51
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Xu X, Cheung DST, Smith R, Lai AYK, Lin CC. The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay. Clin Rehabil 2021; 36:172-189. [PMID: 34496658 DOI: 10.1177/02692155211043267] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. REVIEW METHODS Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. RESULTS Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = -1.68 days, 95% CI = -2.23, -1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = -0.23 days, 95% CI = -1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = -0.17, 95% CI = -0.29, -0.05). CONCLUSION Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.
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Affiliation(s)
- Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Agnes Yuen Kwan Lai
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Alice Ho Miu Ling Nethersole Charity Foundation Professorship in Nursing, Hong Kong.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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52
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Wagnild JM, Akowuah E, Maier RH, Hancock HC, Kasim A. Impact of prehabilitation on objectively measured physical activity levels in elective surgery patients: a systematic review. BMJ Open 2021; 11:e049202. [PMID: 34493516 PMCID: PMC8424868 DOI: 10.1136/bmjopen-2021-049202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To systematically review the impact of prehabilitation on objectively measured physical activity (PA) levels in elective surgery patients. DATA SOURCES Articles published in Web of Science Core Collections, PubMed, Embase (Ovid), CINAHL (EBSCOHost), PsycInfo (EBSCOHost) and CENTRAL through August 2020. STUDY SELECTION Studies that met the following criteria: (1) written in English, (2) quantitatively described the effect(s) of a PA intervention among elective surgery patients prior to surgery and (3) used and reported objective measures of PA in the study. DATA EXTRACTION AND SYNTHESIS Participant characteristics, intervention details, PA measurement, and clinical and health-related outcomes were extracted. Risk of bias was assessed following the revised Cochrane risk of bias tool. Meta-analysis was not possible due to heterogeneity, therefore narrative synthesis was used. RESULTS 6533 unique articles were identified in the search; 21 articles (based on 15 trials) were included in the review. There was little evidence to suggest that prehabilitation is associated with increases in objectively measured PA, but this may be due to insufficient statistical power as most (n=8) trials included in the review were small feasibility/pilot studies. Where studies tested associations between objectively measured PA during the intervention period and health-related outcomes, significant beneficial associations were reported. Limitations in the evidence base precluded any assessment via meta-regression of the association between objectively measured PA and clinical or health-related outcomes. CONCLUSIONS Additional large-scale studies are needed, with clear and consistent reporting of objective measures including accelerometry variables and outcome variables, to improve our understanding of the impact of changes in PA prior to surgery on surgical and health-related outcomes. PROSPERO REGISTRATION NUMBER CRD42019151475.
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Affiliation(s)
| | - Enoch Akowuah
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
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53
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de Oliveira Vacchi C, Martha BA, Macagnan FE. Effect of inspiratory muscle training associated or not to physical rehabilitation in preoperative anatomic pulmonary resection: a systematic review and meta-analysis. Support Care Cancer 2021; 30:1079-1092. [PMID: 34417883 DOI: 10.1007/s00520-021-06467-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/24/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study is to systematically review the effect of inspiratory muscle training (IMT) associated or not with physical rehabilitation in the preoperative period of anatomical pulmonary resection. METHODS Search in the databases: MEDLINE, Cochrane CENTRAL, EMBASE, LILACS and PEDro up to November 2019. Randomized clinical trials (RCTs) were included in adults in the preoperative period of pulmonary resection. The selection of studies and data extraction was performed by two independent reviewers. The risk of bias assessed with RoB 2.0 and the quality of evidence with GRADE. PROSPERO CRD42018105859. RESULTS Six RCTs were included; patients who underwent IMT in the preoperative period showed a significant improvement in functional capacity assessed by the 6-min walk test (6WT) (MD 28,93 [IC 95% 0,28; 57,58], p = 0,04, I2 = 0%) and significantly reduced the length of hospital stay (MD -3,63 [IC 95% -4,96; -2,29], p = 0,00, I2 = 0%). There was no significant difference between groups regarding pulmonary function, in postoperative complications such as pneumonia (RR 0,56 [IC 95% 0,29; 1,10], p = 0,09, I2 = 0%), atelectasis (RR 0,81 [IC 95% 0,24; 2,69], p = 0,72, I2 = 0%), mechanical ventilation > 48 h (RR 0,43 [IC 95% 0,12; 1,58], p = 0,20, I2 = 0%), in mortality (RR 0,33 [IC 95% 0,04; 3,12], p = 0,33, I2 = 0%), and quality of life. CONCLUSION IMT associated with physical exercise in the preoperative period of pulmonary resection improves functional capacity and reduces the length of hospital stay in the postoperative period.
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Affiliation(s)
- Cindy de Oliveira Vacchi
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil.
| | - Bianca Andrade Martha
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Fabrício Edler Macagnan
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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54
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Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery. A Systematic Review and Meta-analysis with Trial Sequential Analysis. Ann Am Thorac Soc 2021; 18:678-688. [PMID: 33030962 DOI: 10.1513/annalsats.202002-183oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: Poor preoperative physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications (PPCs) that result in prolonged hospital length of stay and increased mortality.Objectives: To examine the effect of preoperative exercise training on the risk of PPCs across different surgical settings.Methods: We searched MEDLINE, Web of Science, Embase, the Physiotherapy Evidence Database, and the Cochrane Central Register, without language restrictions, for studies from inception to July 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. PPCs were the main outcome; secondary outcomes were preoperative functional changes and postoperative mortality, cardiovascular complications, and hospital length of stay. The study was registered with PROSPERO (International Prospective Register of Systematic Reviews).Results: From 29 studies, 2,070 patients were pooled for meta-analysis. Compared with the control condition, preoperative exercise training was associated with a lower incidence of PPCs (23 studies, 1,864 patients; relative risk, 0.52; 95% confidence interval [CI], 0.41 to 0.66; grading of evidence, moderate); Trial Sequential Analysis confirmed effectiveness, and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined), or preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference [WMD], +2 ml/kg/min; 99% CI, 0.3 to 3.7) and higher maximal inspiratory pressure (WMD, +12.2 cm H2O; 99% CI, 6.3 to 18.2). Hospital length of stay was shortened (WMD, -2.3 d; 99% CI, -3.82 to -0.75) in the intervention group, whereas no difference was found in postoperative mortality.Conclusions: Preoperative exercise training improves physical fitness and reduces the risk of developing PPCs while minimizing hospital resources use, regardless of the type of intervention and surgery performed.Systematic review registered with https://www.crd.york.ac.uk/prospero/ (CRD 42018096956).
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Shukla A, Granger CL, Wright GM, Edbrooke L, Denehy L. Attitudes and Perceptions to Prehabilitation in Lung Cancer. Integr Cancer Ther 2021; 19:1534735420924466. [PMID: 32447995 PMCID: PMC7249590 DOI: 10.1177/1534735420924466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Prehabilitation to maximize exercise capacity before
lung cancer surgery has the potential to improve operative tolerability and
patient outcomes. However, translation of this evidence into clinical practice
is limited. Aims: To determine the acceptability and perceived
benefit of prehabilitation in lung cancer among thoracic surgeons.
Procedure: 198 cardiothoracic surgeons within Australia and New
Zealand were surveyed to evaluate their attitudes and perceived benefits of
prehabilitation in lung cancer. Results: Response rate was 14%. A
moderate proportion of respondents reported that there is a need to refer lung
resection patients to preoperative physiotherapy/prehabilitation, particularly
high-risk patients or those with borderline fitness for surgery. 91% of surgeons
were willing to delay surgery (as indicated by cancer stage/type) to optimize
patients via prehabilitation. The main barriers to prehabilitation reported were
patient comorbidities and access to allied health professionals, with 33%
stating that they were unsure who to refer to for prehabilitation in thoracic
surgery. This is despite 60% of the cohort reporting that pulmonary
rehabilitation is available as a preoperative resource. 92% of respondents
believe that further research into prehabilitation in lung cancer is warranted.
Conclusion: The benefits of prehabilitation for the oncology
population have been well documented in the literature over recent years and
this is reflected in the perceptions surgeons had on the benefits of
prehabilitation for their patients. This survey demonstrates an interest among
cardiothoracic surgeons in favor of prehabilitation, and therefore further
research and demonstration of its benefit is needed in lung cancer to facilitate
implementation into practice.
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Affiliation(s)
- Anna Shukla
- The University of Melbourne, Melbourne, Victoria, Australia.,St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Catherine L Granger
- The University of Melbourne, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gavin M Wright
- St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Lara Edbrooke
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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56
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Assessment and Rehabilitation of the Compromised Patient Prior to Thoracotomy. Thorac Surg Clin 2021; 31:309-316. [PMID: 34304839 DOI: 10.1016/j.thorsurg.2021.04.013] [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: 11/23/2022]
Abstract
Patients for whom pulmonary resection is anticipated often have compromised pulmonary function and decreased exercise tolerance. To avoid major morbidity and reduce mortality, identification of the high-risk patient becomes extremely important. The means of identification include rather simple testing modalities as well as those that are more complex, which report specific physiologic data. This article develops a schematic for a logical progression through the assessment of prethoracotomy patients in order that those facing a significant surgical risk might undergo pulmonary rehabilitation to improve exercise performance followed by reassessment prior to surgery.
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57
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Lawson C, Ferreira V, Carli F, Chevalier S. Effects of multimodal prehabilitation on muscle size, myosteatosis, and dietary intake of surgical patients with lung cancer - a randomized feasibility study. Appl Physiol Nutr Metab 2021; 46:1407-1416. [PMID: 34265218 DOI: 10.1139/apnm-2021-0249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Many patients with lung cancer undergo surgery, which can increase the risk for muscle loss, leading to worsened outcomes. A multimodal prehabilitation intervention integrating dietary and muscle assessment may help clinicians better understand changes in these outcomes. This pilot assessed feasibility of multimodal prehabilitation in early-stage surgical lung cancer patients and explored relationships between body composition, muscle characteristics and dietary intake, as well as muscle changes due to prehabilitation. Patients were randomized to one of two groups: multimodal prehabilitation including nutritional supplements (fish oil with vitamin D3 + whey protein with leucine), exercise and relaxation, or standard of care. Physical function, dietary intake and muscle were evaluated at 0 and 4 weeks pre-operatively. Of 87 patients assessed for eligibility, 34 (39%) were randomized and 3 (9%) were lost to follow-up. Median age was 69 years and baseline protein intake was 1.0 g/kg/d. Adherence to exercise (86%) and supplements was high (93%); 3 patients (16%) reported side effects. Supplements significantly increased protein, omega-3 fatty acid, leucine and vitamin D intake. There were no significant changes in muscle characteristics. Multimodal prehabilitation with dietary and muscle analyses proved to be feasible. An adequately powered randomized controlled trial is warranted. ClinicalTrials.gov registration no: NCT04610606. Novelty: • Multimodal prehabilitation incorporating dietary assessment and muscle analysis is feasible for early-stage surgical lung cancer patients. • An adequately powered randomized controlled trial is warranted to further explore functional and post-operative outcomes.
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Affiliation(s)
- Claire Lawson
- McGill University, 5620, School of Human Nutrition, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, 507266, Montreal, Quebec, Canada;
| | - Vanessa Ferreira
- McGill University, 5620, Department of Kinesiology and Physical Education, Montreal, Quebec, Canada;
| | - Francesco Carli
- McGill University, 5620, Department of Anesthesia, Montreal, Quebec, Canada;
| | - Stéphanie Chevalier
- McGill University, School of Human Nutrition, Ste-Anne-de-Bellevue, Quebec, Canada.,Research Institute of the McGill University Health Centre, 507266, Montreal, Quebec, Canada;
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58
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Liu L, Zhang J, Wang G, Guo C, Chen Y, Huang C, Li S. Delayed Discharge after Thoracic Surgery under the Guidance of ERAS Protocols. Thorac Cardiovasc Surg 2021; 70:405-412. [PMID: 34176111 DOI: 10.1055/s-0041-1727232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been applied in thoracic surgery and are beneficial to patients. However, some issues about ERAS are still pending. METHODS A total of 1,654 patients who underwent thoracic surgery under the guidance of ERAS protocols were enrolled in this study. We set the length of postoperative stay (LOPS) as our key research indicator. Patients were divided into routine discharge group and delayed discharge group based on LOPS. Causes of delayed discharge were analyzed to improve management of postoperative recovery. RESULTS Male, old age, underlying disease (coronary artery disease, chronic kidney disease, old cerebral infarction, chronic obstructive pulmonary disease, and arrhythmia), intensive care unit (ICU) stay, type of insurance, and lower forced expiratory volume in one second (FEV1) are the independent impact factors causing delayed discharge. Increased nonchylous drainage (INCD) and prolonged air leakage were the two leading causes for delayed discharge. CONCLUSION Patients should have personalized recovery goal under the same ERAS protocols. We should accept that patients in poor general condition have a prolonged LOPS. More stringent ICU stay indications should be developed to increase postoperative patients' ERAS protocols compliance. Further research on chest tube management will make a contribution to ERAS protocols.
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Affiliation(s)
- Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
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59
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Zhou C, Li S, Liu J, Chu Q, Miao L, Cai L, Cai X, Chen Y, Cui F, Dong Y, Dong W, Fang W, He Y, Li W, Li M, Liang W, Lin G, Lin J, Lin X, Liu H, Liu M, Mu X, Hu Y, Hu J, Jin Y, Li Z, Qin Y, Ren S, Sun G, Shen Y, Su C, Tang K, Wu L, Wang M, Wang H, Wang K, Wang Y, Wang P, Wang H, Wang Q, Wang Z, Xie X, Xie Z, Xu X, Xu F, Yang M, Yang B, Yi X, Ye X, Ye F, Yu Z, Yue D, Zhang B, Zhang J, Zhang J, Zhang X, Zhang W, Zhao W, Zhu B, Zhu Z, Zhong W, Bai C, Chen L, Han B, Hu C, Lu S, Li W, Song Y, Wang J, Zhou C, Zhou J, Zhou Y, Saito Y, Ichiki Y, Igai H, Watanabe S, Bravaccini S, Fiorelli A, Petrella F, Nakada T, Solli P, Tsoukalas N, Kataoka Y, Goto T, Berardi R, He J, Zhong N. International consensus on severe lung cancer-the first edition. Transl Lung Cancer Res 2021; 10:2633-2666. [PMID: 34295668 PMCID: PMC8264326 DOI: 10.21037/tlcr-21-467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jun Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liyun Miao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Linbo Cai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Xiuyu Cai
- Department of General Internal Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuchao Dong
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wen Dong
- Department of Oncology, Hainan Cancer Hospital, Haikou, China
| | - Wenfeng Fang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Weifeng Li
- Department of Respiratory Medicine, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhua Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Gen Lin
- Department of Thoracic Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jie Lin
- Department of Medical Oncology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ming Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinlin Mu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Yi Hu
- Department of Medical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jie Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziming Li
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinyin Qin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Gengyun Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yihong Shen
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kejing Tang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kai Wang
- Department of Respiratory Medicine, Fourth Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yuehong Wang
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Hongmei Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhijie Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhanhong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng Yang
- Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Boyan Yang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangjun Yi
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqun Ye
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Feng Ye
- Department of Medical Oncology, The first affiliated hospital of Xiamen University, Xiamen, China
| | - Zongyang Yu
- Department of Pulmonary and Critical Care Medicine, The th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Dongsheng Yue
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bicheng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian Zhang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianqing Zhang
- Second Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhao
- Department of Pulmonary and Critical Care Medicine, The General Hospital of People's Liberation Army, Beijing, China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liangan Chen
- Department of Respiratory, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Baohui Han
- Department of Pulmonology, Shanghai Chest Hospital, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shun Lu
- Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China
| | - Jie Wang
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanbin Zhou
- Department of Internal Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Ichiki
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Wako, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Universitàdella Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Takeo Nakada
- Division of Thoracic Surgery, Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Italy
| | - Jianxing He
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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60
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Ma RC, Yin YY, Liu X, Wang YQ, Xie J. Effect of Exercise Interventions on Quality of Life in Patients With Lung Cancer: A Systematic Review of Randomized Controlled Trials. Oncol Nurs Forum 2021; 47:E58-E72. [PMID: 32301933 DOI: 10.1188/20.onf.e58-e72] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PROBLEM IDENTIFICATION Improving quality of life (QOL) is a key issue for patients with lung cancer. Exercise interventions could positively affect patients' QOL; however, there is no clear-cut understanding of the role of exercise in improving QOL in patients with lung cancer. LITERATURE SEARCH The PubMed®, Embase®, Cochrane Library, and Web of Science electronic databases were searched from inception to September 6, 2019. DATA EVALUATION 16 randomized controlled trials met the inclusion criteria. A qualitative synthesis method was used to identify the effect of exercise interventions on QOL in patients with lung cancer. SYNTHESIS This review indicates that exercise interventions may have beneficial effects on the QOL of patients with lung cancer. The effectiveness seems to be affected by the duration of the intervention, as well as exercise frequency, intensity, and adherence. IMPLICATIONS FOR PRACTICE Exercise interventions can be integrated into management plans for patients with lung cancer to improve their QOL. Healthcare providers should consider developing optimal exercise prescriptions to maximize the results for this population.
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Lv F, Zhang Y, Min S, Li P, Peng L, Ren L, Yu J, Wang B, Shen Y, Tong S, Jin J, Luo X, Chen J, Chen Y, Li Y, Chen J, Zeng X, Luo F, Xiong Q, Zou L, Guo Y, Cao J, Chen Q, Wu B, Chen G, Liu X, Xie B. Perioperative Exercise Intention and Influencing Factors: A Multi-Centered Cross-Sectional Study. Front Public Health 2021; 9:653055. [PMID: 34095058 PMCID: PMC8172588 DOI: 10.3389/fpubh.2021.653055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to evaluate the level and factors affecting the perioperative exercise intention in China. Design: This study was a cross-sectional survey in Southwest China. Methods: Four hundred and ninety nine participants were randomly sampled in eight medical centers from November 23, 2020 to November 27, 2020. The survey included sociodemographic information and a 24-item modified questionnaire, which aimed to evaluate the attitude toward daily exercise, perception of perioperative exercise, social support and the perioperative exercise intention. A multivariable linear regression model was used to evaluate the effect of different items on the patients' intention for perioperative exercise. Results: A total of 523 responses (95.09%) were collected and 499 (95.41%) were analyzed. The level of exercise intention of the patients during the perioperative period was: 14.83% planned to exercise every day in the hospital, 21.04% planned to exercise every other day, and 35.87% planned to exercise every week. Intensity of daily exercise (P = 0.016), positive attitude of daily exercise (P < 0.001), positive attitude of perioperative exercise (P < 0.001) and social support (P < 0.001) were positively associated with the intention for perioperative exercise. Female (P = 0.012), non-tertiary center (P = 0.011), and preoperative anxiety (P = 0.023) was negatively associated with it. Conclusions: The intention for perioperative exercise was low in Southwest China. The authors aimed to relieve preoperative anxiety, promote the education of perioperative exercise, design perioperative exercise programs, and provide more social support from medical staff and family for inpatients undergoing elective surgery.
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Affiliation(s)
- Feng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxi Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lihua Peng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ren
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiwei Shen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shanshan Tong
- Department of Anesthesiology, Jiangjin Centre Hospital, Chongqing, China
| | - Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Luo
- Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingrui Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Li
- Department of Anesthesiology, The People's Hospital of Liangping District of Chongqing, Chongqing, China
| | - Jin Chen
- Department of Anesthesiology, The People's Hospital of Liangping District of Chongqing, Chongqing, China
| | - Xing Zeng
- Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Fuquan Luo
- Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Qiuju Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Guo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Cao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Chen
- Department of Anesthesiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Xiaoli Liu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing, China
| | - Boli Xie
- Department of Anesthesiology, Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Jarosch I, Schneeberger T, Glöckl R, Leitl D, Koczulla AR. [Referral to pulmonary rehabilitation and its options for chronic lung disease patients]. MMW Fortschr Med 2021; 163:40-47. [PMID: 33961258 PMCID: PMC8103051 DOI: 10.1007/s15006-021-9811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Inga Jarosch
- Forschungsinstitut für pneumologische RehabilitationSchön Klinik Berchtesgadener Land, Malterhöh 1, 83471, Schönau am Königssee, Deutschland.
| | - Tessa Schneeberger
- Forschungsinstitut für pneumologische RehabilitationSchön Klinik Berchtesgadener Land, Malterhöh 1, 83471, Schönau am Königssee, Deutschland
| | - Rainer Glöckl
- Schön Klinik Berchtesgadener Land, Schönau am Königssee, Deutschland
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63
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Matsugaki R, Ohtani M, Mine Y, Saeki S, Fushimi K, Matsuda S. Pre-transplant Rehabilitation to Decrease the Post-transplant Length of Stay for Hematological Malignancy Patients Undergoing Allo-HSCT. Prog Rehabil Med 2021; 6:20210020. [PMID: 33937548 PMCID: PMC8080154 DOI: 10.2490/prm.20210020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Pre-transplant rehabilitation for hematological malignancy patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) helps improve physical capacity. However, its benefit with respect to post-transplant hospital length of stay (LOS) is unclear. Consequently, the aim of this study was to investigate the effect of pre-transplant rehabilitation on post-transplant LOS for hematological malignancy patients undergoing allo-HSCT. Methods: Data on patients diagnosed between April 2014 and March 2017 were collected from the Japanese Diagnosis Procedure Combination database. The patients were identified using the ICD-10 codes C81–85, C90–94, C96, and D46. Multilevel linear regression analyses were conducted to identify the effects of pre-transplant rehabilitation on post-transplant LOS (log transformed). Results: In total, 3614 patients were included in the study. Pre-transplant rehabilitation was associated with a significant reduction in post-transplant hospital LOS (β=–0.134, P<0.001). Conclusions: Pre-transplant rehabilitation may be an effective strategy for shortening the post-transplant hospital LOS in hematological malignancy patients undergoing allo-HSCT. Consequently, it may be necessary to consider starting rehabilitation before transplantation.
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Affiliation(s)
- Ryutaro Matsugaki
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Ohtani
- Information Systems Center for Occupational Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuko Mine
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoru Saeki
- Department of Rehabilitation Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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64
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Bibo L, Goldblatt J, Merry C. Does preoperative pulmonary rehabilitation/physiotherapy improve patient outcomes following lung resection? Interact Cardiovasc Thorac Surg 2021; 32:933-937. [PMID: 33907813 DOI: 10.1093/icvts/ivab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/15/2020] [Accepted: 01/01/2021] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether preoperative physiotherapy (pulmonary prehabilitation) is beneficial for patients undergoing lung resection. Altogether 177 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A meta-analysis by Li et al. showed that patients who received a preoperative rehabilitation programme (PRP) had reduced incidence of postoperative pulmonary complications (PPCs) (odds ratio 0.44, 95% CI 0.27-0.71), reduced length of stay (LOS) (-4.23 days, 95% CI -6.14 to -2.32 days) and improved 6-min walking distance (71.25 m, 95% CI 39.68-102.82) and peak oxygen uptake consumption (VO2 peak) (3.26, 95% CI 2.17-4.35). A meta-analysis by Steffens et al. showed that PPCs were reduced in patients with PRP (relative risk 0.49, 95% CI 0.33-0.73) and reduced LOS (-2.86 days, 95% CI -5.40 to -0.33). The results of 3 additional meta-analyses, 4 randomized controlled trials and 1 observational study all provide further support to PRP in enhanced recovery after surgery and the improvement in exercise capacity. We conclude that PRP improves exercise capacity in patients undergoing surgical resection for lung cancer. Moderate quality evidence supports preoperative exercise providing significant reduction in PPCs and hospital LOS. Referral to exercise programmes should be considered in patients awaiting lung resection, particularly those deemed borderline for suitability for surgical resection.
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Affiliation(s)
- Liam Bibo
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Joshua Goldblatt
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Christopher Merry
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
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66
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Billé A, Buxton J, Viviano A, Gammon D, Veres L, Routledge T, Harrison-Phipps K, Dixon A, Minetto MA. Preoperative Physical Activity Predicts Surgical Outcomes Following Lung Cancer Resection. Integr Cancer Ther 2021; 20:1534735420975853. [PMID: 33835869 PMCID: PMC8040616 DOI: 10.1177/1534735420975853] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives: To assess whether preoperative levels of physical activity predict the incidence of post-operative complications following anatomical lung resection. Methods: Levels of physical activity (daily steps) were measured for 15 consecutive days using pedometers in 90 consecutive patients (prior to admission). Outcomes measured were cardiac and respiratory complications, length of stay, and 30-day re-admission rate. Results: A total of 78 patients’ datasets were analysed (12 patients were excluded due to non-compliance). Based on steps performed they were divided into quartiles; 1 (low physical activity) to 4 (high physical activity). There were no significant differences in age, smoking history, COPD, BMI, percentage predicted FEV1 and KCO and cardiovascular risk factors between the groups. There were significantly fewer total complications in quartiles 3 and 4 (high physical activity) compared to quartiles 1 and 2 (low physical activity) (8 vs 22; P = .01). There was a trend (P > .05) towards shorter hospital length of stay in quartiles 3 and 4 (median values of 4 and 5 days, respectively) compared to quartiles 1 and 2 (6 days for both groups). Conclusions: Preoperative physical activity can help to predict postoperative outcome and can be used to stratify risk of postoperative complications and to monitor impact of preoperative interventions, ultimately improving short term outcomes.
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Affiliation(s)
- Andrea Billé
- Guy's Hospital, London, UK.,King's College London Faculty of Life Sciences & Medicine at Guy's, London, UK
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Higgins MI, Martini DJ, Patil DH, Nabavizadeh R, Steele S, Williams M, Joshi SS, Narayan VM, Sekhar A, Psutka SP, Ogan K, Bilen MA, Master VA. Sarcopenia and modified Glasgow Prognostic Score predict postsurgical outcomes in localized renal cell carcinoma. Cancer 2021; 127:1974-1983. [PMID: 33760232 DOI: 10.1002/cncr.33462] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Body composition and inflammation are gaining importance for prognostication in cancer. This study investigated the individual and combined utility of the preoperative skeletal muscle index (SMI) and the modified Glasgow Prognostic Score (mGPS) for estimating postoperative outcomes in patients with localized renal cell carcinoma (RCC) undergoing nephrectomy. METHODS The authors performed a retrospective review of 352 patients with localized RCC. SMI was measured via computed tomography or magnetic resonance imaging. Patients met the criteria for sarcopenia by body mass index- and sex-stratified thresholds. Multivariable and Kaplan-Meier analyses of associations of sarcopenia and mGPS with overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) were performed. Variables were analyzed independently and combined into risk groups: low risk (nonsarcopenic, low mGPS), medium risk (sarcopenia only), medium risk (inflammation only), and high risk (sarcopenic, high mGPS). Receiver operating characteristic (ROC) curves were used to analyze risk groups in comparison with the Stage, Size, Grade, and Necrosis (SSIGN) score and the modified International Metastatic RCC Database Consortium (IMDC) score. RESULTS The majority of the patients were at stage pT3 (63%), 39.5% of the patients were sarcopenic, and 19.3% had an elevated mGPS at the baseline. The median follow-up time was 30.4 months. Sarcopenia and mGPS were independently associated with worse OS (hazard ratio for sarcopenia, 1.64; P = .006; hazard ratio for mGPS, 1.72; P = .012), CSS, and RFS. Risk groups had an increasing association with worse RFS (P = .015) and CSS (P = .004) but not OS (P = .087). ROC analyses demonstrated a higher area under the curve for risk groups in comparison with the SSIGN and IMDC scores at 5 years. CONCLUSIONS Sarcopenia and an elevated mGPS were associated with worse clinical outcomes in this study of patients with localized RCC. This has implications for preoperative prognostication and treatment decision-making. LAY SUMMARY Kidney cancer is a disease with a wide variety of outcomes. Among patients undergoing surgical removal of the kidney for cancer that has not spread beyond the kidney, many are cured, but some experience recurrence. Physicians are seeking ways to better predict who is at risk for recurrence or death from kidney cancer. This study has evaluated body composition and markers of inflammation before surgery to predict the risk of recurrence or death after surgery. Specifically, low muscle mass and an elevated inflammation score (the modified Glasgow Prognostic Score) have been associated with an increased likelihood of recurrence of kidney cancer and death.
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Affiliation(s)
- Michelle I Higgins
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Sean Steele
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Milton Williams
- Department of Urology, University of Alabama, Birmingham, Alabama
| | - Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Vikram M Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Aarti Sekhar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, Washington
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
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Elsayed HH, Moharram AA. Tailored anaesthesia for thoracoscopic surgery promoting enhanced recovery: The state of the art. Anaesth Crit Care Pain Med 2021; 40:100846. [PMID: 33774262 DOI: 10.1016/j.accpm.2021.100846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW The current review focuses on precise anaesthesia for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced recovery. The main aim of an enhanced recovery program after thoracic surgery is to reduce postoperative stress response, protect from postoperative pulmonary complications, give hospitals a better financial option and improve overall patient outcome. This can ultimately reduce hospital stay and increase patient satisfaction. With advances in endoscopic, robotic and endovascular techniques, video-assisted thoracoscopic surgery (VATS) can be performed in a minimally invasive way in managing most pulmonary, pleural and mediastinal diseases. As a minimally invasive technique, video-assisted thoracoscopic surgery (VATS) represents an important element of enhanced recovery program in thoracic surgery as it can achieve most of its goals. Anaesthetic management during preoperative, intraoperative and postoperative period is essential for the establishment of a successful enhanced recovery program. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key anaesthetic elements of the enhanced recovery program during all phases of thoracoscopic surgery. Having reviewed recent literature, a systematic review of literature will highlight successful ERAS protocols published for thoracoscopic surgery.
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Affiliation(s)
| | - Assem Adel Moharram
- Department of Anaesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
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69
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Guida JL, Agurs-Collins T, Ahles TA, Campisi J, Dale W, Demark-Wahnefried W, Dietrich J, Fuldner R, Gallicchio L, Green PA, Hurria A, Janelsins MC, Jhappan C, Kirkland JL, Kohanski R, Longo V, Meydani S, Mohile S, Niedernhofer LJ, Nelson C, Perna F, Schadler K, Scott JM, Schrack JA, Tracy RP, van Deursen J, Ness KK. Strategies to Prevent or Remediate Cancer and Treatment-Related Aging. J Natl Cancer Inst 2021; 113:112-122. [PMID: 32348501 PMCID: PMC7850536 DOI: 10.1093/jnci/djaa060] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Up to 85% of adult cancer survivors and 99% of adult survivors of childhood cancer live with an accumulation of chronic conditions, frailty, and/or cognitive impairments resulting from cancer and its treatment. Thus, survivors often show an accelerated development of multiple geriatric syndromes and need therapeutic interventions. To advance progress in this area, the National Cancer Institute convened the second of 2 think tanks under the auspices of the Cancer and Accelerated Aging: Advancing Research for Healthy Survivors initiative. Experts assembled to share evidence of promising strategies to prevent, slow, or reverse the aging consequences of cancer and its treatment. The meeting identified research and resource needs, including geroscience-guided clinical trials; comprehensive assessments of functional, cognitive, and psychosocial vulnerabilities to assess and predict age-related outcomes; preclinical and clinical research to determine the optimal dosing for behavioral (eg, diet, exercise) and pharmacologic (eg, senolytic) therapies; health-care delivery research to evaluate the efficacy of integrated cancer care delivery models; optimization of intervention implementation, delivery, and uptake; and patient and provider education on cancer and treatment-related late and long-term adverse effects. Addressing these needs will expand knowledge of aging-related consequences of cancer and cancer treatment and inform strategies to promote healthy aging of cancer survivors.
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Affiliation(s)
- Jennifer L Guida
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tanya Agurs-Collins
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith Campisi
- Buck Institute for Research on Aging, Novato, CA, USA
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | | | | | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca Fuldner
- Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Gallicchio
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Paige A Green
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Michelle C Janelsins
- Department of Surgery and Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Chamelli Jhappan
- Division of Cancer Biology, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Ronald Kohanski
- Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Valter Longo
- University of Southern California, Los Angeles, California, USA
- IFOM Institute, Milan, Italy
| | - Simin Meydani
- Jean Mayer USDA Human Nutritional Research Center on Aging, Tufts University, Boston, MA, USA
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Laura J Niedernhofer
- Department of Biochemistry, Molecular Biology, and Biophysics, Institute on the Biology of Aging and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank Perna
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Keri Schadler
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Russell P Tracy
- Departments of Pathology & Laboratory Medicine, and Biochemistry, Larner College of Medicine, University of Vermont, Colchester, VT, USA
| | | | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Lim Y, Lee H, Kim DH, Kim YD. [Applying Extended Theory of Planned Behavior for Lung Cancer Patients Undergone Pulmonary Resection: Effects on Self-Efficacy for Exercise, Physical Activities, Physical Function, and Quality of Life]. J Korean Acad Nurs 2020; 50:66-80. [PMID: 32131074 DOI: 10.4040/jkan.2020.50.1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/05/2019] [Accepted: 01/19/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aims to examine the effects of nursing interventions based on the Extended Theory of Planned Behavior (ETPB) regarding self-efficacy for exercise (SEE), physical activity (PA), physical function (PF), and quality of life (QOL) in patients with lung cancer who have undergone pulmonary resection. METHODS This quasi-experimental study was conducted between July 2015 and June 2018 in two university-affiliated hospitals. The intervention included pre-operative patient education, goal setting (action and coping planning), and feedback (behavior intention and perceived behavioral control). The intervention group (IG) (n=51) received nursing interventions from the day before surgery to 12 months after lung resection, while the comparison group (CG) (n=36) received usual care. SEE, PA, PF (dyspnea, functional status, and 6-minute walking distance [6MWD]), and QOL were measured before surgery and at one, three, six, and 12 months after surgery. Data were analyzed using the χ² test, Fisher's exact test, Mann-Whitney U test, t-test, and generalized estimation equations (GEE). RESULTS There were significant differences between the two groups regarding SEE (χ²=13.53, p=.009), PA (χ²=9.51, p=.049), functional status (χ²=10.55, p=.032), and 6MWD (χ²=15.62, p=.004). Although there were no time or group effects, the QOL mental component (Z=-2.78, p=.005) of the IG was higher than that of the CG one month after surgery. Interventions did not affect dyspnea or the QOL physical component. CONCLUSION The intervention of this study was effective in improving SEE, PA, functional status, and 6MWD of lung cancer patients after lung resection. Further extended investigations that utilize ETPB are warranted to confirm these results.
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Affiliation(s)
- Yeonjung Lim
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Haejung Lee
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Do Hyung Kim
- Pulmonary Medicine Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
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71
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Himbert C, Klossner N, Coletta AM, Barnes CA, Wiskemann J, LaStayo PC, Varghese TK, Ulrich CM. Exercise and lung cancer surgery: A systematic review of randomized-controlled trials. Crit Rev Oncol Hematol 2020; 156:103086. [PMID: 33038630 PMCID: PMC7677203 DOI: 10.1016/j.critrevonc.2020.103086] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Lung cancer patients undergoing surgery are often left physically deconditioned and/or with functional deficits. Exercise interventions may improve pulmonary and physical function before and after lung resection. We conducted a systematic review of randomized-controlled trials (RCTs) testing the impact of pre-, post-, and combined pre-and-post surgery exercise interventions on physical and pulmonary function in lung cancer patients. Exercise pre-surgery seems to substantially improve physical and pulmonary function, which are factors associated with improved ability to undergo surgery while reducing post-surgery complications. Evidence is inconsistent for post-surgery interventions, reporting no or moderate effects. Results from pre-and-post surgery interventions are limited to one study. In conclusion, pre- and post-surgery exercise interventions, individually, have shown beneficial effects for lung cancer patients undergoing surgery. The impact of interventions combining both pre- and post-surgery exercise programs remains unknown. More evidence is needed on the ideal exercise setting, and timing across the lung cancer care continuum.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT, United States; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Nicole Klossner
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT, United States
| | - Adriana M Coletta
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT, United States; Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT, United States
| | - Christopher A Barnes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States; Department of Surgery, University of Utah, Salt Lake City, UT, United States; Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Clinic, Heidelberg, Germany
| | - Paul C LaStayo
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT, United States; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Thomas K Varghese
- Department of Surgery, University of Utah, Salt Lake City, UT, United States; Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT, United States; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States.
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72
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care. Perioper Med (Lond) 2020; 9:37. [PMID: 33292657 PMCID: PMC7704118 DOI: 10.1186/s13741-020-00168-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. METHODS A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. RESULTS Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). CONCLUSIONS These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy.
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padua, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital - Torino, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, V Fazzi Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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73
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Alderman G, Keegan R, Semple S, Toohey K. Physical activity for people living with cancer: Knowledge, attitudes, and practices of general practitioners in Australia. PLoS One 2020; 15:e0241668. [PMID: 33166304 PMCID: PMC7652282 DOI: 10.1371/journal.pone.0241668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background Healthcare professionals’ (Oncologists, doctors, and nurses) physical activity (PA) recommendations impact patients living with cancer PA levels. General practitioners (GPs) monitor the overall health of patients living with cancer throughout their treatment journey. This is the first study to explore GP’s knowledge, attitudes and practices of PA for patients living with cancer. Methods GPs who see patients living with cancer regularly (n = 111) completed a survey based on The Theory of Planned Behaviour (TPB). Participants (GP’s) reported knowledge, attitudes, perceived behaviour control and subjective norms of PA within the cancer population. GP recommendation and referral rates of PA were reported. Principal component analysis was conducted to establish a set of survey items aligned to TPB constructs (attitude, subjective norms, perceived control), and multiple regression analyses characterised associations between these predictor variables and (a) recommendation; and (b) referral–of PA to cancer patients. Results GPs (n = 111) recommended PA to 41–60% of their patients and referred 1–20% to PA programs. Multiple regression models significantly predicted the percent of patients recommended PA, p < .0005 adj. R2 = 0.40 and referred PA, p < .0005, adj. R2 = 0.21. GP attitudes and perceived behavioural control and GP’s own activity levels were significant predictors of whether patients were recommended and referred for PA, p<0.05. Conclusion GPs reported positive attitudes and perceptions towards promoting PA for their patients living with cancer. Despite having a positive correlation between PA recommendations and referral rates, a gap was evident between GP’s PA beliefs and their individual referral practices. More GP’s willing to promote and refer their patients for PA, would improve the physical and mental health outcomes of the cancer population.
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Affiliation(s)
- Georgina Alderman
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
| | - Richard Keegan
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Stuart Semple
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Kellie Toohey
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
- * E-mail:
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74
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Lavín‐Pérez AM, Collado‐Mateo D, Mayo X, Humphreys L, Liguori G, James Copeland R, Del Villar Álvarez F, Jiménez A. High‐intensity exercise to improve cardiorespiratory fitness in cancer patients and survivors: A systematic review and meta‐analysis. Scand J Med Sci Sports 2020; 31:265-294. [DOI: 10.1111/sms.13861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Ana Myriam Lavín‐Pérez
- Program of Epidemiology and Public Health (Interuniversity) PhD International School of the Rey Juan Carlos University Madrid Spain
- Centre for Sport Studies Rey Juan Carlos University Madrid Spain
- GO fitLAB Ingesport Madrid Spain
| | | | - Xián Mayo
- Centre for Sport Studies Rey Juan Carlos University Madrid Spain
| | - Liam Humphreys
- Advanced Wellbeing Research Centre College of Health Wellbeing and Life Sciences Sheffield Hallam University Sheffield UK
| | | | - Robert James Copeland
- Advanced Wellbeing Research Centre College of Health Wellbeing and Life Sciences Sheffield Hallam University Sheffield UK
| | | | - Alfonso Jiménez
- Centre for Sport Studies Rey Juan Carlos University Madrid Spain
- GO fitLAB Ingesport Madrid Spain
- Advanced Wellbeing Research Centre College of Health Wellbeing and Life Sciences Sheffield Hallam University Sheffield UK
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75
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Olsen DB, Pedersen PU, Noergaard MW. Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review protocol. JBI Evid Synth 2020; 19:469-476. [PMID: 33074988 DOI: 10.11124/jbies-20-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and map existing preoperative interventions, referred to as prehabilitation, in adult patients at home awaiting coronary bypass grafting (CABG) surgery. This scoping review also seeks to examine the feasibility and patient experiences in order to inform clinical practice and underpin a future systematic review. INTRODUCTION As patients age, comorbidities become more common. Strategies to improve postoperative outcomes and to accelerate recovery are required in patients undergoing CABG. Prehabilitation refers to a proactive process of increasing functional capacity before surgery to improve the patient's capacity to withstand upcoming physiologic stress and thus avoid postoperative complications. INCLUSION CRITERIA This scoping review will consider any studies including adult patients at home awaiting CABG surgery. Studies will provide information on any prehabilitation intervention to optimize preoperative physical and psychological health status. Studies conducted in any setting will be included. METHODS The methodology will follow the JBI recommendations for scoping reviews. Any published or unpublished source of information will be considered. Studies published in English, German, Danish, Swedish, and Norwegian will be included, with no geographical or cultural limitations. Retrieved papers will be screened by two independent reviewers, and a standardized tool will be used to extract data from each included source. The results will be presented as a map of the data extracted in a tabular form together with a narrative summary to provide a description of the existing evidence.
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Affiliation(s)
- Dorte Baek Olsen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Preben U Pedersen
- Danish Centre of Systematic Reviews: A JBI Centre of Excellence, The Centre of Clinical Guidelines, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Wetendorff Noergaard
- Danish Centre of Systematic Reviews: A JBI Centre of Excellence, The Centre of Clinical Guidelines, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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76
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Zhou W, Woo S, Larson JL. Effects of perioperative exercise interventions on lung cancer patients: An overview of systematic reviews. J Clin Nurs 2020; 29:4482-4504. [DOI: 10.1111/jocn.15511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Weijiao Zhou
- School of Nursing University of Michigan Ann Arbor MI USA
| | - Seoyoon Woo
- School of Nursing University of Michigan Ann Arbor MI USA
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77
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Zhou K, Lai Y, Wang Y, Sun X, Mo C, Wang J, Wu Y, Li J, Chang S, Che G. Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study. Cancer Manag Res 2020; 12:8903-8912. [PMID: 33061586 PMCID: PMC7520117 DOI: 10.2147/cmar.s267322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the effectiveness and cost minimization of comprehensive pulmonary rehabilitation (CPR) in lung cancer patients who underwent surgery. Patients and Methods A retrospective observational study based on medical records was conducted, with 2410 lung cancer patients who underwent an operation with/without CPR during the peri-operative period. Variables including clinical characteristics, length of stay (LOS), postoperative pulmonary complications (PPCs), and hospitalization expenses were compared between the intervention group (IG) and control group (CG). The CPR regimen consists of inspiratory muscle training (IMT), aerobic endurance training, and pharmacotherapy. Results Propensity score matching analysis was performed between two groups, and the ratio of matched patients was 1:4. Finally, 205 cases of IG and 820 cases of CG in the matched cohort of our study were identified. The length of postoperative hospital stay [median: 5 interquartile (4–7) vs 7 (4–8) days, P < 0.001] and drug expenses [7146 (5411–8987) vs 8253 (6048–11,483) ¥, P < 0.001] in the IG were lower compared with the CG. Additionally, the overall incidence of PPCs in the IG was reduced compared with the CG (26.8% vs 36.7%, P = 0.008), including pneumonia (10.7% vs 16.8%, P = 0.035) and atelectasis (8.8% vs 14.0%, P = 0.046). Multivariable analysis showed that CPR intervention (OR = 0.655, 95% CI: 0.430–0.865, P = 0.006), age ≥70 yr (OR = 1.919, 95% CI: 1.342–2.744, P < 0.001), smoking (OR = 2.048, 95% CI: 1.552–2.704, P < 0.001) and COPD (OR = 1.158, 95% CI: 1.160–2.152, P = 0.004) were related to PPCs. Conclusion The retrospective cohort study revealed a lower PPC rate and the shorter postoperative length of stay in the patients receiving CPR, demonstrating the clinical value of CRP as an effective strategy for surgical lung cancer patients with risk factors.
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Affiliation(s)
- Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.,Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Chunmei Mo
- Medical Record Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Jiao Wang
- Rehabilitation Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yanming Wu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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Smondack P, Gravier FÉ, Prieur G, Repel A, Muir JF, Cuvelier A, Combret Y, Medrinal C, Bonnevie T. [Physiotherapy and COVID-19. From intensive care unit to home care-An overview of international guidelines]. Rev Mal Respir 2020; 37:811-822. [PMID: 33067078 PMCID: PMC7552976 DOI: 10.1016/j.rmr.2020.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The new coronavirus disease 2019 (COVID-19) is responsible for a global pandemic and many deaths. This context requires an adaptation of health systems as well as the role of each healthcare professional, including physiotherapists. STATE OF THE ART In order to optimize the management of people with COVID-19, many savant societies published guidelines about physiotherapy interventions within the crisis but none offered a global overview from the intensive care unit to home care. Therefore, the aim of this review is to offer an overview of recommended physiotherapy interventions in order to facilitate the management of these patients, whatever the stage of the disease. PERSPECTIVES Owing to the emergent character of the COVID-19, actual guidelines will have to be adjusted according to the evolution of the pandemic and the resources of the hospital and liberal sectors, in particular for the long-term follow-up of these patients. Current and future research will aim to assess the effectiveness of physiotherapy interventions for people with COVID-19. CONCLUSION The emergence of COVID-19 required a very rapid adaptation of the health system. The role of physiotherapists is justified at every stage of patients care in order to limit the functional consequences of the disease.
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Affiliation(s)
- P Smondack
- ADIR Association, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France.
| | - F-É Gravier
- ADIR Association, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; UPRES EA 3830 (GRHV), institut de recherche et d'innovation biomédicale de Haute-Normandie, Normandie université UNIROUEN, Rouen, France
| | - G Prieur
- UPRES EA 3830 (GRHV), institut de recherche et d'innovation biomédicale de Haute-Normandie, Normandie université UNIROUEN, Rouen, France; Unité de soins intensifs, groupe hospitalier du Havre, Montivilliers, France
| | | | - J-F Muir
- UPRES EA 3830 (GRHV), institut de recherche et d'innovation biomédicale de Haute-Normandie, Normandie université UNIROUEN, Rouen, France; Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, centre hospitalier universitaire de Rouen, Rouen, France
| | - A Cuvelier
- UPRES EA 3830 (GRHV), institut de recherche et d'innovation biomédicale de Haute-Normandie, Normandie université UNIROUEN, Rouen, France; Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, centre hospitalier universitaire de Rouen, Rouen, France
| | - Y Combret
- Unité de soins intensifs, groupe hospitalier du Havre, Montivilliers, France; Institut de recherche expérimentale et clinique, université Catholique de Louvain, Bruxelles, Belgique
| | - C Medrinal
- UPRES EA 3830 (GRHV), institut de recherche et d'innovation biomédicale de Haute-Normandie, Normandie université UNIROUEN, Rouen, France; Unité de soins intensifs, groupe hospitalier du Havre, Montivilliers, France
| | - T Bonnevie
- ADIR Association, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; UPRES EA 3830 (GRHV), institut de recherche et d'innovation biomédicale de Haute-Normandie, Normandie université UNIROUEN, Rouen, France
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79
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Klassen O, König A, von Haehling S, Braulke F. [Cardiovascular fitness in oncology : Exercise and sport]. Internist (Berl) 2020; 61:1140-1150. [PMID: 33025125 DOI: 10.1007/s00108-020-00882-1] [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: 10/23/2022]
Abstract
BACKGROUND Malignant diseases lead to a decline in physical performance in a large number of patients. This includes a reduction of the musculoskeletal system, restrictions in cardiovascular fitness and psychogenically influenced syndromes such as fatigue and asthenia. It is not yet clear to what extent physical training can counteract these limitations or undesirable side effects and how this training needs to be designed in the individual situation. AIM OF THIS ARTICLE The aim of this article is to find out whether physical training can be performed in cancer patients, how this training should be designed and which physical disorders can be influenced favorably. MATERIALS AND METHODS In this review, the currently available work on this topic was evaluated and classified with regard to its feasibility and effects in cancer patients. RESULTS AND DISCUSSION Physical training can be performed without complications in most patients even under treatment for the underlying malignant disease. It has a positive effect on physical performance, cardiovascular function, the perception of one's own cancer and overall well-being. Ideally, physical training for cancer patients should include a mixture of strength and endurance training. It should be carried out regularly and its intensity should be slowly increased. The type of physical activity should be adapted to the individual needs of the patient, take into account the particularities of the malignant disease and exclude any risk to the patient. CONCLUSION In summary, a physical training program to accompany cancer therapy should be offered to virtually all patients with malignant disease.
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Affiliation(s)
- O Klassen
- Institut für Sportwissenschaften, Arbeitsbereich Trainings- und Bewegungswissenschaft, Georg-August-Universität Göttingen, Sprangerweg 2, 37075, Göttingen, Deutschland.
| | - A König
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - S von Haehling
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Göttingen, Deutschland
| | - F Braulke
- Klinik für Hämatologie und Medizinische Onkologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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80
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Liu ZJ, Zhang YL, Huang YG. Prehabilitation in video-assisted thoracoscopic surgery lobectomy for lung cancer: current situation and future perspectives. J Thorac Dis 2020; 12:4578-4580. [PMID: 32944379 PMCID: PMC7475593 DOI: 10.21037/jtd-20-1930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Zi-Jia Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Lun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, China
| | - Yu-Guang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
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81
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Armenian SH, Iukuridze A, Teh JB, Mascarenhas K, Herrera A, McCune JS, Zain JM, Mostoufi‐Moab S, McCormack S, Slavin TP, Scott JM, Jones LW, Sun C, Forman SJ, Wong FL, Nakamura R. Abnormal body composition is a predictor of adverse outcomes after autologous haematopoietic cell transplantation. J Cachexia Sarcopenia Muscle 2020; 11:962-972. [PMID: 32212263 PMCID: PMC7432567 DOI: 10.1002/jcsm.12570] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The number of patients undergoing autologous haematopoietic cell transplant (HCT) is growing, but little is known about the factors that predict adverse outcomes. Low muscle mass and obesity are associated with disability and premature mortality in individuals with non-malignant diseases and may predict outcomes after autologous HCT. METHODS This was a retrospective cohort study of 320 patients who underwent autologous HCT for Hodgkin or non-Hodgkin lymphoma between 2009 and 2014. Sarcopenia {skeletal muscle index male: <43 cm/m2 [body mass index (BMI) < 25 kg/m2 ] or < 53 cm/m2 [BMI ≥ 25 kg/m2 ] and female: <41 cm/m2 [regardless of BMI]) and obesity [total abdominal adiposity ≥450.0 cm2 (male), ≥396.4 cm2 (female)] were assessed from single-slice abdominal pre-HCT computed tomography images. Length of hospital stay, first unplanned intensive care unit admission, and 30-day unplanned readmission were evaluated based on body composition using multivariable regression analysis, and mortality was evaluated with Kaplan-Meier analysis and Gray's test. RESULTS Median age at HCT was 53.3 years (range, 18.5 to 78.1 years); 26.3% were sarcopenic and an additional 7.8% were sarcopenic obese pre-HCT. Sarcopenic obesity was associated with increased risk of prolonged hospitalization [odds ratio (OR) = 3.6, 95% confidence interval (CI) 1.3-9.8], intensive care unit admission (OR = 4.7, 95% CI 1.5-16.1), and unplanned readmission after HCT (OR = 13.6, 95% CI 2.5-62.8). Patients who were sarcopenic obese also had the highest mortality risk at 1 year [hazard ratio (HR): 3.9, 95% CI 1.1-11.0] and 5 years (HR: 2.5, 95% CI 1.1-5.5), compared with patients with normal body composition. Sarcopenia alone, but not obesity alone, was associated with an increased risk of these outcomes, albeit with a lower magnitude of risk than in patients who were sarcopenic obese. CONCLUSIONS Sarcopenic obesity was an important predictor of outcomes in patients undergoing autologous HCT. These findings could inform targeted prevention strategies in patients at highest risk of complications after HCT.
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Affiliation(s)
| | | | | | | | - Alex Herrera
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | | | - Jasmine M. Zain
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | - Sogol Mostoufi‐Moab
- Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Shana McCormack
- Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | | | - Jessica M. Scott
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Lee W. Jones
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
- Department of MedicineWeill Cornell Medical CenterNew YorkNYUSA
| | - Can‐Lan Sun
- Department of Supportive Care MedicineCity of HopeDuarteCAUSA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | - F. Lennie Wong
- Department of Population SciencesCity of HopeDuarteCAUSA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
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82
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Frailty Predicts Severe Postoperative Complications After Elective Minimally Invasive Surgery in Patients with Colorectal Cancer. Indian J Surg 2020. [DOI: 10.1007/s12262-019-02001-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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83
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Armenian SH, Xiao M, Berano Teh J, Lee B, Chang HA, Mascarenhas K, Lee S, Iukuridze A, Xie JJ, Scott JM, Jones LW, Lennie Wong F, Forman SJ, Nakamura R. Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation. J Natl Cancer Inst 2020; 111:837-844. [PMID: 30951603 DOI: 10.1093/jnci/djy231] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/09/2018] [Accepted: 12/20/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High intensity treatments such as hematopoietic cell transplantation (HCT) can be curative for patients with hematologic malignancies, but this needs to be balanced by the high risk of nonrelapse mortality (NRM) during the first 2 years after HCT. Sarcopenia (low muscle mass) is associated with physical disability and premature mortality in individuals with nonmalignant diseases and may be a predictor of NRM and poor overall survival in patients undergoing HCT. METHODS This was a retrospective cohort study of 859 patients with acute leukemia or myelodysplastic syndrome who underwent a first HCT as adults (≥18 years) between 2007 and 2014. Sarcopenia was assessed from pre-HCT abdominal computed tomography scans. Two-year cumulative incidence of NRM was calculated, with relapse/progression considered as a competing risk event. Fine-Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained and adjusted for relevant covariates. Kaplan-Meier method was used to examine overall survival. All statistical tests were two-sided. RESULTS Median age at HCT was 51 years (range = 18-74 years); 52.5% had a high [≥3] HCT-comorbidity index; 33.7% had sarcopenia pre-HCT. Sarcopenia was an independent predictor of higher NRM risk (hazard ratio = 1.58, 95% CI = 1.16 to 2.16) compared with patients who were not. The 2-year incidence of NRM approached 30% in patients with sarcopenia and high (≥3) HCT-comorbidity index. Patients with sarcopenia had on average a longer hospitalization (37.2 days vs 31.5 days, P < .001) and inferior overall survival at 2 years (55.2%, 95% CI = 49.5% to 61.0% vs 66.9%, 95% CI = 63.0% to 70.8%, P < .001). CONCLUSIONS Sarcopenia is an important and independent predictor of survival after HCT, with potential additional downstream impacts on health-economic outcomes. This information can be used to facilitate treatment decisions prior to HCT and guide interventions to decrease the risk of treatment-related complications after HCT.
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Affiliation(s)
- Saro H Armenian
- See the Notes section for the full list of authors' affiliations
| | - Meisi Xiao
- See the Notes section for the full list of authors' affiliations
| | | | - Brandyn Lee
- See the Notes section for the full list of authors' affiliations
| | - Howard A Chang
- See the Notes section for the full list of authors' affiliations
| | | | - Sean Lee
- See the Notes section for the full list of authors' affiliations
| | - Alex Iukuridze
- See the Notes section for the full list of authors' affiliations
| | - Jack J Xie
- See the Notes section for the full list of authors' affiliations
| | - Jessica M Scott
- See the Notes section for the full list of authors' affiliations
| | - Lee W Jones
- See the Notes section for the full list of authors' affiliations
| | - F Lennie Wong
- See the Notes section for the full list of authors' affiliations
| | - Stephen J Forman
- See the Notes section for the full list of authors' affiliations
| | - Ryotaro Nakamura
- See the Notes section for the full list of authors' affiliations
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84
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Finley DJ, Fay KA, Batsis JA, Stevens CJ, Sacks OA, Darabos C, Cook SB, Lyons KD. A feasibility study of an unsupervised, pre-operative exercise program for adults with lung cancer. Eur J Cancer Care (Engl) 2020; 29:e13254. [PMID: 32469129 DOI: 10.1111/ecc.13254] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/23/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the feasibility, acceptability and perceived utility of the provision of a wearable fitness device and an exercise prescription from a surgeon, prior to surgery for lung cancer. METHODS A single-arm, pre-post feasibility study was conducted with 30 participants scheduled for surgery to treat stage I, II or III lung cancer. Participants were given a Garmin Vivoactive HR device and a prescription for 150 min of moderately to vigorous exercise per week. Participants completed assessments on four occasions and completed a semi-structured interview on two occasions. Descriptive statistics were used to assess the feasibility and acceptability of study procedures, including synchronising the Garmin device and engaging in study assessments. RESULTS Seventy-nine per cent of enrolled participants completed the pre-operative study activities. Seventy-one per cent of enrolled participants successfully synchronised their device during the pre-operative period. Data were transmitted from the device to the study team for an average of 70% of the pre-operative days. CONCLUSION This pilot study demonstrated the feasibility and acceptability of a pre-operative exercise program for patients scheduled to undergo surgery for lung cancer. TRIAL REGISTRATION The study protocol was registered with ClinicalTrials.gov prior to the initiation of participant recruitment (NCT03162718).
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Affiliation(s)
- David J Finley
- Department of Surgery, Thoracic Surgery Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kayla A Fay
- Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.,Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.,Dartmouth Weight & Wellness Center, Lebanon, NH, USA.,Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH, USA
| | - Courtney J Stevens
- Dartmouth Centers for Health & Aging, Geisel School of Medicine, Hanover, NH, USA.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Olivia A Sacks
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH, USA
| | - Christian Darabos
- Research Information, Technology and Consulting, Dartmouth College, Hanover, NH, USA
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - Kathleen Doyle Lyons
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Cancer Population Sciences Program, Norris Cotton Cancer Center, Lebanon, NH, USA
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85
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Patient acceptance of prehabilitation for major surgery: an exploratory survey. Support Care Cancer 2020; 29:779-785. [DOI: 10.1007/s00520-020-05547-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
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86
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Stout NL, Brown JC, Schwartz AL, Marshall TF, Campbell AM, Nekhlyudov L, Zucker DS, Basen-Engquist KM, Campbell G, Meyerhardt J, Cheville AL, Covington KR, Ligibel JA, Sokolof JM, Schmitz KH, Alfano CM. An exercise oncology clinical pathway: Screening and referral for personalized interventions. Cancer 2020; 126:2750-2758. [PMID: 32212338 DOI: 10.1002/cncr.32860] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Nicole L Stout
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.,Hematology Oncology Department, Division of Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Justin C Brown
- Cancer Metabolism Research Program, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | | | - Anna M Campbell
- Sighthill Campus, Edinburgh Napier University, Edinburgh, Scotland
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David S Zucker
- Swedish Cancer Rehabilitation Medicine Services, Swedish Cancer Institute, Swedish Health Services, Seattle, Washington
| | - Karen M Basen-Engquist
- Department of Behavioral Science, Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace Campbell
- University of Pittsburgh School of Nursing and Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania
| | | | - Andrea L Cheville
- Department of Rehabilitation Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kelley R Covington
- Cancer Rehabilitation Program, Select Medical, Mechanicsburg, Pennsylvania
| | | | - Jonas M Sokolof
- Department of Physical Medicine and Rehabilitation, New York University Langone Health, New York, New York
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87
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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.
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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
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88
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A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors After Curative-Intent Treatment. Am J Phys Med Rehabil 2020; 99:233-240. [PMID: 31361623 PMCID: PMC6982544 DOI: 10.1097/phm.0000000000001281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors. DESIGN We used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders exercise intervention compared with usual care for stage I-IIIA lung cancer survivors after curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios of less than US $100,000/quality-adjusted life-year as cost-effective and assessed model uncertainty using sensitivity analyses. RESULTS The base-case model showed that the Lifestyle Interventions and Independence for Elders exercise program would increase overall cost by US $4740 and effectiveness by 0.06 quality-adjusted life-years compared with usual care and have an incremental cost-effectiveness ratio of US $79,504/quality-adjusted life-year. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of US $100,000/quality-adjusted life-year, Lifestyle Interventions and Independence for Elders had a 71% probability of being cost-effective compared with 27% for usual care. When we included opportunity costs, Lifestyle Interventions and Independence for Elders had an incremental cost-effectiveness ratio of US $179,774/quality-adjusted life-year, exceeding the cost-effectiveness threshold. CONCLUSIONS A simulation of the Lifestyle Interventions and Independence for Elders exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective.
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89
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Giles AE, Srinathan SK. Prehabilitation prior to lung cancer surgery: a small step forward. J Thorac Dis 2020; 11:5664-5665. [PMID: 32030295 DOI: 10.21037/jtd.2019.12.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Andrew E Giles
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Manitoba, Canada
| | - Sadeesh K Srinathan
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Manitoba, Canada
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90
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Kong S, Park HY, Kang D, Lee JK, Lee G, Kwon OJ, Shim YM, Zo JI, Cho J. Seasonal Variation in Physical Activity among Preoperative Patients with Lung Cancer Determined Using a Wearable Device. J Clin Med 2020; 9:E349. [PMID: 32012720 PMCID: PMC7073689 DOI: 10.3390/jcm9020349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 01/04/2023] Open
Abstract
We aim to examine how season and temperature levels affect physical activity using a wearable device among patients scheduled to undergo surgical resection of lung cancer. Physical activity (PA) data from the wearable device were analyzed by seasons for 555 preoperative lung cancer patients from the CATCH-LUNG cohort study. The seasons were divided into spring, summer, autumn, and winter using the study enrollment date before surgery. The overall mean (SD) age was 61.1 (8.9) years, and the mean (SD) daily steps at each season were 11,438 (5922), 11,147 (5065), 10,404 (4403), and 8548 (4293), respectively. In the fully-adjusted models, patients in the winter season had 27.04% fewer daily steps (95% CI = -36.68%, -15.93%) and 35.22% less time spent performing moderate to vigorous physical activity (MVPA) compared to patients in the spring. The proportion of participants with over 8000 steps and duration of MVPA were significantly lower in the winter than the spring. In particular, daily steps had a negative linear association with wind chill temperature in patients who lived in Seoul. In conclusion, PA was significantly lower in the winter and it was more robust in patients who had a low cardiorespiratory function.
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Affiliation(s)
- Sunga Kong
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (D.K.)
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul 06351, Korea; (J.K.L.); (G.L.)
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.Y.P.); (O.J.K.)
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (D.K.)
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jae Kyung Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul 06351, Korea; (J.K.L.); (G.L.)
| | - Genehee Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul 06351, Korea; (J.K.L.); (G.L.)
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.Y.P.); (O.J.K.)
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (D.K.)
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Departments of Epidemiology and Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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91
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Zheng YT, Zhang JX. Preoperative exercise and recovery after cardiac surgery: a meta-analysis. BMC Cardiovasc Disord 2020; 20:2. [PMID: 31914929 PMCID: PMC6947961 DOI: 10.1186/s12872-019-01308-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/12/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To evaluate the association between preoperative exercise and recovery after cardiac surgery. METHODS Literature comparing preoperative exercise and the control group for patients receiving cardiac surgery was retrieved in multiple databases. Review Manager 5.2 was adopted for meta-analysis, sensitivity analysis and bias analysis. RESULTS Finally, 6 relevant studies satisfied the inclusion criteria. There was significant difference in length of stay in intensive care unit (ICU) (MD- = 1.35, 95%CI [- 2.64, - 0.06], P = 0.04; P for heterogeneity < 0.0001, I2 = 88%) and physical function after operation (P of heterogeneity = 0.32, I2 = 12%, Z = 9.92, P of over effect< 0.00001). The meta-analysis suggested that there was no significant difference in white blood cell count (WBC) at postoperative day 7 and mental health after operation between the exercise group and the control group. Limited publication bias was observed in this study. CONCLUSION Preoperative exercise including inhaled muscle training, aerobics, resistance training and stretching could promote recovery after cardiac surgery.
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Affiliation(s)
- Yu-Ting Zheng
- Department of Interventional vascular surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiang-Xu Zhang
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China.
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92
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Gravier FE, Bonnevie T, Cuvelier A. Reply from the authors: Prehabilitation versus standard care-What impact on complications? J Thorac Cardiovasc Surg 2019; 159:e148-e149. [PMID: 31604636 DOI: 10.1016/j.jtcvs.2019.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA3830 (GRHV), Normandie University UNIROUEN, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA3830 (GRHV), Normandie University UNIROUEN, Rouen, France
| | - Antoine Cuvelier
- UPRES EA3830 (GRHV), Normandie University UNIROUEN, Rouen, France; Pulmonary, Thoracic Oncology, and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
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93
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Oprea AD, Perrino AC, Popescu WM. Enhanced Recovery After Lung Surgery: Fad or Fashion? J Cardiothorac Vasc Anesth 2019; 33:2445-2447. [DOI: 10.1053/j.jvca.2019.03.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 11/11/2022]
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94
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Abstract
OBJECTIVE The objective of this study was to evaluate if a preoperative wellness bundle significantly decreases the risk of hospital acquired infections (HAI). BACKGROUND HAI threaten patient outcomes and are a significant burden to the healthcare system. Preoperative wellness efforts may significantly decrease the risk of infections. METHODS A group of 12,396 surgical patients received a wellness bundle in a roller bag during preoperative screening at an urban academic medical center. The wellness bundle consisted of a chlorhexidine bath solution, immuno-nutrition supplements, incentive spirometer, topical mupirocin for the nostrils, and smoking cessation information. Study staff performed structured patient interviews, observations, and standardized surveys at key intervals throughout the perioperative period. Statistics compare HAI outcomes of patients in the wellness program to a nonintervention group using the Fisher's exact test, logistic regression, and Poisson regression. RESULTS Patients in the nonintervention and intervention groups were similar in demographics, comorbidity, and type of operations. Compliance with each element was high (80% mupirocin, 72% immuno-nutrition, 71% chlorhexidine bath, 67% spirometer). The intervention group had statistically significant reductions in surgical site infections, Clostridium difficile, catheter associated urinary tract infections, and patient safety indicator 90. CONCLUSIONS A novel, preoperative, patient-centered wellness program dramatically reduced HAI in surgical patients at an urban academic medical center.
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95
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Liu Z, Qiu T, Pei L, Zhang Y, Xu L, Cui Y, Liang N, Li S, Chen W, Huang Y. Two-Week Multimodal Prehabilitation Program Improves Perioperative Functional Capability in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial. Anesth Analg 2019; 131:840-849. [DOI: 10.1213/ane.0000000000004342] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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96
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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.
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97
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Kadiri SB, Kerr AP, Oswald NK, Budacan AM, Flanagan S, Golby C, Lightfoot S, Naidu B. Fit 4 surgery, a bespoke app with biofeedback delivers rehabilitation at home before and after elective lung resection. J Cardiothorac Surg 2019; 14:132. [PMID: 31277671 PMCID: PMC6611050 DOI: 10.1186/s13019-019-0951-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/24/2019] [Indexed: 11/12/2022] Open
Abstract
Background Pulmonary rehabilitation programme for lung surgery patients can reduce the risk of post-operative complications but compliance to programmes can be limited by access to health care. We developed a home-based rehabilitation app and tested its feasibility in patients undergoing lung resection surgery. Methods A cohort study was conducted over 18 months at a regional thoracic unit. The Fit 4 Surgery app included ten exercises. Patients were instructed to exercise for at least three minutes for each exercise. Data was transmitted back to the researchers remotely. Data was also collected from a contemporaneous group of surgery patients who attended local outpatient-based Chronic Obstructive Pulmonary Disease rehabilitation classes. Quality of Life and outcomes data in the app group were collected. Patients were also interviewed about their experience of the app. Results App patients had a shorter wait before surgery compared to patients attending rehabilitation classes (24 vs 45 days) but managed four times as many sessions (2 vs 9), improving incremental shuttle walk test distance by 99 ± 83 (p < 0.05) metres before surgery. Five themes were gathered from the interviews. Conclusion An app based programme of rehabilitation can be delivered in a timely fashion to lung surgery patients with demonstrable physiological benefits; this will need to be confirmed in further clinical trials. Clinical trial registration number ISRCTN00061628. Registered 27 May 2011. Electronic supplementary material The online version of this article (10.1186/s13019-019-0951-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salma Bibi Kadiri
- Department of Thoracic Surgery Research, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Amy Pamela Kerr
- Department of Thoracic Surgery Research, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Nicola Katy Oswald
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Centre for Translational Inflammation Research, University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alina-Maria Budacan
- Department of Thoracic Surgery Research, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Sarah Flanagan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Christopher Golby
- Evolyst- The Innovation Centre, Warwick Technology Park, Gallows Hill, Warwick, CV34 6UW, UK
| | - Stuart Lightfoot
- Department of Thoracic Surgery Research, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Babu Naidu
- Department of Thoracic Surgery Research, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK. .,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Centre for Translational Inflammation Research, University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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98
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Cavalheri V, Burtin C, Formico VR, Nonoyama ML, Jenkins S, Spruit MA, Hill K. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database Syst Rev 2019; 6:CD009955. [PMID: 31204439 PMCID: PMC6571512 DOI: 10.1002/14651858.cd009955.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Decreased exercise capacity and health-related quality of life (HRQoL) are common in people following lung resection for non-small cell lung cancer (NSCLC). Exercise training has been demonstrated to confer gains in exercise capacity and HRQoL for people with a range of chronic conditions, including chronic obstructive pulmonary disease and heart failure, as well as in people with prostate and breast cancer. A programme of exercise training may also confer gains in these outcomes for people following lung resection for NSCLC. This systematic review updates our 2013 systematic review. OBJECTIVES The primary aim of this review was to determine the effects of exercise training on exercise capacity and adverse events in people following lung resection (with or without chemotherapy) for NSCLC. The secondary aims were to determine the effects of exercise training on other outcomes such as HRQoL, force-generating capacity of peripheral muscles, pressure-generating capacity of the respiratory muscles, dyspnoea and fatigue, feelings of anxiety and depression, lung function, and mortality. SEARCH METHODS We searched for additional randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 2 of 12), MEDLINE (via PubMed) (2013 to February 2019), Embase (via Ovid) (2013 to February 2019), SciELO (The Scientific Electronic Library Online) (2013 to February 2019), and PEDro (Physiotherapy Evidence Database) (2013 to February 2019). SELECTION CRITERIA We included RCTs in which participants with NSCLC who underwent lung resection were allocated to receive either exercise training, which included aerobic exercise, resistance exercise, or a combination of both, or no exercise training. DATA COLLECTION AND ANALYSIS Two review authors screened the studies and identified those eligible for inclusion. We used either postintervention values (with their respective standard deviation (SD)) or mean changes (with their respective SD) in the meta-analyses that reported results as mean difference (MD). In meta-analyses that reported results as standardised mean difference (SMD), we placed studies that reported postintervention values and those that reported mean changes in separate subgroups. We assessed the certainty of evidence for each outcome by downgrading or upgrading the evidence according to GRADE criteria. MAIN RESULTS Along with the three RCTs included in the original version of this review (2013), we identified an additional five RCTs in this update, resulting in a total of eight RCTs involving 450 participants (180 (40%) females). The risk of selection bias in the included studies was low and the risk of performance bias high. Six studies explored the effects of combined aerobic and resistance training; one explored the effects of combined aerobic and inspiratory muscle training; and one explored the effects of combined aerobic, resistance, inspiratory muscle training and balance training. On completion of the intervention period, compared to the control group, exercise capacity expressed as the peak rate of oxygen uptake (VO2peak) and six-minute walk distance (6MWD) was greater in the intervention group (VO2peak: MD 2.97 mL/kg/min, 95% confidence interval (CI) 1.93 to 4.02 mL/kg/min, 4 studies, 135 participants, moderate-certainty evidence; 6MWD: MD 57 m, 95% CI 34 to 80 m, 5 studies, 182 participants, high-certainty evidence). One adverse event (hip fracture) related to the intervention was reported in one of the included studies. The intervention group also achieved greater improvements in the physical component of general HRQoL (MD 5.0 points, 95% CI 2.3 to 7.7 points, 4 studies, 208 participants, low-certainty evidence); improved force-generating capacity of the quadriceps muscle (SMD 0.75, 95% CI 0.4 to 1.1, 4 studies, 133 participants, moderate-certainty evidence); and less dyspnoea (SMD -0.43, 95% CI -0.81 to -0.05, 3 studies, 110 participants, very low-certainty evidence). We observed uncertain effects on the mental component of general HRQoL, disease-specific HRQoL, handgrip force, fatigue, and lung function. There were insufficient data to comment on the effect of exercise training on maximal inspiratory and expiratory pressures and feelings of anxiety and depression. Mortality was not reported in the included studies. AUTHORS' CONCLUSIONS Exercise training increased exercise capacity and quadriceps muscle force of people following lung resection for NSCLC. Our findings also suggest improvements on the physical component score of general HRQoL and decreased dyspnoea. This systematic review emphasises the importance of exercise training as part of the postoperative management of people with NSCLC.
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Affiliation(s)
- Vinicius Cavalheri
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
| | - Chris Burtin
- Hasselt UniversityReval Rehabilitation Research Center, BIOMED, Faculty of Rehabilitation SciencesAgoralaan Gebouw ADiepenbeekLimburgBelgium3590
| | - Vittoria R Formico
- Universidade Estadual Paulista (UNESP)Physiotherapy Department, Faculdade de Ciências e TecnologiaPresidente PrudenteBrazil
| | - Mika L Nonoyama
- University of Ontario Institute of TechnologyFaculty of Health Sciences2000 Simcoe Street NorthOshawaONCanadaL1H 7K4
| | - Sue Jenkins
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalPhysiotherapy DepartmentHospital AvenuePerthAustralia
| | - Martijn A. Spruit
- Hasselt UniversityReval Rehabilitation Research Center, BIOMED, Faculty of Rehabilitation SciencesAgoralaan Gebouw ADiepenbeekLimburgBelgium3590
- CIROResearch and EducationHornerheide 1HornNetherlands6085 NM
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterRespiratory MedicineMaastrichtNetherlands6202 AZ
| | - Kylie Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
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99
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Gravier FE, Bonnevie T, Boujibar F, Médrinal C, Prieur G, Combret Y, Muir JF, Cuvelier A, Baste JM, Debeaumont D. Effect of prehabilitation on ventilatory efficiency in non–small cell lung cancer patients: A cohort study. J Thorac Cardiovasc Surg 2019; 157:2504-2512.e1. [DOI: 10.1016/j.jtcvs.2019.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/09/2019] [Accepted: 02/03/2019] [Indexed: 12/25/2022]
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100
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Okabe H, Hayashi H, Higashi T, Nitta H, Ikuta Y, Yusa T, Takeyama H, Ogawa K, Ozaki N, Akahoshi S, Ogata K, Osaki T, Baba H, Takamori H. Frailty Predicts Severe Postoperative Complication after Elective Hepatic Resection. Gastrointest Tumors 2019; 6:28-35. [PMID: 31602374 DOI: 10.1159/000500086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022] Open
Abstract
Background Frail patients are likely to suffer from postoperative complication, but this assumption has not been well confirmed. Objectives This study aims to clarify the importance of frailty in patients undergoing hepatectomy for predicting severe postoperative complications. Method One hundred and forty-three patients aged >65 years undergoing hepatectomy between 2011 and 2016 were enrolled in this study. The relevance of frailty versus sarcopenia for postoperative outcome was assessed. We defined clinical frailty (CF) as a CF scale >4. Sarcopenia was defined by the total muscle area at the level of the third lumbar vertebra measured on computed tomography. Results There were 16 patients (11%) with CF and 80 patients (56%) with sarcopenia. CF was associated with high age (p < 0.0001), severe postoperative complications (Clavien-Dindo classification ≥3) (p = 0.0059), and postoperative in-hospital stay (p = 0.0013). On the other hand, sarcopenia was not associated with postoperative outcome. Logistic regression analysis revealed that only CF was an independent predictor of severe postoperative complication (risk ratio of 4.2; p = 0.017). The occurrence of organ/space surgical site infection was significantly higher in the frailty group than in the non-frailty group. Conclusion CF, but not sarcopenia, is a robust predictor of severe postoperative complications for patients undergoing hepatectomy.
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Affiliation(s)
- Hirohisa Okabe
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan.,Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Takaaki Higashi
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yoshiaki Ikuta
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Toshihiko Yusa
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hideaki Takeyama
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Katsuhiro Ogawa
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Nobuyuki Ozaki
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Kenichi Ogata
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Takayuki Osaki
- Department of Rehabilitation, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
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