (Mosk) 2019:58-62. [PMID: 31355816 DOI: 10.17116/hirurgia201907158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess standardized protocol for fast track recovery after lung cancer surgery. MATERIAL AND METHODS There were 201 patients. Patients underwent VATS lung resection, VATS lobectomy and various open resections of lungs. Patients had either primary lung cancer or metastatic lung lesion with indications for surgical treatment. Management of patients was divided into 3 periods: preoperative, intraoperative and postoperative. The protocol of fast track recovery was developed considering literature data and own experience. Requirements of this protocol were applied in perioperative management. RESULTS Application of the protocol was successful in all patients. Minimum number of complications (6%) and length of postoperative hospital-stay of 4 days were observed after VATS resection of lung. VATS lobectomy was followed by complication rate 25% and postoperative hospital-stay of 6 days. In the group of open resections these values were 29% and 7 days.
Collapse
Affiliation(s)
- A K Kachur
- Clinical hospital #1 'Medsi', Moscow, Russia
| | - R T Yaduta
- Clinical hospital #1 'Medsi', Moscow, Russia
| | - V K Lyadov
- Clinical hospital #1 'Medsi', Moscow, Russia
| |
Collapse
|
54
|
Systematic Review and Meta-Analysis of Randomized, Controlled Trials on Preoperative Physical Exercise Interventions in Patients with Non-Small-Cell Lung Cancer. Cancers (Basel) 2019; 11:cancers11070944. [PMID: 31284372 PMCID: PMC6678369 DOI: 10.3390/cancers11070944] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
Abstract
Preoperative physical exercise protocols prior to cancer surgery increased in popularity over recent years; however, the beneficial effect of such protocols is not well established, with conflicting results reported. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of different modalities or combinations of preoperative exercise interventions and/or prehabilitation multicomponent training in patients with non-small-cell lung cancer (NSCLC) after surgery on the outcomes related to functional capacity, mental wellness and medical care. We searched in OVID Embase, Pubmed, Cochrane Library, CINAHL, Scopus, and Web of Science. Characteristics of studies and program results and outcome data were extracted. Changes between the intervention and control groups, from baseline to follow-up (standardized mean difference (SMD) or relative risk (RR) with 95% confidence interval (CI) for each intervention was pooled using weighted random-effects models). A total of 676 participants from 10 RCTs were included in the final analysis (aerobic training + inspiratory muscle training, n = 5; aerobic training + strength training + inspiratory muscle training, n = 2; aerobic training + strength training, n = 1; multicomponent training, n = 1; aerobic training alone, n = 1). The results showed intervention-induced improvement in walking endurance (SMD = 0.27; 95% CI, 0.11 to 0.44; I2 = 0.0%), peak exercise capacity (SMD = 0.78; 95% CI, 0.35 to 1.21; I2 = 76.7%), dyspnoea (SMD = −0.30; 95% CI, −0.51 to −0.10; I2 = 0.0%), risk of hospitalization (SMD = −0.58; 95% CI, −0.97 to −0.20; I2 = 70.7%), and postoperative pulmonary complications (relative risk (RR) = 0.50; 95% CI, 0.39 to 0.66; I2 = 0.0%). For the functional capacity and medical care parameters, preoperative combined aerobic, resistance, and inspiratory muscle training was shown to be effective if comprising one to four weeks, performing 1–3 sessions per week, with moderate intensity (50% for endurance capacity). Further studies with larger samples and higher methodological quality are needed to clarify the potential benefits of preoperative exercise training for patients with NSCLC.
Collapse
|
55
|
Piegeler T, Stehr SN, Pfirrmann D, Knödler M, Lordick F, Mehnert A, Selig L, Weimann A, Mehdorn M, Gockel I, Simon P. [Special situations of preconditioning and prehabilitation in oncological visceral surgery]. Chirurg 2019; 89:903-908. [PMID: 30377726 DOI: 10.1007/s00104-018-0708-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prehabilitation prior to complex visceral oncological surgery is playing an increasingly important role. OBJECTIVE The aim of this review article is to present special situations of preconditioning in visceral oncological patient cohorts. The following conditions were defined as special situations with subsequently increased risk profile: cardiopulmonary comorbidities, geriatric patients, neoadjuvant therapy and simultaneous fatigue. MATERIAL AND METHODS A selective literature review based on a search in the electronic databases MEDLINE, PubMed, Cochrane Library and the International Standard Randomization Controlled Trial Number (ISRCTN) was performed. RESULTS The identification of high-risk patients is an essential part of the preoperative evaluation conducted by the anesthesiologist prior to surgery. The cardiovascular and the pulmonary risk profile are determined by means of prediction indices evaluating patient-specific and surgery-related risk factors. The increased use of new oral anticoagulants and dual platelet aggregation inhibition requires individualized treatment strategies. Numerous studies have shown clinically relevant effects of exercise therapy interventions throughout all phases of oncological treatment. In addition to positive effects on therapy-associated side effects, sport can also counteract the effects of sedentary behavior in cancer patients and improve the health-related quality of life. The effectiveness of sport and exercise therapies as well as psychological interventions in oncological patients with fatigue (CRF) is broad, with important components being motivation and compliance. DISCUSSION In high-risk patients an interdisciplinary approach to planning and conduction of prehabilitation is essential for the early detection and optimization of perioperative risk factors and potential complications. The aim is faster recovery, reduced morbidity and mortality and the possibility to improve long-term survival and quality of life.
Collapse
Affiliation(s)
- T Piegeler
- Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - S N Stehr
- Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - D Pfirrmann
- Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - M Knödler
- Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - F Lordick
- Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - A Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - L Selig
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie; Ernährungsteam, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - A Weimann
- Klinik und Poliklinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Deutschland
| | - M Mehdorn
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - I Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - P Simon
- Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| |
Collapse
|
56
|
Abstract
BACKGROUND Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment. OBJECTIVE The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery. MATERIAL AND METHODS Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided. RESULTS This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate. DISCUSSION In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.
Collapse
|
57
|
Topal B, Smelt HJ, Van Helden EV, Celik A, Verseveld M, Smeenk F, Pouwels S. Utility of preoperative exercise therapy in reducing postoperative morbidity after surgery; a clinical overview of current evidence. Expert Rev Cardiovasc Ther 2019; 17:395-412. [DOI: 10.1080/14779072.2019.1625771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Esmee V. Van Helden
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Alper Celik
- Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli, Istanbul, Turkey
| | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Frank Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
- SHE School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Sjaak Pouwels
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| |
Collapse
|
58
|
A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation. Can J Anaesth 2019; 66:388-405. [DOI: 10.1007/s12630-019-01297-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/17/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022] Open
|
59
|
The effects of physical activity on cancer prevention, treatment and prognosis: A review of the literature. Complement Ther Med 2019; 44:9-13. [PMID: 31126580 DOI: 10.1016/j.ctim.2019.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The World Health Organization has reported that approximately 35% of cancer-related deaths are attributed to modifiable risk factors. Among the most important risk factors amenable to modification are obesity and lack of physical activity. The purpose of this article is to review the current evidence of the benefits of physical activity in various types of cancer. METHODS A PubMed search for the key words "physical activity and cancer" as well as "exercise and cancer" was used to identify all indexed publications on this topic for potential utilization in this review. One MET was defined as the amount of oxygen consumed while a person is sitting quietly and is about 3.5 mL O2/kg body weight/min. MET represents the ratio of the working metabolic rate to the resting metabolic rate. RESULTS Routine physical activity was found to be associated with a reduced incidence of several of the most common malignancies, including colon, breast, lung, and endometrial cancer as well as many others. Physical activity also appears to reduce all-cause mortality and cancer-related mortality among patients with breast and colon cancer, and may improve the functional status and quality of life for these patients during cancer therapy. CONCLUSIONS The benefits of physical activity in the prevention and progression of cancer patients are multiple. However, the strength of the available evidence is limited by the observational nature of most studies. Given the probable improvement in prevention, mortality, and quality of life with structured physical activity in different malignancies, it is important that healthcare providers discuss physical activity programs with their cancer patients. Larger randomized trials are recommended.
Collapse
|
60
|
Faithfull S, Turner L, Poole K, Joy M, Manders R, Weprin J, Winters-Stone K, Saxton J. Prehabilitation for adults diagnosed with cancer: A systematic review of long-term physical function, nutrition and patient-reported outcomes. Eur J Cancer Care (Engl) 2019; 28:e13023. [PMID: 30859650 DOI: 10.1111/ecc.13023] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/21/2018] [Accepted: 01/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prehabilitation is increasingly being used to mitigate treatment-related complications and enhance recovery. An individual's state of health at diagnosis, including obesity, physical fitness and comorbidities, are influencing factors for the occurrence of adverse effects. This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post-treatment and considers the utility of prehabilitation before cancer treatment. METHODS A database search was conducted for articles published with prehabilitation as a pre-cancer treatment intervention between 2009 and 2017. Studies with no 30 days post-treatment data were excluded. Outcomes post-prehabilitation were extracted for physical function, nutrition and patient-reported outcomes. RESULTS Sixteen randomised controlled trials with a combined 2017 participants and six observational studies with 289 participants were included. Prehabilitation interventions provided multi-modality components including exercise, nutrition and psychoeducational aspects. Prehabilitation improved gait, cardiopulmonary function, urinary continence, lung function and mood 30 days post-treatment but was not consistent across studies. CONCLUSION When combined with rehabilitation, greater benefits were seen in 30-day gait and physical functioning compared to prehabilitation alone. Large-scale randomised studies are required to translate what is already known from feasibility studies to improve overall health and increase long-term cancer patient outcomes.
Collapse
Affiliation(s)
- Sara Faithfull
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Lauren Turner
- Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | - Karen Poole
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Mark Joy
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Ralph Manders
- Exercise Physiology and Sports Science, University Surrey, Guildford, UK
| | - Jennifer Weprin
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kerri Winters-Stone
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - John Saxton
- Department of Sport Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| |
Collapse
|
61
|
Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next? Anaesthesia 2019; 74 Suppl 1:20-26. [PMID: 30604416 DOI: 10.1111/anae.14505] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/29/2022]
Abstract
Just as there is growing interest in enhancing recovery after surgery, prehabilitation is becoming a recognised means of preparing the patient physically for their operation and/or subsequent treatment. Exercise training is an important stimulus for improving low cardiovascular fitness and preserving lean muscle mass, which are critical factors in how well the patient recovers from surgery. Despite the usual focus on exercise, it is important to recognise the contribution of nutritional optimisation and psychological wellbeing for both the adherence and the response to the physical training stimulus. This article reviews the importance of a multi-modal approach to prehabilitation in order to maximise its impact in the pre-surgical period, as well as critical future steps in its development and integration in the healthcare system.
Collapse
Affiliation(s)
- C Scheede-Bergdahl
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada.,Department of Kinesiology and Physical Education, McGill Research Centre for Physical Activity and Health, McGill University, Montreal, QC, Canada.,McGill Research Centre for Physical Activity and Health, McGill University, Montreal, QC, Canada
| | - E M Minnella
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada
| | - F Carli
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada
| |
Collapse
|
62
|
Falandry C, Ravot C, Collange V. [Prehabilitation, therapeutic innovation]. SOINS. GÉRONTOLOGIE 2019; 24:25-28. [PMID: 30765083 DOI: 10.1016/j.sger.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of prehabilitation emerged in the United States in the 1940s to maintain the performance of American soldiers notably through good nutrition and sport. It was then a question of optimising the patient's health status in a pre-treatment situation and reducing surgical stress. The specific collaborative programme Proadapt, comprising multiprofessional expertise, was put in place for elderly patients in 2016.
Collapse
Affiliation(s)
- Claire Falandry
- Unité d'oncogériatrie, service de gériatrie, CHU Lyon-Sud, 165 chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - Christine Ravot
- Unité d'oncogériatrie, service de gériatrie, CHU Lyon-Sud, 165 chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - Vincent Collange
- Clinique du Grand Large, 2 avenue Léon-Blum, 69150 Décines-Charpieu, France
| |
Collapse
|
63
|
Loughney LA, West MA, Kemp GJ, Grocott MPW, Jack S. Exercise interventions for people undergoing multimodal cancer treatment that includes surgery. Cochrane Database Syst Rev 2018; 12:CD012280. [PMID: 30536366 PMCID: PMC6517034 DOI: 10.1002/14651858.cd012280.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND People undergoing multimodal cancer treatment are at an increased risk of adverse events. Physical fitness significantly reduces following cancer treatment, which is related to poor postoperative outcome. Exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity may contribute to improved physical fitness. OBJECTIVES To determine the effects of exercise interventions for people undergoing multimodal treatment for cancer, including surgery, on physical fitness, safety, health-related quality of life (HRQoL), fatigue, and postoperative outcomes. SEARCH METHODS We searched electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, SPORTDiscus, and trial registries up to October 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared the effects of exercise training with usual care, on physical fitness, safety, HRQoL, fatigue, and postoperative outcomes in people undergoing multimodal cancer treatment, including surgery. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, performed the data extraction, assessed the risk of bias, and rated the quality of the studies using Grading of Recommendation Assessment, Development, and Evaluation (GRADE) criteria. We pooled data for meta-analyses, where possible, and reported these as mean differences using the random-effects model. MAIN RESULTS Eleven RCTs were identified involving 1067 participants; 568 were randomly allocated to an exercise intervention and 499 to a usual care control group. The majority of participants received treatment for breast cancer (73%). Due to the nature of the intervention, it was not possible to blind the participants or personnel delivering the intervention. The risk of detection bias was either high or unclear in some cases, whilst most other domains were rated as low risk. The included studies were of moderate to very low-certainty evidence. Pooled data demonstrated that exercise training may have little or no difference on physical fitness (VO2 max) compared to usual care (mean difference (MD) 0.05 L/min-1, 95% confidence interval (CI) -0.03 to 0.13; I2 = 0%; 2 studies, 381 participants; low-certainty evidence). Included studies also showed in terms of adverse effects (safety), that it may be of benefit to exercise (8 studies, 507 participants; low-certainty evidence). Furthermore, exercise training probably made little or no difference on HRQoL (EORTC global health status subscale) compared to usual care (MD 2.29, 95% CI -1.06 to 5.65; I2 = 0%; 3 studies, 472 participants; moderate-certainty evidence). However, exercise training probably reduces fatigue (multidimensional fatigue inventory) compared to usual care (MD -1.05, 95% CI -1.83 to -0.28; I2 = 0%; 3 studies, 449 participants moderate-certainty evidence). No studies reported postoperative outcomes. AUTHORS' CONCLUSIONS The findings should be interpreted with caution in view of the low number of studies, the overall low-certainty of the combined evidence, and the variation in included cancer types (mainly people with breast cancer), treatments, exercise interventions, and outcomes. Exercise training may, or may not, confer modest benefit on physical fitness and HRQoL. Limited evidence suggests that exercise training is probably not harmful and probably reduces fatigue. These findings highlight the need for more RCTs, particularly in the neoadjuvant setting.
Collapse
Affiliation(s)
- Lisa A Loughney
- Dublin City UniversitySchool of Health and Human PerformanceDublin 9Ireland
- University of Southampton NHS Foundation Trust / University of SouthamptonRespiratory and Critical Care Research Theme, Southampton NIHR Biomedical Research CentreSouthamptonUKSO16 6YD
| | - Malcolm A West
- University of Southampton NHS Foundation Trust / University of SouthamptonRespiratory and Critical Care Research Theme, Southampton NIHR Biomedical Research CentreSouthamptonUKSO16 6YD
- University of SouthamptonAcademic Unit of Cancer Sciences, Faculty of MedicineSouth Academic BlockTremona RoadSouthamptonUKSO16 6YD
- University of SouthamptonIntegrative Physiology and Critical Illness Group, Clinical and Experimental SciencesSouthamptonUKSO16 6YD
| | - Graham J Kemp
- University of SouthamptonIntegrative Physiology and Critical Illness Group, Clinical and Experimental SciencesSouthamptonUKSO16 6YD
- University of LiverpoolDepartment of Musculoskeletal Biology and MRC – Arthritis Research UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Faculty of Health and Life SciencesLiverpoolUK
| | - Michael PW Grocott
- University of SouthamptonIntegrative Physiology and Critical Illness Group, Clinical and Experimental SciencesSouthamptonUKSO16 6YD
- University Hospital Southampton NHS Foundation TrustAnaesthesia and Critical Care Research UnitSouthamptonUK
| | - Sandy Jack
- University of SouthamptonIntegrative Physiology and Critical Illness Group, Clinical and Experimental SciencesSouthamptonUKSO16 6YD
- University Hospital Southampton NHS Foundation TrustAnaesthesia and Critical Care Research UnitSouthamptonUK
| | | |
Collapse
|
64
|
Exercise and Nutrition Prehabilitation for the Evaluation of Risk and Therapeutic Potential in Cancer Patients: A Review. Int Anesthesiol Clin 2018; 54:e47-61. [PMID: 27648892 DOI: 10.1097/aia.0000000000000122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
65
|
Abstract
OBJECTIVES To address the estimated rates of incidence, potential underlying etiologies, and cognitive domains affected from diagnosis and treatment. To describe potential cognitive function interventions. DATA SOURCES PubMed. CONCLUSION Adults with gliomas report that the most distressing, persistent, and greatest negative impact on their lives relates to the cognitive impairment they experience. However, there are several potential interventions that may prevent cognitive decline during treatment or maintain cognitive function long term. IMPLICATIONS FOR NURSING PRACTICE Awareness of cognitive sequela that adults with gliomas face can lead to early identification, full neurocognitive profiling, and implementation of evidence-based interventions for those experiencing cognitive impairments following cancer treatment.
Collapse
|
66
|
Abstract
Survival alone is no longer an adequate outcome for persons with brain tumors; the quality of the survivorship experience should be viewed with equal importance. Symptom management is a significant component of quality survivorship care. Regardless of their histology, brain tumors and therapies used to treat them produce symptoms that affect an individual's ability to function in everyday life. Common symptoms include fatigue, cognitive impairment, distress, and sleep disturbance. Symptom-based interventions for persons with brain tumors focus on prevention, self-management, and prescriptive interventions targeted to these problems. Unfortunately, little evidence exists to support many interventions, making it challenging for clinicians to provide concrete recommendations. Research is needed to provide evidence in support of symptom-based interventions while novel approaches to these challenging problems are developed.
Collapse
Affiliation(s)
- Christina Amidei
- Northwestern Medicine, Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
67
|
The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review. Int J Rehabil Res 2018; 41:189-196. [PMID: 29683834 DOI: 10.1097/mrr.0000000000000288] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Prehabilitation benefits among patients undergoing various oncological surgeries have been demonstrated. However, the effects of presurgical exercise and fitness on postoperative ipsilateral upper extremity recovery outcomes in patients with breast cancer surgery are less evident. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Systematic literature search was performed in 12 electronic databases. Study eligibility was accessed using the PICOS (Participants, Interventions, Comparison, Outcome and Study Design) criteria. Six eligible studies were found: three cohort-control and three prospective observational studies. One randomized-controlled trial showed that prehabilitation was beneficial in shoulder range of motion (ROM) and upper extremity functional recovery. One cohort-control study demonstrated that preoperative exercises reduced postoperative pain without increasing the risk of developing a seroma. A prospective cohort study showed that preoperatively active individuals had a significantly better chance of feeling recovered physically at 3 weeks after surgery. Baseline ipsilateral grip strength, shoulder flexion, and abduction ROM were reliable predictors of shoulder flexion and abduction ROM and grip strength improvements at 1 month following breast cancer surgery. One study showed that preoperative conditioning alone without postoperative rehabilitation was insufficient to aid recovery. Implementing exercise program and optimizing preoperative fitness, especially shoulder ROM, before breast cancer surgery in conjunction with individualized rehabilitation program may benefit postmastectomy ipsilateral upper extremity recovery.
Collapse
|
68
|
Veal I, Peat N, Jones GD, Tsianakas V, Armes J. Missed opportunities for physical activity management at key points throughout the chemotherapy pathway for colorectal survivors: an observational interview study. Support Care Cancer 2018; 27:1215-1222. [PMID: 30310988 DOI: 10.1007/s00520-018-4472-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Physical activity (PA) is central to self-management for people with colorectal cancer (CRC) to support health behaviour and function secondary to cancer treatment. However, there is limited evidence on how health professionals (HPs) promote PA during cancer treatment. This study aimed to investigate how and when PA is promoted throughout the chemotherapy pathway among colorectal cancer survivors. METHODS A qualitative study was conducted with adults with CRC receiving chemotherapy at a large cancer centre. Cross-sectional observation of clinical consultations was conducted at four points during the chemotherapy pathway: prior, midpoint, final cycle, and 8 weeks following chemotherapy. Following completion of treatment, audio-recorded, semi-structured interviews were conducted with patients and HPs and transcribed verbatim. Codes and themes were identified and triangulated from all the data using framework analysis. Observational themes are reported and complimented by interview data. RESULTS Throughout the chemotherapy pathway (pre, midpoint, end), many opportunities were missed by HPs to promote PA as a beneficial means to maintain functioning and ameliorate cancer treatment side effects. When discussed, PA levels were used only to determine fitness for future oncological treatment. No PA promotion was observed despite patients reporting low PA levels or treatment side effects. Post-treatment, PA promotion was more routinely delivered by HPs, as evidenced by problem-solving and onward referrals to relevant HPs. CONCLUSION PA promotion was largely absent during treatment despite it being a key component of patient self-management following treatment. This suggests considerable missed opportunities for HPs to provide cancer survivors with PA evidence-based interventions. Further research is necessary to identify how best to ensure PA is promoted throughout the cancer journey. IMPLICATION FOR CANCER SURVIVORS These findings suggest many may not be receiving support to be physically active during treatment.
Collapse
Affiliation(s)
- I Veal
- Guy's and St Thomas' NHS Foundation Physiotherapy Department, Great Maze Pond, London, SE1 9RT, UK.,Florence Nightingale Faculty of Nursing & Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - N Peat
- Guy's and St Thomas' NHS Foundation Physiotherapy Department, Great Maze Pond, London, SE1 9RT, UK
| | - G D Jones
- Guy's and St Thomas' NHS Foundation Physiotherapy Department, Great Maze Pond, London, SE1 9RT, UK
| | - V Tsianakas
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
| | - J Armes
- School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| |
Collapse
|
69
|
Abstract
Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.
Collapse
Affiliation(s)
- Hui-Shan Lin
- Centre for Research in Geriatric Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia,
- PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia,
| | - Rebecca L McBride
- PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia,
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia,
- PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia,
| |
Collapse
|
70
|
Piraux E, Caty G, Reychler G. Effects of preoperative combined aerobic and resistance exercise training in cancer patients undergoing tumour resection surgery: A systematic review of randomised trials. Surg Oncol 2018; 27:584-594. [DOI: 10.1016/j.suronc.2018.07.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/27/2018] [Accepted: 07/15/2018] [Indexed: 12/14/2022]
|
71
|
Luo H, Newton RU, Ma'ayah F, Galvão DA, Taaffe DR. Recreational soccer as sport medicine for middle-aged and older adults: a systematic review. BMJ Open Sport Exerc Med 2018; 4:e000336. [PMID: 30112181 PMCID: PMC6089298 DOI: 10.1136/bmjsem-2017-000336] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2018] [Indexed: 12/25/2022] Open
Abstract
Background Strategies to prevent or attenuate the age-related decline in physical and physiological function and reduce chronic disease risk factors are of clinical importance. Objective To examine the health benefits of recreational soccer in middle-aged and older adults. Design Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources All available records up until 9 June 2017 in PubMed, Web of Science, SPORTDiscus, MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library databases. Eligibility criteria for selecting studies All randomised trials with or without a control group (randomised controlled trials or randomised uncontrolled trials) and non-randomised controlled trials that used recreational soccer, which includes small-sided soccer games, as the sole or principal intervention, and reported relevant effects in untrained/sedentary, healthy or unhealthy adults aged 40 years and above were included. Results Five trials described in 13 articles were included, which scored 6–9 out of 12 points on the modified Delphi quality rating scale. The duration was from 12 to 52 weeks, with various frequencies, volumes and game formats performed both outdoors and indoors with men and women. The trials indicate that recreational soccer may result in improvement in cardiovascular function, body composition and functional ability, although no significant changes were observed in postural balance. Conclusion Recreational soccer should be considered an alternative exercise modality for untrained, healthy or unhealthy middle-aged and older adults of both sexes to maintain an active lifestyle and mitigate a wide array of physical and physiological age-related changes.
Collapse
Affiliation(s)
- Hao Luo
- Department of Exercise and Health Sciences, Guangdong Vocational Institute of Sport, Guangzhou, Guangdong, China.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.,Institute of Human Performance, The University of Hong Kong, Hong Kong, China
| | - Fadi Ma'ayah
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
72
|
Stout NL, Alfano CM, Belter CW, Nitkin R, Cernich A, Lohmann Siegel K, Chan L. A Bibliometric Analysis of the Landscape of Cancer Rehabilitation Research (1992-2016). J Natl Cancer Inst 2018; 110:815-824. [PMID: 29982543 PMCID: PMC6279275 DOI: 10.1093/jnci/djy108] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/19/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023] Open
Abstract
Cancer rehabilitation research has accelerated as great attention has focused on improving survivorship care. Recent expert consensus has attempted to prioritize research needs and suggests greater focus on studying physical functioning of survivors. However, no analysis of the publication landscape has substantiated these proposed needs. This manuscript provides an analysis of PubMed indexed articles related to cancer rehabilitation published between 1992 and 2017. A total of 22 171 publications were analyzed using machine learning and text analysis to assess publication metrics, topic areas of emphasis, and their interrelationships through topic similarity networks. Publications have increased at a rate of 136 articles per year. Approximately 10% of publications were funded by the National Institutes of Health institutes and centers, with the National Cancer Institute being the most prominent funder. The greatest volume and rate of publication increase were in the topics of Cognitive and Behavioral Therapies and Psychological Interventions, followed by Depression and Exercise Therapy. Four research topic similarity networks were identified and provide insight on areas of robust publication and notable deficits. Findings suggest that publication emphasis has strongly supported cognitive, behavioral, and psychological therapies; however, studies of functional morbidity and physical rehabilitation research are lacking. Three areas of publication deficits are noted: research on populations outside of breast, prostate, and lung cancers; methods for integrating physical rehabilitation services with cancer care, specifically regarding functional screening and assessment; and physical rehabilitation interventions. These deficits align with the needs identified by expert consensus and support the supposition that future research should emphasize a focus on physical rehabilitation.
Collapse
Affiliation(s)
- Nicole L Stout
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Bethesda, MD
| | | | | | - Ralph Nitkin
- Eunice Kennedy Shriver National Institute of Child Health and Development, Center for Medical Rehabilitation Research, Rockville, MD
| | - Alison Cernich
- Eunice Kennedy Shriver National Institute of Child Health and Development, Center for Medical Rehabilitation Research, Rockville, MD
| | - Karen Lohmann Siegel
- Department of Veterans Affairs, Rehabilitation Research and Development Service, Washington, DC
| | - Leighton Chan
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Bethesda, MD
| |
Collapse
|
73
|
Vermillion SA, James A, Dorrell RD, Brubaker P, Mihalko SL, Hill AR, Clark CJ. Preoperative exercise therapy for gastrointestinal cancer patients: a systematic review. Syst Rev 2018; 7:103. [PMID: 30041694 PMCID: PMC6058356 DOI: 10.1186/s13643-018-0771-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gastrointestinal cancer patients are susceptible to significant postoperative morbidity. The aim of this systematic review was to examine the effects of preoperative exercise therapy (PET) on patients undergoing surgery for GI malignancies. METHODS In accordance with PRISMA statement, all prospective clinical trials of PET for patients diagnosed with GI cancer were identified by searching MEDLINE, Embase, Cochrane Library, ProQuest, PROSPERO, and DARE (March 8, 2017). The characteristics and outcomes of each study were extracted and reviewed. Risk of bias was evaluated using the Cochrane risk of bias tool by two independent reviewers. RESULTS Nine studies (534 total patients) were included in the systematic review. All interventions involved aerobic training but varied in terms of frequency, duration, and intensity. PET was effective in reducing heart rate, as well as increasing oxygen consumption and peak power output. The postoperative course was also improved, as PET was associated with more rapid recovery to baseline functional capacity after surgery. CONCLUSIONS PET for surgical patients with gastrointestinal malignancies may improve physical fitness and aid in postoperative recovery.
Collapse
Affiliation(s)
- Sarah A Vermillion
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC, 27101, USA
| | - Alston James
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC, 27101, USA
| | - Robert D Dorrell
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC, 27101, USA
| | - Peter Brubaker
- Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO BOX 7868, Winston-Salem, NC, 27109, USA
| | - Shannon L Mihalko
- Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO BOX 7868, Winston-Salem, NC, 27109, USA
| | - Adrienne R Hill
- Department of Physical Medicine and Rehabilitation, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Clancy J Clark
- Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| |
Collapse
|
74
|
Chang IY, Yi ES. The influence of environmental constraints within hospitals on physical activity level of cancer patients. J Exerc Rehabil 2018; 14:382-386. [PMID: 30018922 PMCID: PMC6028198 DOI: 10.12965/jer.1836240.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/10/2018] [Indexed: 01/04/2023] Open
Abstract
This study aims to examine the influence of hospital environmental constraints on physical activity level of cancer patients. The subjects of this study were 194 cancer patients from five general hospitals in the Seoul metropolitan area (Seoul, Gyeonggi-do, and Incheon). The collected data was analyzed by using SPSS ver. 23.0. As a result of analyzing the effect of environmental constraints on the physical activity level of cancer patients, the constraints related to hospital facilities and programs had no effect on patients’ time spent in a hospital bed and their time spent on daily. However, the time cancer patients spend on intentional physical movements is affected by hospital facilities or programs. This means that hospital facilities or programs play an important role in patients’ intentional physical activities. In conclusion, for hospitalized cancer patients, physical activity levels are influenced by environmental constraints in the hospital. Therefore, it is important to improve the hospital environment to increase physical activities such as walking and physical exercise, which are an important factor for cancer recovery and prevention of recurrence.
Collapse
Affiliation(s)
- Ik Young Chang
- Department of Community Sport, Korea National Sport University, Seoul, Korea
| | - Eun-Surk Yi
- Department of Exercise Rehabilitation and Welfare, College of Health Science, Gachon University, Incheon, Korea
| |
Collapse
|
75
|
Woodfield J, Zacharias M, Wilson G, Munro F, Thomas K, Gray A, Baldi J. Protocol, and practical challenges, for a randomised controlled trial comparing the impact of high intensity interval training against standard care before major abdominal surgery: study protocol for a randomised controlled trial. Trials 2018; 19:331. [PMID: 29941028 PMCID: PMC6019731 DOI: 10.1186/s13063-018-2701-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Risk factors, such as the number of pre-existing co-morbidities, the extent of the underlying pathology and the magnitude of the required operation, cannot be changed before surgery. It may, however, be possible to improve the cardiopulmonary fitness of the patient with an individualised exercise program. We are performing a randomised controlled trial (RCT) assessing the impact of High Intensity Interval Training (HIIT) on preoperative cardiopulmonary fitness and postoperative outcomes in patients undergoing major abdominal surgery. METHODS Consecutive eligible patients undergoing elective abdominal surgery are being randomised to HIIT or standard care in a 1:1 ratio. Participants allocated to HIIT will perform 14 exercise sessions on a stationary cycle ergometer, over a period of 4-6 weeks before surgery. The sessions, which are individualised, aim to start with ten repeated 1-min blocks of intense exercise with a target of reaching a heart rate exceeding 90% of the age predicted maximum, followed by 1 min of lower intensity cycling. As endurance improves, the duration of exercise is increased to achieve five 2-min intervals of high intensity exercise followed by 2 min of lower intensity cycling. Each training session lasts approximately 30 min. The primary endpoint, change in peak oxygen consumption (Peak VO2) measured during cardiopulmonary exercise testing, is assessed at baseline and before surgery. Secondary endpoints include postoperative complications, length of hospital stay and three clinically validated scores: the surgical recovery scale; the postoperative morbidity survey; and the SF-36 quality of life score. The standard deviation for changes in Peak VO2 will be assessed after the first 30 patients and will be used to calculate the required sample size. DISCUSSION We want to assess if 14 sessions of HIIT is sufficient to improve Peak VO2 by 2 mL/kg/min in patients undergoing major abdominal surgery and to explore the best clinical endpoint for a subsequent RCT designed to assess if improving Peak VO2 will translate into improving clinical outcomes after surgery. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12617000587303 . Registered on 26 April 2017.
Collapse
Affiliation(s)
- John Woodfield
- Department of Surgery, University of Otago, Dunedin, New Zealand
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Matthew Zacharias
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
- Department of Anaesthesia, University of Otago, Dunedin, New Zealand
| | - Genevieve Wilson
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Fran Munro
- Department of Surgery, University of Otago, Dunedin, New Zealand
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Kate Thomas
- Department of Surgery, University of Otago, Dunedin, New Zealand
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Andrew Gray
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - James Baldi
- Department of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
76
|
A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005-2017). PM R 2018; 9:S347-S384. [PMID: 28942909 DOI: 10.1016/j.pmrj.2017.07.074] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/27/2017] [Accepted: 07/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evidence supports the benefits of exercise for patients with cancer; however, specific guidance for clinical decision making regarding exercise timing, frequency, duration, and intensity is lacking. Efforts are needed to optimize clinical recommendations for exercise in the cancer population. OBJECTIVES To aggregate information regarding the benefit of exercise through a systematic review of existing systematic reviews in the cancer exercise literature. DATA SOURCES PubMed, CINAHL Plus, Scopus, Web of Science, and EMBASE. STUDY ELIGIBILITY CRITERIA Systematic reviews and meta-analyses of the impact of movement-based exercise on the adult cancer population. METHODS Two author teams reviewed 302 abstracts for inclusion with 93 selected for full-text review. A total of 53 studies were analyzed. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used as a quality measure of the reviews. Information was extracted using the PICO format (ie, participants, intervention, comparison, outcomes). Descriptive findings are reported. RESULTS Mean AMSTAR score = 7.66/11 (±2.04) suggests moderate quality of the systematic reviews. Exercise is beneficial before, during, and after cancer treatment, across all cancer types, and for a variety of cancer-related impairments. Moderate-to-vigorous exercise is the best level of exercise intensity to improve physical function and mitigate cancer-related impairments. Therapeutic exercises are beneficial to manage treatment side effects, may enhance tolerance to cancer treatments, and improve functional outcomes. Supervised exercise yielded superior benefits versus unsupervised. Serious adverse events were not common. LIMITATIONS Movement-based exercise intervention outcomes are reported. No analysis of pooled effects was calculated across reviews due to significant heterogeneity within the systematic reviews. Findings do not consider exercise in advanced cancers or pediatric populations. CONCLUSIONS Exercise promotes significant improvements in clinical, functional, and in some populations, survival outcomes and can be recommended regardless of the type of cancer. Although generally safe, patients should be screened and appropriate precautions taken. Efforts to strengthen uniformity in clinical trial reporting, develop clinical practice guidelines, and integrate exercise and rehabilitation services into the cancer delivery system are needed.
Collapse
|
77
|
Santa Mina D, Hilton WJ, Matthew AG, Awasthi R, Bousquet-Dion G, Alibhai SM, Au D, Fleshner NE, Finelli A, Clarke H, Aprikian A, Tanguay S, Carli F. Prehabilitation for radical prostatectomy: A multicentre randomized controlled trial. Surg Oncol 2018; 27:289-298. [DOI: 10.1016/j.suronc.2018.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 05/03/2018] [Indexed: 10/17/2022]
|
78
|
Abstract
PURPOSE OF REVIEW Exercise is a provocative medicine, known for its preventive, complimentary and rehabilitative role in the management of cancer. Impressively, exercise is also emerging as a synergistic and targeted medicine to enhance symptom control, modulate tumour biology and delay disease progression, with the potential to increase overall survival. Given the complex clinical presentation of advanced prostate cancer patients and their omnipresent comorbidities, this review describes the current and potential role of exercise medicine in advanced prostate cancer. RECENT FINDINGS Exercise has been shown to be safe, feasible and effective for advanced prostate cancer patients, inclusive of patients with bone metastases; a previously excluded population due to patient and clinician fear of adverse events. Preclinical data provide insight into the ability of exercise to modulate cancer-specific outcomes, may synergistically increase the potency of chemotherapy and radiotherapy and may endogenously and/or mechanically suppress tumour formation, growth and invasion in visceral and skeletal tissue. Epidemiological studies have also shown an association between physical activity and increased survival. SUMMARY Exercise oncology is rapidly evolving, with impressive possibilities that may directly improve patient outcomes in advanced prostate cancer. Research must focus on translating preclinical trials into human clinical trials and investigate the direct effect of exercise on overall survival.
Collapse
|
79
|
Abstract
Patients with brain tumor exhibit wide-ranging prognoses and functional implications of their disease and treatments. In general, the supportive care needs of patients with brain tumor, including disabling effects, have been recognized to be high. This review (1) briefly summarizes brain tumor types, treatments, and prognostic information for the rehabilitation clinician; (2) reviews evidence for rehabilitation, including acute inpatient rehabilitation and cognitive rehabilitation, and the approaches to selected common symptom and medical management issues; and (3) examines emerging data about survivorship, such as employment, community integration, and fitness.
Collapse
Affiliation(s)
- Mary M Vargo
- Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| |
Collapse
|
80
|
Sposato NS, Bjerså K. Osteopathic Manipulative Treatment in Surgical Care: Short Review of Research Publications in Osteopathic Journals During the Period 1990 to 2017. J Evid Based Integr Med 2018; 23:2515690X18767671. [PMID: 29637792 PMCID: PMC5900809 DOI: 10.1177/2515690x18767671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background. A growing trend in surgical care is the investigation and incorporation of multimodal interventions into standardized programs. Additionally, manual therapies such as osteopathic manipulative treatment (OMT) are being used with patients in surgical care. Yet the scientific dialogue and the use of OMT in surgical care are currently insubstantial. Objective. The aim of this study was to present an overview of published research articles within the subject field of OMT in surgical care. Method. Summative review of peer-reviewed research articles published in osteopathic journals during the period 1990 to 2017. In total, 10 articles were identified. Result. Previous research has been conducted within the areas of abdominal, thoracic, gynecological, and/or orthopedic surgery with measured outcomes such as pain, analgesia consumption, length of hospital stay, and range of motion. Heterogeneity was identified in usage of osteopathic techniques, treatment duration, and occurrence, as well as in the treating osteopath’s experience. Conclusion. Despite the small number of research articles within this field, both positive measured effects as well as the absence of such effects were identified. Overall, there was a heterogeneity concerning surgical contexts, diagnoses, signs and symptoms, as well as surgical phases in current interprofessional osteopathic publications. In this era of multimodal surgical care, we argue that there is an urgent need to evaluate OMT in this context of care and with a proper research approach.
Collapse
Affiliation(s)
- Niklas S Sposato
- 1 Scandinavian School of Osteopathy, Gothenburg, Sweden.,2 The Institute of Orthopaedic Medicine, Gothenburg, Sweden
| | - Kristofer Bjerså
- 3 Linköping University, Linköping, Sweden.,4 Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
81
|
The role of physical activity in breast and gynecologic cancer survivorship. Gynecol Oncol 2018; 149:198-204. [DOI: 10.1016/j.ygyno.2018.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
|
82
|
Cortés OL, Moreno K, Alvarado P, Povea C, Lloyd M, Dennis R. Inactivity and Its Associated Factors in Adults Scheduled for Noncardiac Surgery: The PAMP Phase I Study. Rehabil Nurs 2018. [DOI: 10.1002/rnj.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
83
|
Steffens D, Beckenkamp PR, Hancock M, Solomon M, Young J. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med 2018; 52:344. [DOI: 10.1136/bjsports-2017-098032] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
ObjectiveTo investigate the effectiveness of preoperative exercises interventions in patients undergoing oncological surgery, on postoperative complications, length of hospital stay and quality of life.DesignIntervention systematic review with meta-analysis.Data sourcesMEDLINE, Embase and PEDro.Eligibility criteria for selecting studiesTrials investigating the effectiveness of preoperative exercise for any oncological patient undergoing surgery were included. The outcomes of interest were postoperative complications, length of hospital stay and quality of life. Relative risks (RRs), mean differences (MDs) and 95% CI were calculated using random-effects models.ResultsSeventeen articles (reporting on 13 different trials) involving 806 individual participants and 6 tumour types were included. There was moderate-quality evidence that preoperative exercise significantly reduced postoperative complication rates (RR 0.52, 95% CI 0.36 to 0.74) and length of hospital stay (MD −2.86 days, 95% CI −5.40 to −0.33) in patients undergoing lung resection, compared with control. For patients with oesophageal cancer, preoperative exercise was not effective in reducing length of hospital stay (MD 2.00 days, 95% CI −2.35 to 6.35). Although only assessed in individual studies, preoperative exercise improved postoperative quality of life in patients with oral or prostate cancer. No effect was found in patients with colon and colorectal liver metastases.ConclusionsPreoperative exercise was effective in reducing postoperative complications and length of hospital stay in patients with lung cancer. Whether preoperative exercise reduces complications, length of hospital stay and improves quality of life in other groups of patients undergoing oncological surgery is uncertain as the quality of evidence is low.PROSPEROregistration number
Collapse
|
84
|
Corrigan LR, Bracken-Clarke DM, Horgan AM. The challenge of treating older patients with pancreaticobiliary malignancies. Curr Probl Cancer 2018; 42:59-72. [PMID: 29459178 DOI: 10.1016/j.currproblcancer.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
Abstract
Pancreatic and biliary tract cancers are aggressive malignancies. They commonly present with metastatic or unresectable disease. Those that do present with resectable cancer have high rates of recurrence. Despite recent advances in surgical technique, chemotherapy, and radiotherapy regimens, they are associated with poor survival outcomes. These cancers represent an exception to the trend of improved overall survival evident in most malignancies in recent decades. Depending on the goal of treatment, active management of pancreatic and biliary cancers involves surgery, chemotherapy, and radiation therapy, either alone or in combination. Both pancreatic and biliary tract cancers have a preponderance in the older population. Older patients are a heterogeneous group; although tolerability of multimodality treatment may be a challenge for some, many fit older patients may be undertreated based on their age alone. The growing field of geriatric oncology has highlighted the importance of a comprehensive assessment of these patients, and not relying on age alone as a discriminating factor for treatment. Management of older patients with pancreaticobiliary cancers is particularly challenging owing to limited prospective data in this population. As such, there is uncertainty with regard to optimal treatment approaches for these patients. In this article, we outline the therapeutic options available to patients with localized or advanced pancreatic and biliary tract cancers, and the evidence for specified treatment options in the elderly. We examine the inclusion and outcomes of elderly patients in relevant clinical trials; the morbidity that may be encountered by elderly patients receiving specified treatments and the tools that may assist the physician in selecting elderly patients for particular treatments.
Collapse
Affiliation(s)
- Lynda R Corrigan
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland.
| | - Dara M Bracken-Clarke
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland
| | - Anne M Horgan
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland
| |
Collapse
|
85
|
Newton RU, Taaffe DR, Chambers SK, Spry N, Galvão DA. Effective Exercise Interventions for Patients and Survivors of Cancer Should be Supervised, Targeted, and Prescribed With Referrals From Oncologists and General Physicians. J Clin Oncol 2018; 36:927-928. [PMID: 29373097 DOI: 10.1200/jco.2017.76.7400] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Robert U Newton
- Robert U. Newton, Edith Cowan University, Joondalup, Western Australia; and University of Queensland, Brisbane, Queensland, Australia; Dennis R. Taaffe, Edith Cowan University, Joondalup, Western Australia, Australia; Suzanne K. Chambers, Edith Cowan University, Joondalup, Western Australia; Griffith University-Gold Coast, Southport; and Cancer Council Queensland, Brisbane, Queensland, Australia; Nigel Spry, Edith Cowan University; Genesis CancerCare, Joondalup; and University of Western Australia, Nedlands, Western Australia, Australia; and Daniel A. Galvão, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dennis R Taaffe
- Robert U. Newton, Edith Cowan University, Joondalup, Western Australia; and University of Queensland, Brisbane, Queensland, Australia; Dennis R. Taaffe, Edith Cowan University, Joondalup, Western Australia, Australia; Suzanne K. Chambers, Edith Cowan University, Joondalup, Western Australia; Griffith University-Gold Coast, Southport; and Cancer Council Queensland, Brisbane, Queensland, Australia; Nigel Spry, Edith Cowan University; Genesis CancerCare, Joondalup; and University of Western Australia, Nedlands, Western Australia, Australia; and Daniel A. Galvão, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Suzanne K Chambers
- Robert U. Newton, Edith Cowan University, Joondalup, Western Australia; and University of Queensland, Brisbane, Queensland, Australia; Dennis R. Taaffe, Edith Cowan University, Joondalup, Western Australia, Australia; Suzanne K. Chambers, Edith Cowan University, Joondalup, Western Australia; Griffith University-Gold Coast, Southport; and Cancer Council Queensland, Brisbane, Queensland, Australia; Nigel Spry, Edith Cowan University; Genesis CancerCare, Joondalup; and University of Western Australia, Nedlands, Western Australia, Australia; and Daniel A. Galvão, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nigel Spry
- Robert U. Newton, Edith Cowan University, Joondalup, Western Australia; and University of Queensland, Brisbane, Queensland, Australia; Dennis R. Taaffe, Edith Cowan University, Joondalup, Western Australia, Australia; Suzanne K. Chambers, Edith Cowan University, Joondalup, Western Australia; Griffith University-Gold Coast, Southport; and Cancer Council Queensland, Brisbane, Queensland, Australia; Nigel Spry, Edith Cowan University; Genesis CancerCare, Joondalup; and University of Western Australia, Nedlands, Western Australia, Australia; and Daniel A. Galvão, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Robert U. Newton, Edith Cowan University, Joondalup, Western Australia; and University of Queensland, Brisbane, Queensland, Australia; Dennis R. Taaffe, Edith Cowan University, Joondalup, Western Australia, Australia; Suzanne K. Chambers, Edith Cowan University, Joondalup, Western Australia; Griffith University-Gold Coast, Southport; and Cancer Council Queensland, Brisbane, Queensland, Australia; Nigel Spry, Edith Cowan University; Genesis CancerCare, Joondalup; and University of Western Australia, Nedlands, Western Australia, Australia; and Daniel A. Galvão, Edith Cowan University, Joondalup, Western Australia, Australia
| |
Collapse
|
86
|
Morielli AR, Usmani N, Boulé NG, Severin D, Tankel K, Nijjar T, Joseph K, Fairchild A, Courneya KS. Exercise during and after neoadjuvant rectal cancer treatment (the EXERT trial): study protocol for a randomized controlled trial. Trials 2018; 19:35. [PMID: 29329555 PMCID: PMC5767015 DOI: 10.1186/s13063-017-2398-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/07/2017] [Indexed: 12/15/2022] Open
Abstract
Background Standard treatment for locally advanced rectal cancer includes 5–6 weeks of neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision 6–8 weeks later. NACRT improves local disease control and surgical outcomes but also causes side effects including fatigue, diarrhea, hand-foot syndrome, and physical deconditioning that may impede quality of life (QoL), treatment completion, treatment response, and long-term prognosis. Interventions to improve treatment outcomes and manage side effects that are safe, tolerable and low-cost are highly desirable. Exercise has been shown to improve some of these outcomes in other cancer patient groups but no study to date has examined the potential benefits (and harms) of exercise training during and after NACRT for rectal cancer. Methods/design The Exercise During and After Neoadjuvant Rectal Cancer Treatment (EXERT) trial is a single-center, prospective, two-armed, phase II randomized controlled trial designed to test the preliminary efficacy of exercise training in this clinical setting and to further evaluate its feasibility and safety. Participants will be 60 rectal cancer patients scheduled to receive long-course NACRT followed by total mesorectal excision. Participants will be randomly assigned to exercise training or usual care. Participants in the exercise training group will be asked to complete three supervised, high-intensity interval training sessions/week during NACRT and ≥ 150 min/week of unsupervised, moderate-to-vigorous-intensity, continuous exercise training after NACRT prior to surgery. Participants in the usual care group will be asked not to increase their exercise from baseline. Assessments will be completed pre NACRT, post NACRT, and pre surgery. The primary endpoint will be cardiorespiratory fitness (VO2 peak) at the post-NACRT time point assessed by a graded exercise test. Secondary endpoints will include functional fitness assessed by the Senior’s Fitness Test, QoL assessed by the European Organisation of Research and Treatment of Cancer, and symptom management assessed by the M.D. Anderson Symptom Inventory. Exploratory clinical endpoints will include treatment toxicities, treatment completion, treatment response, and surgical complications. Discussion If the preliminary findings of EXERT are positive, additional research will be warranted to confirm whether exercise is an innovative treatment to maintain QoL, manage side effects, and/or improve treatment outcomes in rectal cancer patients. Trial registration ClinicalTrials.gov, ID: NCT03082495. Registered on 9 February, 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2398-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Andria R Morielli
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-113 University Hall, Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada
| | - Nawaid Usmani
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-113 University Hall, Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada
| | - Diane Severin
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Keith Tankel
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Tirath Nijjar
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Kurian Joseph
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Alysa Fairchild
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-113 University Hall, Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada.
| |
Collapse
|
87
|
Molecular Mechanisms Linking Exercise to Cancer Prevention and Treatment. Cell Metab 2018; 27:10-21. [PMID: 29056514 DOI: 10.1016/j.cmet.2017.09.015] [Citation(s) in RCA: 305] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/09/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022]
Abstract
The benefits of exercise training for cancer patients are becoming increasingly evident. Physical exercise has been shown to reduce cancer incidence and inhibit tumor growth. Here we provide the status of the current molecular understanding of the effect of exercise on cancer. We propose that exercise has a role in controlling cancer progression through a direct effect on tumor-intrinsic factors, interplay with whole-body exercise effects, alleviation of cancer-related adverse events, and improvement of anti-cancer treatment efficacy. These findings have wide-ranging societal implications, as this understanding may lead to changes in cancer treatment strategies.
Collapse
|
88
|
Feasibility and Efficacy of Presurgical Exercise in Survivors of Rectal Cancer Scheduled to Receive Curative Resection. Clin Colorectal Cancer 2017; 16:358-365. [DOI: 10.1016/j.clcc.2017.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/13/2017] [Indexed: 11/24/2022]
|
89
|
Ngo-Huang A, Parker NH, Wang X, Petzel MQB, Fogelman D, Schadler KL, Bruera E, Fleming JB, Lee JE, Katz MHG. Home-based exercise during preoperative therapy for pancreatic cancer. Langenbecks Arch Surg 2017; 402:1175-1185. [PMID: 28710540 PMCID: PMC8372869 DOI: 10.1007/s00423-017-1599-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/25/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Exercise concurrent with neoadjuvant chemotherapy and/or chemoradiation for pancreatic adenocarcinoma (PDAC) may mitigate the decline in function that may occur as a result of the disease or its treatment in the preoperative period. The primary objective of this single-arm prospective trial was to determine adherence to a home-based exercise program administered during preoperative therapy. METHODS Twenty patients from a quaternary cancer center with potentially resectable PDAC were enrolled. Patients were prescribed a minimum of 120 min of moderate-intensity exercise weekly: at least 60 min of aerobic exercise and 60 min of resistance exercise. Self-reported exercise was recorded in daily logs. Functional and survey measures were collected upon enrollment, following preoperative therapy, and 1 month after surgery. RESULTS Fifteen out of 20 patients participated in the program. They reported a mean (standard deviation (SD)) of 98.6 (69.8) min of aerobic exercise weekly and 57.4 (36.0) min of strengthening exercise weekly over a median of 17 weeks (range, 5-35 weeks) of preoperative therapy, for a mean (SD) of 156.0 (64.5) min of total exercise weekly. Eighty percent reported a mean of least 120 min of total exercise weekly during preoperative therapy. Patients with low baseline physical activity based on the International Physical Activity Questionnaire significantly increased their preoperative physical activity (p = .01). There were no adverse events associated with the exercise program. CONCLUSIONS Patients with PDAC will participate in a home-based exercise program of aerobic and strengthening exercise and will increase physical activity, concurrent with preoperative chemotherapy and/or chemoradiation.
Collapse
Affiliation(s)
- An Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX, 77030, USA.
| | - Nathan H Parker
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria Q B Petzel
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keri L Schadler
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX, 77030, USA
| | - Jason B Fleming
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
90
|
Vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy: a feasibility randomised controlled trial. Support Care Cancer 2017; 26:1515-1523. [PMID: 29181804 DOI: 10.1007/s00520-017-3991-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/20/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE Strategies to improve pre-operative cardiopulmonary fitness could positively impact recovery after surgery. This study investigated the feasibility of vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy (RC). METHODS A total of 60 patients were randomised (1:1) to exercise or control following a cardiopulmonary exercise test (CPET). The exercise group was offered twice-weekly pre-operative supervised vigorous intensity aerobic interval exercise in addition to standard treatment. The controls received standard treatment only. A repeat CPET was undertaken before surgery and post-operative recovery outcomes were recorded. RESULTS Over half of the 112 eligible patients approached in the clinic were recruited to the study (53.5%), with recruited patients attending a median of 8 (range 1-10) exercise sessions over a pre-operative period of 3-6 weeks. Improvements in peak values of oxygen pulse (P = 0.001), minute ventilation (P = 0.002) and power output (P < 0.001) were observed at the follow-up CPET in the exercise group versus controls and there were no adverse events. Although this feasibility study was not powered to detect changes in post-operative recovery outcomes, there were marginal (non-significant) differences in favour of the exercise group in post-operative Clavien-Dindo score and need for high dependency unit inotropic support. CONCLUSIONS Bladder cancer patients respond well to pre-surgical aerobic interval exercise, and the improvements in cardiopulmonary fitness variables could have important implications for post-operative recuperation after RC. These findings provide a strong foundation for an adequately powered randomised controlled trial.
Collapse
|
91
|
West MA, Wischmeyer PE, Grocott MPW. Prehabilitation and Nutritional Support to Improve Perioperative Outcomes. CURRENT ANESTHESIOLOGY REPORTS 2017; 7:340-349. [PMID: 29200973 PMCID: PMC5696441 DOI: 10.1007/s40140-017-0245-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW The purpose of this study is to evaluate the role of physical exercise and nutrition interventions in adult patients before elective major surgery. RECENT FINDINGS Exercise training before elective adult major surgery is feasible, safe, and efficacious, but the clinical effectiveness remains uncertain. Early data suggests a reduction in morbidity, length of stay, and quality of life, but the results of larger definitive studies are awaited. Nutritional interventions are less well evaluated and when they are, it is often in combination with exercise interventions as part of a prehabilitation package. SUMMARY Studies evaluating exercise and nutrition interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical evidence is currently very limited. Future research should focus on refining interventions, exploring mechanism, and evaluating the interactions between therapies and large-scale clinical effectiveness studies.
Collapse
Affiliation(s)
- Malcolm A. West
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton NIHR Biomedical Research Centre, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul E. Wischmeyer
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC USA
- Duke Clinical Research Institute, Durham, NC USA
| | - Michael P. W. Grocott
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton NIHR Biomedical Research Centre, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Anaesthesia and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
92
|
Prehabilitation in gynecological surgery? What do gynecologists know and need to know. Arch Gynecol Obstet 2017; 297:27-31. [DOI: 10.1007/s00404-017-4565-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/11/2017] [Indexed: 11/25/2022]
|
93
|
Singh F, Newton RU, Baker MK, Spry NA, Taaffe DR, Thavaseelan J, Galvão DA. Feasibility of Presurgical Exercise in Men With Prostate Cancer Undergoing Prostatectomy. Integr Cancer Ther 2017; 16:290-299. [PMID: 27585629 PMCID: PMC5759940 DOI: 10.1177/1534735416666373] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/22/2016] [Accepted: 07/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prostatectomy is associated with short- and long-term morbidity, which includes attenuation of muscle function and deterioration of lean body mass. Physical function is a known predictor of morbidity and mortality, with initial evidence indicating that presurgical exercise is associated with fewer postsurgical complications and shorter hospitalization. The aim was to determine the feasibility of a supervised presurgical exercise program for prostate cancer (PCa) patients scheduled for prostatectomy. METHODS Ten men (68+6.4 years old) with localized PCa undertook a 6-week resistance and aerobic exercise program prior surgery. Training was undertaken twice weekly and patients were assessed at baseline, presurgery, and 6 weeks postsurgery. Outcome measures included muscle and physical performance, body composition, urinary incontinence and questionnaire. RESULTS Muscle strength increased by 7.5% to 24.3% ( P < .05) from baseline to presurgery but decreased to pretraining levels postsurgery, except for knee extensor strength ( P = .247). There were significant improvements ( P < .05) in the 6-m fast walk (9.3%), 400-m walk (7.4%), and chair rise (12.3%) at presurgery. Following surgery, improvements in physical performance were maintained. There was no change in lean or fat mass prior to surgery, but lean mass declined by 2.7 kg ( P = .014) following surgery. There were no adverse effects from the exercise program. CONCLUSIONS Exercise undertaken prior to prostatectomy improved muscle and physical performance, with functional benefits maintained 6 weeks postsurgery. Presurgical exercise for PCa patients has the potential to facilitate recovery by improving physical reserve capacity, especially in men with poor muscle nd physical performance.
Collapse
Affiliation(s)
- Favil Singh
- Edith Cowan University, Joondalup, WA, Australia
| | | | - Michael K. Baker
- University of Sydney, NSW, Australia
- Australian Catholic University, NSW, Australia
| | - Nigel A. Spry
- Edith Cowan University, Joondalup, WA, Australia
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- University of Western Australia, Nedlands, WA, Australia
| | - Dennis R. Taaffe
- Edith Cowan University, Joondalup, WA, Australia
- University of Wollongong, NSW, Australia
| | | | | |
Collapse
|
94
|
Maltser S, Cristian A, Silver JK, Morris GS, Stout NL. A Focused Review of Safety Considerations in Cancer Rehabilitation. PM R 2017; 9:S415-S428. [PMID: 28942913 PMCID: PMC5627359 DOI: 10.1016/j.pmrj.2017.08.403] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/12/2022]
Abstract
Cancer and its treatments introduce various adverse effects that may affect survivors' physical, cognitive and psychological functioning. Frequently both tolerance to activity and exercise are affected as well. Rehabilitation providers should have substantive knowledge about the effect of cancer progression and common side effects associated with antineoplastic treatment to safely integrate rehabilitation interventions. Rehabilitation may mitigate loss of function and disability; however, these patients are among the most medically complex that providers treat. This report provides a focused review that synthesizes the current evidence regarding disease progression and oncology-directed treatment side effects within the context of safety considerations for rehabilitation interventions throughout the continuum of cancer care. Descriptive information regarding the evidence for precautions and contraindications is provided so that rehabilitation providers can promote a safe plan of rehabilitation care. It is incumbent upon but also challenging for rehabilitation providers to stay up to date on the many advances in cancer treatment, and there are many gaps in the literature regarding safety issues. Although further research is needed to inform care, this review provides clinicians with a framework to assess patients with the goal of safely initiating rehabilitation interventions.
Collapse
Affiliation(s)
- Susan Maltser
- Department of Physical Medicine and Rehabilitation, Hofstra Northwell School of Medicine, Hempstead, NY; Long Island Jewish Medical Center, Manhasset, NY(∗)
| | - Adrian Cristian
- Department of Rehabilitation Medicine, Northwell-Glen Cove Hospital, Glen Cove, NY(†)
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital Network, Boston, MA; Massachusetts General Hospital, Boston, MA; Physiatry, Brigham and Women's Hospital, Boston, MA(‡)
| | - G Stephen Morris
- Department of Physical Therapy, Wingate University, Wingate, NC(§)
| | - Nicole L Stout
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Office of Strategic Research, Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, MSC 1604, 10 Center Dr, Bethesda, MD 20892-1604(‖).
| |
Collapse
|
95
|
|
96
|
Fugazzaro S, Costi S, Mainini C, Kopliku B, Rapicetta C, Piro R, Bardelli R, Rebelo PFS, Galeone C, Sgarbi G, Lococo F, Paci M, Ricchetti T, Cavuto S, Merlo DF, Tenconi S. PUREAIR protocol: randomized controlled trial of intensive pulmonary rehabilitation versus standard care in patients undergoing surgical resection for lung cancer. BMC Cancer 2017; 17:508. [PMID: 28760151 PMCID: PMC5537935 DOI: 10.1186/s12885-017-3479-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023] Open
Abstract
Background Non-small cell lung cancer is the most common type of lung cancer. Surgery is proven to be the most effective treatment in early stages, despite its potential impact on quality of life. Pulmonary rehabilitation, either before or after surgery, is associated with reduced morbidity related symptoms and improved exercise capacity, lung function and quality of life. Methods We describe the study protocol for the open-label randomized controlled trial we are conducting on patients affected by primary lung cancer (stages I-II) eligible for surgical treatment. The control group receives standard care consisting in one educational session before surgery and early inpatient postoperative physiotherapy. The treatment group receives, in addition to standard care, intensive rehabilitation involving 14 preoperative sessions (6 outpatient and 8 home-based) and 39 postoperative sessions (15 outpatient and 24 home-based) with aerobic, resistance and respiratory training, as well as scar massage and group bodyweight exercise training. Assessments are performed at baseline, the day before surgery and one month and six months after surgery. The main outcome is the long-term exercise capacity measured with the Six-Minute Walk Test; short-term exercise capacity, lung function, postoperative morbidity, length of hospital stay, quality of life (Short Form 12), mood disturbances (Hospital Anxiety and Depression Scale) and pain (Numeric Rating Scale) are also recorded and analysed. Patient compliance and treatment-related side effects are also collected. Statistical analyses will be performed according to the intention-to-treat approach. T-test for independent samples will be used for continuous variables after assessment of normality of distribution. Chi-square test will be used for categorical variables. Expecting a 10% dropout rate, assuming α of 5% and power of 80%, we planned to enrol 140 patients to demonstrate a statistically significant difference of 25 m at Six-Minute Walk Test. Discussion Pulmonary Resection and Intensive Rehabilitation study (PuReAIR) will contribute significantly in investigating the effects of perioperative rehabilitation on exercise capacity, symptoms, lung function and long-term outcomes in surgically treated lung cancer patients. This study protocol will facilitate interpretation of future results and wide application of evidence-based practice. Trial registration ClinicalTrials.gov Registry n. NCT02405273 [31.03.2015].
Collapse
Affiliation(s)
- Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy. .,Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Via del Pozzo n°71, 41124, Modena, Italy. .,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, L.go P. Daneo n°3, 16132, Genoa, Italy.
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Besa Kopliku
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Cristian Rapicetta
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberto Piro
- Pulmonology Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberta Bardelli
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Patricia Filipa Sobral Rebelo
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Carla Galeone
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Giorgio Sgarbi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Filippo Lococo
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Massimiliano Paci
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Tommaso Ricchetti
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Domenico Franco Merlo
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Sara Tenconi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| |
Collapse
|
97
|
Bock D, Angenete E, Bjartell A, Carlsson S, Steineck G, Stranne J, Thorsteinsdottir T, Wiklund P, Haglind E. Habits and self-assessed quality of life, negative intrusive thoughts and depressed mood in patients with prostate cancer: a longitudinal study. Scand J Urol 2017. [DOI: 10.1080/21681805.2017.1326523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG (Scandinavian Surgical Outcomes Research Group), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG (Scandinavian Surgical Outcomes Research Group), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Stefan Carlsson
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden
| | | | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG (Scandinavian Surgical Outcomes Research Group), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| |
Collapse
|
98
|
Driessen EJ, Peeters ME, Bongers BC, Maas HA, Bootsma GP, van Meeteren NL, Janssen-Heijnen ML. Effects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: A systematic review. Crit Rev Oncol Hematol 2017; 114:63-76. [DOI: 10.1016/j.critrevonc.2017.03.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/22/2017] [Indexed: 01/24/2023] Open
|
99
|
Hart NH, Newton RU, Spry NA, Taaffe DR, Chambers SK, Feeney KT, Joseph DJ, Redfern AD, Ferguson T, Galvão DA. Can exercise suppress tumour growth in advanced prostate cancer patients with sclerotic bone metastases? A randomised, controlled study protocol examining feasibility, safety and efficacy. BMJ Open 2017; 7:e014458. [PMID: 28559456 PMCID: PMC5777463 DOI: 10.1136/bmjopen-2016-014458] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Exercise may positively alter tumour biology through numerous modulatory and regulatory mechanisms in response to a variety of modes and dosages, evidenced in preclinical models to date. Specifically, localised and systemic biochemical alterations produced during and following exercise may suppress tumour formation, growth and distribution by virtue of altered epigenetics and endocrine-paracrine activity. Given the impressive ability of targeted mechanical loading to interfere with metastasis-driven tumour formation in human osteolytic tumour cells, it is of equal interest to determine whether a similar effect is observed in sclerotic tumour cells. The study aims to (1) establish the feasibility and safety of a combined modular multimodal exercise programme with spinal isometric training in advanced prostate cancer patients with sclerotic bone metastases and (2) examine whether targeted and supervised exercise can suppress sclerotic tumour growth and activity in spinal metastases in humans. METHODS AND ANALYSIS A single-blinded, two-armed, randomised, controlled and explorative phase I clinical trial combining spinal isometric training with a modular multimodal exercise programme in 40 men with advanced prostate cancer and stable sclerotic spinal metastases. Participants will be randomly assigned to (1) the exercise intervention or (2) usual medical care. The intervention arm will receive a 3-month, supervised and individually tailored modular multimodal exercise programme with spinal isometric training. Primary endpoints (feasibility and safety) and secondary endpoints (tumour morphology; biomarker activity; anthropometry; musculoskeletal health; adiposity; physical function; quality of life; anxiety; distress; fatigue; insomnia; physical activity levels) will be measured at baseline and following the intervention. Statistical analyses will include descriptive characteristics, t-tests, effect sizes and two-way (group × time) repeated-measures analysis of variance (or analysis of covariance) to examine differences between groups over time. The data-set will be primarily examined using an intention-to-treat approach with multiple imputations, followed by a secondary sensitivity analysis to ensure data robustness using a complete cases approach. ETHICS AND DISSEMINATION Ethics approval was obtained from the Human Research Ethics Committee (HREC) of Edith Cowan University and the Sir Charles Gairdner and Osborne Park Health Care Group. If proven to be feasible and safe, this study will form the basis of future phase II and III trials in human patients with advanced cancer. To reach a maximum number of clinicians, practitioners, patients and scientists, outcomes will be disseminated through national and international clinical, conference and patient presentations, as well as publication in high-impact, peer-reviewed academic journals. TRIAL REGISTRATION NUMBER ACTRN 12616000179437.
Collapse
Affiliation(s)
- Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Nigel A Spry
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Radiation Oncology, Genesis CancerCare, Perth, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kynan T Feeney
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Medical Oncology, St John of God Hospital, Perth, Australia
- School of Medicine, University of Notre Dame Australia, Perth, Australia
| | - David J Joseph
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Radiation Oncology, Genesis CancerCare, Perth, Australia
| | - Andrew D Redfern
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Tom Ferguson
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| |
Collapse
|
100
|
van Rooijen SJ, Engelen MA, Scheede-Bergdahl C, Carli F, Roumen RMH, Slooter GD, Schep G. Systematic review of exercise training in colorectal cancer patients during treatment. Scand J Med Sci Sports 2017; 28:360-370. [PMID: 28488799 DOI: 10.1111/sms.12907] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 12/11/2022]
Abstract
Colorectal cancer surgery results in considerable postoperative morbidity, mortality and reduced quality of life. As many patients will undergo additional (neo)adjuvant therapy, it is imperative that each individual optimize their physical function. To elucidate the potential of exercise in patient optimization, we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients. A systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions, the guidelines of the Physical Therapy Journal and the PRISMA guidelines. No literature pertaining to exercise training during preoperative neoadjuvant treatment was found. Seven studies, investigating the effects of regular exercise during adjuvant chemotherapy for patients with colorectal cancer or a mixed population, were identified. A small effect (effect size (ES) 0.4) of endurance/interval training and strength training (ES 0.4) was found in two studies conducted in patients with colorectal and gastrointestinal cancer. In five studies that included a mixed population of cancer patients, interval training resulted in a large improvement (ES 1.5; P≤.05). Endurance training alone was found to increase both lower extremity strength and endurance capacity. The effects of strength training in the lower extremity are moderate, whereas, in the upper extremity, the increase is small. There is limited evidence available on exercise training during treatment in colorectal cancer patients. One study concluded exercise therapy may be beneficial for colorectal cancer patients during adjuvant treatment. The possible advantages of training during neoadjuvant treatment may be explored by prehabilitation trials.
Collapse
Affiliation(s)
- S J van Rooijen
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M A Engelen
- Department of Physiotherapy, Máxima Medical Center, Veldhoven, The Netherlands
| | - C Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada.,Department of Anesthesiology, The Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - F Carli
- Department of Anesthesiology, The Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - R M H Roumen
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, The Netherlands
| | - G D Slooter
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, The Netherlands
| | - G Schep
- Department of Sports Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| |
Collapse
|