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Borrell-Vega J, Esparza Gutierrez AG, Humeidan ML. Multimodal Prehabilitation Programs for Older Surgical Patients. Anesthesiol Clin 2019; 37:437-452. [PMID: 31337477 DOI: 10.1016/j.anclin.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances in perioperative care, short-term and long-term postoperative complications are still experienced by many patients, which is of special relevance to the older adult population, considered to be high-risk surgical candidates because of less functional reserve and comorbidity burden. Through the implementation of prehabilitation programs, patients can be optimized to handle the physical and mental stress of surgery. Benefits have been described in a variety of surgical populations, but more studies targeting older surgical patients are needed. These studies should include standardized prehabilitation protocols and large sample sizes to avoid the limitations of the existing prehabilitation literature.
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Affiliation(s)
- Jaume Borrell-Vega
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA.
| | - Alan G Esparza Gutierrez
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
| | - Michelle L Humeidan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
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102
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El-Gabalawy R, Sommer JL, Pietrzak R, Edmondson D, Sareen J, Avidan MS, Jacobsohn E. Post-traumatic stress in the postoperative period: current status and future directions. Can J Anaesth 2019; 66:1385-1395. [DOI: 10.1007/s12630-019-01418-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
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103
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Faithfull S, Turner L, Poole K, Joy M, Manders R, Weprin J, Winters-Stone K, Saxton J. Prehabilitation for adults diagnosed with cancer: A systematic review of long-term physical function, nutrition and patient-reported outcomes. Eur J Cancer Care (Engl) 2019; 28:e13023. [PMID: 30859650 DOI: 10.1111/ecc.13023] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/21/2018] [Accepted: 01/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prehabilitation is increasingly being used to mitigate treatment-related complications and enhance recovery. An individual's state of health at diagnosis, including obesity, physical fitness and comorbidities, are influencing factors for the occurrence of adverse effects. This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post-treatment and considers the utility of prehabilitation before cancer treatment. METHODS A database search was conducted for articles published with prehabilitation as a pre-cancer treatment intervention between 2009 and 2017. Studies with no 30 days post-treatment data were excluded. Outcomes post-prehabilitation were extracted for physical function, nutrition and patient-reported outcomes. RESULTS Sixteen randomised controlled trials with a combined 2017 participants and six observational studies with 289 participants were included. Prehabilitation interventions provided multi-modality components including exercise, nutrition and psychoeducational aspects. Prehabilitation improved gait, cardiopulmonary function, urinary continence, lung function and mood 30 days post-treatment but was not consistent across studies. CONCLUSION When combined with rehabilitation, greater benefits were seen in 30-day gait and physical functioning compared to prehabilitation alone. Large-scale randomised studies are required to translate what is already known from feasibility studies to improve overall health and increase long-term cancer patient outcomes.
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Affiliation(s)
- Sara Faithfull
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Lauren Turner
- Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | - Karen Poole
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Mark Joy
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Ralph Manders
- Exercise Physiology and Sports Science, University Surrey, Guildford, UK
| | - Jennifer Weprin
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kerri Winters-Stone
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - John Saxton
- Department of Sport Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
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104
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McAdams-DeMarco MA, Chu NM, Segev DL. Frailty and Long-Term Post-Kidney Transplant Outcomes. CURRENT TRANSPLANTATION REPORTS 2019; 6:45-51. [PMID: 31768307 PMCID: PMC6876846 DOI: 10.1007/s40472-019-0231-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To highlight recent research about frailty and its role as a predictor of adverse, long-term post-kidney transplant (KT) outcomes. RECENT FINDINGS Frailty is easily measured using the physical frailty phenotype (PFP) developed by gerontologist Dr. Linda Fried and colleagues. In recent studies, >50% of KT recipients were frail (20%) or intermediately frail (32%) at KT admission. Frail recipients were at 1.3-times higher risk of immunosuppression intolerance and 2.2-times higher risk of mortality, even after accounting for recipient, donor, and transplant factors; these findings were consistent with those on short-term post-KT outcomes. Pilot data suggests that prehabilitation may be an intervention that increases physiologic reserve in frail KT recipients. SUMMARY The PFP is a effective tool to measure frailty in ESRD that improves risk stratification for short-term and long-term post-KT outcomes. Interventions to improve physiologic reserve and prevent adverse KT outcomes, particularly among frail KT recipients, are needed.
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Affiliation(s)
- Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD
| | - Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD
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105
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Ven Fong Z, Chang DC, Lillemoe KD, Nipp RD, Tanabe KK, Qadan M. Contemporary Opportunity for Prehabilitation as Part of an Enhanced Recovery after Surgery Pathway in Colorectal Surgery. Clin Colon Rectal Surg 2019; 32:95-101. [PMID: 30833857 DOI: 10.1055/s-0038-1676473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The implementation of upfront, preoperative habilitation ("prehabilitation"), as opposed to postoperative habilitation (rehabilitation), provides a unique opportunity to optimize surgical outcomes, while ensuring that patients receive necessary conditioning that may otherwise be significantly delayed by postoperative complications. In this review, opportunities to design, implement, monitor, and evaluate a surgical prehabilitation program in colorectal surgery are discussed, and broken down to include emotional, physical, and nutritional aspects of care in the preoperative setting.
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Affiliation(s)
- Zhi Ven Fong
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David C Chang
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan D Nipp
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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106
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Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next? Anaesthesia 2019; 74 Suppl 1:20-26. [PMID: 30604416 DOI: 10.1111/anae.14505] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/29/2022]
Abstract
Just as there is growing interest in enhancing recovery after surgery, prehabilitation is becoming a recognised means of preparing the patient physically for their operation and/or subsequent treatment. Exercise training is an important stimulus for improving low cardiovascular fitness and preserving lean muscle mass, which are critical factors in how well the patient recovers from surgery. Despite the usual focus on exercise, it is important to recognise the contribution of nutritional optimisation and psychological wellbeing for both the adherence and the response to the physical training stimulus. This article reviews the importance of a multi-modal approach to prehabilitation in order to maximise its impact in the pre-surgical period, as well as critical future steps in its development and integration in the healthcare system.
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Affiliation(s)
- C Scheede-Bergdahl
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada.,Department of Kinesiology and Physical Education, McGill Research Centre for Physical Activity and Health, McGill University, Montreal, QC, Canada.,McGill Research Centre for Physical Activity and Health, McGill University, Montreal, QC, Canada
| | - E M Minnella
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada
| | - F Carli
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada
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107
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Fit for Cancer Treatment: a prospective feasibility study of primary care initiated prehabilitation for patients with suspected cancer. BJGP Open 2019; 2:bjgpopen18X101608. [PMID: 30723794 PMCID: PMC6348330 DOI: 10.3399/bjgpopen18x101608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 01/07/2023] Open
Abstract
Background Risk profile assessment and corrective interventions using optimisation of health status and prehabilitation represent an important strategy in the management of patients with a suspected cancer diagnosis. Aim To determine the feasibility of pre-treatment optimisation and prehabilitation commenced at index primary care consultation, to improve patients’ preparation for treatment by maximising the time available. Design & setting Between January 2015 and May 2016, 195 patients presenting to 12 GP practices were deemed eligible to enter the study, of which 189 (96.9%, median age 60 [21–91] years and 65 months; 124 female) were recruited and consented to the prehabilitation bundle. Method All patients were simultaneously referred to secondary care using urgent suspected cancer (USC) pathways. The primary outcome measures were definitive diagnosis and treatment plan. Results Fifteen patients (7.9%) were diagnosed with cancer (three breast, three colon, two lung, two skin [one melanoma, one sarcoma], one tonsil, one vocal cord, one pancreas, one prostate, one ependymoma) and 62 were diagnosed with other significant medical conditions (47 gastrointestinal, 13 sepsis, two respiratory) requiring secondary care assessment and treatment. Of the 15 patients with cancer, 11 (73.3%) underwent potentially curative treatment, and four (26.7%) palliative treatment. Of the total study cohort, 84 (44%) required a form of optimisation in primary care, and patients with cancer were more likely to require optimisation than others (n = 10 [63%] versus n = 74 [43%], χ2 9.384, P = 0.002). Conclusion One in 12 primary care USC patients had cancer (5.6% receiving potentially curative treatment), one in three had other systemic health issues, and overall two in five benefited from healthcare intervention. Primary care optimisation was feasible and associated with important allied health benefits.
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108
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109
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Abstract
PURPOSE The aim of the study was to review the current state of cancer rehabilitation evidence and practice and delineate an agenda for building the future of cancer rehabilitation care. FINDINGS Despite the benefits of cancer rehabilitation interventions and the unmet needs among patients with cancer, very few patients receive these services. CONCLUSIONS Interdisciplinary cancer rehabilitation should be implemented from diagnosis forward. Building this care involves coordinating efforts in four critical areas: innovating cancer rehabilitation care delivery, expanding the team of providers, creating precision medicine cancer rehabilitation, and demonstrating the value of cancer rehabilitation to drive referrals and reimbursement. CLINICAL RELEVANCE Creating next-generation cancer rehabilitation care has the potential to improve the lives of the growing population of cancer survivors.
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110
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Leeds IL, Meyers PM, Enumah ZO, He J, Burkhart RA, Haut ER, Efron JE, Johnston FM. Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients. Ann Surg Oncol 2019; 26:936-944. [DOI: 10.1245/s10434-018-07136-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 11/18/2022]
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111
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Levett DZH, Grimmett C. Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia 2019; 74 Suppl 1:36-42. [DOI: 10.1111/anae.14507] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 12/23/2022]
Affiliation(s)
- D. Z. H. Levett
- Anaesthesia and Critical Care Research Area; Southampton NIHR Biomedical Research Centre; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - C. Grimmett
- School of Health Sciences; University of Southampton; Southampton UK
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112
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McAdams-DeMarco MA, Ying H, Van Pilsum Rasmussen S, Schrack J, Haugen CE, Chu NM, González Fernández M, Desai N, Walston JD, Segev DL. Prehabilitation prior to kidney transplantation: Results from a pilot study. Clin Transplant 2019; 33:e13450. [PMID: 30462375 PMCID: PMC6342659 DOI: 10.1111/ctr.13450] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 12/22/2022]
Abstract
Prehabilitation is the process of enhancing preoperative functional capacity to improve tolerance for the upcoming stressor; it was associated with improved postoperative outcomes in a handful of studies, but never evaluated in transplantation. Kidney transplant (KT) candidates may be uniquely suited for prehabilitation because they experience a profound loss of functional capacity while waiting years on dialysis. To better understand the feasibility and effectiveness of prehabilitation in KT, we conducted a pilot study of center-based prehabilitation for candidates; this intervention consisted of weekly physical therapy sessions at an outpatient center with at-home exercises. We enrolled 24 participants; 18 participated in prehabilitation (75% of enrolled; 17% of eligible). 61% were male, 72% were African American, and mean age = 52 (SD = 12.9); 71% of participants had lower-extremity impairment, and 31% were frail. By 2 months of prehabilitation, participants improved their physical activity by 64% (P = 0.004) based on accelerometry. Participants reported high satisfaction. Among 5 prehabilitation participants who received KT during the study, length of stay was shorter than for age-, sex-, and race-matched control (5 vs 10 days; RR = 0.69; 95% CI:0.50-0.94; P = 0.02). These pilot study findings suggest that prehabilitation is feasible in pretransplant patients and may potentially be a strategy to improve post-KT outcomes.
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Affiliation(s)
- Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hao Ying
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Jennifer Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nadia M Chu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Marlís González Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Niraj Desai
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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113
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Allen S, Brown V, Prabhu P, Scott M, Rockall T, Preston S, Sultan J. A randomised controlled trial to assess whether prehabilitation improves fitness in patients undergoing neoadjuvant treatment prior to oesophagogastric cancer surgery: study protocol. BMJ Open 2018; 8:e023190. [PMID: 30580268 PMCID: PMC6318540 DOI: 10.1136/bmjopen-2018-023190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Neoadjuvant therapy prior to oesophagogastric resection is the gold standard of care for patients with T2 and/or nodal disease. Despite this, studies have taught us that chemotherapy decreases patients' functional capacity as assessed by cardiopulmonary exercise (CPX) testing. We aim to show that a multimodal prehabilitation programme, comprising supervised exercise, psychological coaching and nutritional support, will physically, psychologically and metabolically optimise these patients prior to oesophagogastric cancer surgery so they may better withstand the immense physical and metabolic stress placed on them by radical curative major surgery. METHODS AND ANALYSIS This will be a prospective, randomised, controlled, parallel, single-centre superiority trial comparing a multimodal 'prehabilitation' intervention with 'standard care' in patients with oesophagogastric malignancy who are treated with neoadjuvant therapy prior to surgical resection. The primary aim is to demonstrate an improvement in baseline cardiopulmonary function as assessed by anaerobic threshold during CPX testing in an interventional (prehab) group following a 15-week preoperative exercise programme, throughout and following neoadjuvant treatment, when compared with those that undergo standard care (control group). Secondary objectives include changes in peak oxygen uptake and work rate (total watts achieved) at CPX testing, insulin resistance, quality of life, chemotherapy-related toxicity and completion, nutritional assessment, postoperative complication rate, length of stay and overall mortality. ETHICS AND DISSEMINATION This study has been approved by the London-Bromley Research Ethics Committee and registered on ClinicalTrials.gov. The results will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02950324; Pre-results.
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Affiliation(s)
- Sophie Allen
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Vanessa Brown
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Pradeep Prabhu
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Michael Scott
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Timothy Rockall
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Shaun Preston
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Javed Sultan
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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114
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Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0300-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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115
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Preoperative Preparations for Enhanced Recovery After Surgery Programs: A Role for Prehabilitation. Surg Clin North Am 2018; 98:1149-1169. [PMID: 30390849 DOI: 10.1016/j.suc.2018.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preoperative risk assessment is valuable only if subsequent targeted optimization of patient care is allowed. Early assessment of high-risk surgical patients is essential to facilitate appropriate optimization. Preoperative assessment and optimization should not be exclusively focused on patients' comorbidities, but also include nutritional assessment, functional capacity, and promote healthy life style habits that affect surgical outcomes (eg, smoking cessation); it requires a multidisciplinary approach.
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116
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Santa Mina D, Brahmbhatt P, Lopez C, Baima J, Gillis C, Trachtenberg L, Silver JK. The Case for Prehabilitation Prior to Breast Cancer Treatment. PM R 2018; 9:S305-S316. [PMID: 28942905 DOI: 10.1016/j.pmrj.2017.08.402] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 12/22/2022]
Abstract
Cancer rehabilitation in breast cancer survivors is well established, and there are many studies that focus on interventions to treat impairments as well as therapeutic exercise. However, very little is known about the role of prehabilitation for people with breast cancer. In this narrative review, we describe contemporary clinical management of breast cancer and associated treatment-related morbidity and mortality considerations. Knowing the common short- and long-term sequelae, as well as less frequent but serious sequelae, informs our rationale for multimodal breast cancer prehabilitation. We suggest 5 core components that may help to mitigate short- and long-term sequelae that align with consensus opinion of prehabilitation experts: total body exercise; locoregional exercise pertinent to treatment-related deficits; nutritional optimization; stress reduction/psychosocial support; and smoking cessation. In each of these categories, we review the literature and discuss how they may affect outcomes for women with breast cancer.
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Affiliation(s)
- Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, The University of Toronto, 55 Harbord St, Toronto, ON, M5S 2W6, Canada; Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON, Canada(∗).
| | - Priya Brahmbhatt
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON, Canada(†)
| | - Christian Lopez
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON, Canada(‡)
| | - Jennifer Baima
- University of Massachusetts Medical School, Worcester, MA(§)
| | - Chelsia Gillis
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada(‖)
| | - Lianne Trachtenberg
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada(¶)
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA; Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA(#)
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117
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Leonhardt M, Aschenbrenner K, Kreis ME, Lauscher JC. Exploring the characteristics and potential disparities of non-migrant and migrant colorectal cancer patients regarding their satisfaction and subjective perception of care - a cross-sectional study. BMC Health Serv Res 2018; 18:423. [PMID: 29879958 PMCID: PMC5992698 DOI: 10.1186/s12913-018-3232-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/24/2018] [Indexed: 01/16/2023] Open
Abstract
Background Although a fifth of the German population has a migration background, health research regarding this population is scarce. The few existing studies on migrant health show that migrants are faced with restrictions regarding health care due to communication problems, a lack of information and distinct health literacy. Colorectal cancer (CRC) is the second most common tumor disease in Germany. The aim of the study is to explore the potential differences in patient characteristics between migrants and non-migrants with CRC and identify possible disparities between migrants and non-migrants regarding their satisfaction and perception with health care. Methods A validated questionnaire was modified for CRC, supplemented with items regarding migration background, translated additionally into Arabic, Turkish and Russian and sent out to 1.694 CRC patients. The outcome indicator was ‘health care satisfaction and experience’ concerning ‘medical consultation’, ‘medical treatment (therapy)’ and ‘hospital stay’ measured on 10-point Likert-scales; explanatory variables were migration background, age, gender, mother tongue, occupation, follow-up care, current discomfort and current treatment. Following descriptive statistics, factor analysis was conducted to compute the outcome variables. Differences between migrants and non-migrants were analyzed using Mann-Whitney-U test and regression analyses. Results A total of 522 completed questionnaires – 30.8% response rate – were used for analysis. Patients with a migration background attended less often follow up care than non-migrant patients (74.7% vs. 88.6%; p = 0.001). Mean scores regarding satisfaction and experience with consultation, medical treatment (therapy) and hospital stay were 7.86, 7.11 and 7.51 for migrants and 7.84, 7.19 and 7.33 for non-migrants, measured on a 1 to 10 scale with 10 being most satisfied. Migrants were less satisfied with their own involvement in decision making (p = 0.029) and the aspect “responsiveness to patient’s questions” (p = 0.048) than non-migrants. Conclusions Migrants showed less compliance with regard to follow-up care than non-migrants. Furthermore, migrants were more often dissatisfied with communication with the medical staff than non-migrants. This shows the importance of (cross-cultural) communication skills on the part of physicians and nurses.
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Affiliation(s)
- Marja Leonhardt
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany. .,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post box 104, 2381, Brumunddal, Norway.
| | - Katja Aschenbrenner
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany
| | - Martin E Kreis
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany
| | - Johannes C Lauscher
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany
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Sun V, Kim JY, Raz DJ, Chang W, Erhunmwunsee L, Uranga C, Ireland AM, Reckamp K, Tiep B, Hayter J, Lew M, Ferrell B, McCorkle R. Preparing Cancer Patients and Family Caregivers for Lung Surgery: Development of a Multimedia Self-Management Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:557-563. [PMID: 27542378 PMCID: PMC5573658 DOI: 10.1007/s13187-016-1103-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The surgical treatment of lung malignancies often results in persistent symptoms, psychosocial distress, and decrements in quality of life (QOL) for cancer patients and their family caregivers (FCGs). The potential benefits of providing patients and FCGs with preparatory education that begins in the preoperative setting have been explored in multiple medical conditions, with positive impact observed on postoperative recovery, psychological distress, and QOL. However, few studies have explored the benefits of preparatory educational interventions to promote self-management in cancer surgery, including lung surgery. This paper describes the systematic approach used in the development of a multimedia self-management intervention to prepare cancer patients and their FCGs for lung surgery. Intervention development was informed by (1) contemporary published evidence on the impact of lung surgery on patients and FCG, (2) our previous research that explored QOL, symptoms, and caregiver burden after lung surgery, (3) the use of the chronic care self-management model (CCM) to guide intervention design, and (4) written comments and feedback from patients and FCGs that informed intervention development and refinement. Pilot-testing of the intervention is in process, and a future randomized trial will determine the efficacy of the intervention to improve patient, FCG, and system outcomes.
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Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| | - Jae Y Kim
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA, USA
| | - Dan J Raz
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA, USA
| | - Walter Chang
- Department of Anesthesiology, City of Hope, Duarte, CA, USA
| | - Loretta Erhunmwunsee
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA, USA
| | - Carolina Uranga
- Department of Nursing, Clinical Practice and Education, City of Hope, Duarte, CA, USA
| | - Anne Marie Ireland
- Department of Nursing, Solid Tumor Malignancies Program, City of Hope, Duarte, CA, USA
| | - Karen Reckamp
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Brian Tiep
- Department of Respiratory Diseases and Pulmonary Rehabilitation, City of Hope, Duarte, CA, USA
| | | | - Michael Lew
- Department of Anesthesiology, City of Hope, Duarte, CA, USA
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Ruth McCorkle
- School of Nursing, Yale University, New Haven, CT, USA
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Abstract
To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.
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Affiliation(s)
- Neil N Shah
- Department of Medicine, Dell Medical School, The University of Texas at Austin, Health Discovery Building, 1701 Trinity Street, Austin, TX 78712-1875, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
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120
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Arakelian E, Laurssen E, Öster C. Older Patients' Worries in Connection With General Anesthesia and Surgery-A Qualitative Study. J Perianesth Nurs 2018; 33:822-833. [PMID: 29548667 DOI: 10.1016/j.jopan.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine anxiety and what older patients worry about related to anesthesia and colorectal surgery, and their perceptions regarding nurses' ability to ease preoperative worry. DESIGN Qualitative individual face-to-face interviews. METHODS The study included 18 patients aged between 62 and 91 years with lower abdominal tumors. The study was conducted in two day-surgery wards in Sweden. Interview data were analyzed with Malterud's systematic text condensation. FINDINGS Four themes were identified: (1) losing control of one's body, leaving one's life in someone else's hands, and the feeling that there is no going back, (2) claustrophobia and anticipated pain in an unknown environment, (3) unknown and frightening vocabulary concerning the surgery, and (4) what can happen if something goes wrong. CONCLUSIONS Patients worry about a number of things. If preoperative worry could be identified, actions taken to reduce worry could be personalized and patients' own strategies to reduce worries may be helpful for them.
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121
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Impact of Low Muscularity and Myosteatosis on Long-term Outcome After Curative Colorectal Cancer Surgery: A Propensity Score-Matched Analysis. Dis Colon Rectum 2018; 61:364-374. [PMID: 29377869 DOI: 10.1097/dcr.0000000000000958] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Muscle loss, characterized by reduced muscle mass (myopenia), and infiltration by intermuscular and intramuscular fat (myosteatosis), predicts a poor short-term prognosis in patients with colorectal cancer. However, little is known about the influence of myopenia and myosteatosis on long-term outcomes. OBJECTIVE The present study aimed to evaluate the prognostic influence of both myopenia and myosteatosis on long-term outcomes after curative colorectal cancer surgery. DESIGN This is a retrospective analysis using a propensity score-matched analysis to reduce the possibility of selection bias. SETTINGS The study was conducted at a single institution. PATIENTS We performed a retrospective analysis of 211 consecutive patients with stage I to III colorectal cancer who underwent curative surgery between 2010 and 2011. INTERVENTION CT scans were analyzed to calculate the lumbar skeletal muscle index and mean muscle attenuation using a SYNAPS VINCENT. MAIN OUTCOME MEASURES The primary outcome measure was cancer-specific survival. Secondary end points included overall survival and disease-free survival. RESULTS Of 211 patients, a total of 102 and 106 were matched for myopenia and myosteatosis analyses. The median follow-up was 57.6 months. Versus the nonmyopenia group, the myopenia group manifested a significantly shorter cancer-specific survival, overall survival, and disease-free survival. Significantly shorter cancer-specific survival and overall survival times were also identified for the myosteatosis versus the nonmyosteatosis group. Before matching, multivariate analyses identified both myopenia and myosteatosis as independent prognostic factors for cancer-specific survival (p = 0.04 and p < 0.01), overall survival (p = 0.03 and p < 0.01), and disease-free survival (p < 0.01 and p < 0.01). LIMITATIONS This study is limited by its retrospective, nonrandomized design. CONCLUSIONS Myopenia and myosteatosis adversely affect long-term outcomes after curative colorectal cancer resection. See Video Abstract at http://links.lww.com/DCR/A463.
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122
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Multimodal Prehabilitation Programs as a Bundle of Care in Gastrointestinal Cancer Surgery: A Systematic Review. Dis Colon Rectum 2018; 61:124-138. [PMID: 29219922 DOI: 10.1097/dcr.0000000000000987] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prehabilitation reflects a proactive process of preoperative optimization undertaken between cancer diagnosis and definitive surgical treatment, with the intent of improving physiological capacity to withstand the major insult of surgery. Prehabilitation before GI cancer surgery is currently not widely adopted, and most research has focused on unimodal interventions such as exercise therapy, nutritional supplementation, and hematinic optimization. A review of the existing literature was undertaken to investigate the impact of multimodal prehabilitation programs as a "bundle of care." DATA SOURCE A systematic literature search was performed utilizing Medline, PubMed, Embase, Cinahl, Cochrane, and Google Scholar databases. STUDY SELECTION The quality of studies was assessed by using the Cochrane tool for assessing risk of bias (randomized trials) and the Newcastle-Ottawa Quality Assessment scale (cohort studies). INTERVENTION Studies were chosen that involved pre-operative optimization of patients before GI cancer surgery. MAIN OUTCOMES The primary outcome measured was the impact of prehabilitation programs on preoperative fitness and postoperative outcomes. RESULTS Of the 544 studies identified, 20 were included in the qualitative analysis. Two trials investigated the impact of multimodal prehabilitation (exercise, nutritional supplementation, anxiety management). Trials exploring prehabilitation with unimodal interventions included impact of exercise therapy (7 trials), impact of preoperative iron replacement (5 trials), nutritional optimization (5 trials), and impact of preoperative smoking cessation (2 trials). Compliance within the identified studies was variable (range: 16%-100%). LIMITATIONS There is a lack of adequately powered trials that utilize objective risk stratification and uniform end points. As such, a meta-analysis was not performed because of the heterogeneity in study design. CONCLUSION Although small studies are supportive of multimodal interventions, there are insufficient data to make a conclusion about the integration of prehabilitation in GI cancer surgery as a bundle of care. Larger, prospective trials, utilizing uniform objective risk stratification and structured interventions, with predefined clinical and health economic end points, are required before definitive value can be assigned to prehabilitation programs.
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123
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Rammant E, Decaestecker K, Bultijnck R, Sundahl N, Ost P, Pauwels NS, Deforche B, Pieters R, Fonteyne V. A systematic review of exercise and psychosocial rehabilitation interventions to improve health-related outcomes in patients with bladder cancer undergoing radical cystectomy. Clin Rehabil 2017; 32:594-606. [PMID: 29231044 DOI: 10.1177/0269215517746472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Summarizing the evidence on the effects of pre- and postoperative exercise and psychosocial rehabilitation interventions on patient-reported outcomes (PROs) and physical fitness in bladder cancer patients undergoing radical cystectomy. DATA SOURCES The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science and the Physiotherapy Evidence Database were searched independently by two authors from inception until 10 November 2017. Cited references of the studies and citing references retrieved via Web of Science were also checked. REVIEW METHODS Randomized controlled trials (RCTs) and non-randomized studies assessing effects of exercise and psychosocial interventions in bladder cancer patients undergoing radical cystectomy were eligible. Primary outcome measures were PROs and physical fitness. Risk of bias was assessed using the Cochrane Collaboration tool and the Newcastle-Ottawa Scale. RESULTS Five RCTs (three exercise and two psychosocial studies) and one non-randomized psychosocial study comprising 317 bladder cancer patients were included. Timing of the intervention was preoperative ( n = 2), postoperative ( n = 2) or both pre- and postoperative ( n = 2). Positive effects of exercise were found for physical fitness ( n = 3), some health-related quality-of-life (HRQoL) domains ( n = 2), personal activities in daily living ( n = 1) and muscle strength ( n = 1). Psychosocial interventions showed positive effects on anxiety ( n = 1), fatigue ( n = 1), depression ( n = 1), HRQoL ( n = 1) and posttraumatic growth ( n = 1). Quality assessment showed most shortcomings with sample sizes and strong heterogeneity was observed between studies. CONCLUSION The evidence relating to the effects of exercise in bladder cancer is very limited and is even less for psychosocial interventions.
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Affiliation(s)
- Elke Rammant
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Renée Bultijnck
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Nora Sundahl
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Nele S Pauwels
- 3 Knowledge Center Ghent, Ghent University Hospital, Ghent, Belgium
| | | | - Ronny Pieters
- 2 Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
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124
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Gudenkauf LM, Ehlers SL. Psychosocial interventions in breast cancer survivorship care. Breast 2017; 38:1-6. [PMID: 29169071 DOI: 10.1016/j.breast.2017.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/21/2017] [Accepted: 11/09/2017] [Indexed: 01/03/2023] Open
Abstract
Cancer distress screening and subsequent referral for psychosocial intervention has been mandated for continued cancer center accreditation. Increasing emphasis is being placed on the referral component of this mandate, ensuring that patient distress is not only identified but also effectively treated. Many evidence-based interventions exist for cancer distress. Specific interventions can effectively target biopsychosocial impacts of stress and promote adaptive coping, focusing on problem-solving, social support utilization, assertive communication, sexual health and intimacy, adherence to medical and supportive care recommendations, health behavior change, and emotional processing and expression. In randomized clinical trials, specific interventions have also been associated with biological improvements, including neuroendocrine and immune functioning, decreased rates of breast cancer recurrence, and improved survival rates. As cancer treatments advance and patients live longer, it is pertinent to treat the impacts of breast cancer with evidence-based interventions.
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Affiliation(s)
- Lisa M Gudenkauf
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, United States
| | - Shawna L Ehlers
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, United States.
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125
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Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F. Response to: Is prehabilitation limited to preoperative exercise? Surgery 2017; 162:192-193. [DOI: 10.1016/j.surg.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 02/06/2023]
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126
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A Perioperative Clinical Pathway Can Dramatically Reduce Failure-to-rescue Rates After Cytoreductive Surgery for Peritoneal Carcinomatosis: A Retrospective Study of 666 Consecutive Cytoreductions. Ann Surg 2017; 265:806-813. [PMID: 27775553 DOI: 10.1097/sla.0000000000001723] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether a perioperative, standardized clinical pathway could impact the failure-to-rescue rate after cytoreductive surgery (CRS) for peritoneal carcinomatosis (PC) in a tertiary center. SUMMARY OF BACKGROUND DATA Morbidity and mortality remain significant after CRS for PC. Clinical pathways have been associated with better outcomes after surgery. The failure-to-rescue rate is a useful metric for evaluating quality in surgery. MATERIALS AND METHODS This study included 666 patients that received CRS for PC between 2009 and 2014. Starting in 2012, a standardized perioperative clinical pathway was introduced, which focused on patient selection, nutrition, renal protection, pain management, prevention, and early detection of complications. Complications were evaluated with the National Cancer Institute's Common Terminology Criteria for Adverse Events. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with major complications and failure-to-rescue. Complication rates were compared before and after the clinical pathway implementation. RESULTS Major complications occurred in 341 patients (51%), leading to 15 deaths. The complication rate was similar before and after clinical pathway introduction (54.75% vs 48.9%, respectively; P = 0.138). Only prolonged surgery (longer than 240 mins) was independently associated with major complications. The failure-to-rescue rate was 4.4% for the entire period, but it significantly decreased after introducing the clinical pathway (9.02% vs 1.02%; P < 0.001). On multivariate analysis, only renal complications were associated with the failure-to-rescue. CONCLUSION Morbidity after CRS remains significant, but standardized management facilitated a reduction in the failure-to-rescue rate and improved the quality of care. Specific effort should be dedicated to preventing postoperative renal failure.
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127
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The Michigan Surgical Home and Optimization Program is a scalable model to improve care and reduce costs. Surgery 2017; 161:1659-1666. [DOI: 10.1016/j.surg.2016.12.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 11/17/2022]
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128
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Leong KJ, Chapman MAS. Current data about the benefit of prehabilitation for colorectal cancer patients undergoing surgery are not sufficient to alter the NHS cancer waiting targets. Colorectal Dis 2017; 19:522-524. [PMID: 28498541 DOI: 10.1111/codi.13723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/24/2017] [Indexed: 02/08/2023]
Affiliation(s)
- K J Leong
- Good Hope Hospital, Sutton Coldfield, UK
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129
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Carli F, Gillis C, Scheede-Bergdahl C. Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncol 2017; 56:128-133. [PMID: 28067101 DOI: 10.1080/0284186x.2016.1266081] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Traditional rehabilitative approaches to perioperative cancer care have focused on the postoperative period to facilitate the return to presurgical baseline conditions. However, there is some realization that the preoperative period can be a very effective time for intervention as the patients are more amenable to target their physiological condition to prepare to overcome the metabolic cost of the surgical stress. METHODS We undertook a narrative review of the current literature on surgical prehabilitation and discussed the current evidence of preoperative interventions before cancer surgery in order to increase physiological reserve before surgery and accelerate postoperative recovery. RESULTS Published data indicate the positive impact of prehabilitation on postoperative functional capacity and return to daily activities. However, the current evidence on the impact on short- and long-term clinical outcome is limited, and more research needs to be conducted. CONCLUSION Preliminary findings indicate that a group of interventions such as exercise, nutrition and anxiety reduction in the preoperative period can complement the enhanced recovery program and facilitate the return to baseline activities of daily living. It is not clear at this stage whether the preoperative increase in functional capacity mitigates the burden of postoperative morbidities and subsequent cancer therapies. Therefore, more research is warranted.
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Affiliation(s)
- Francesco Carli
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- Cumming School of Medicine, University of Calgary, AB, Canada
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill Research, Centre for Physical Activity & Health, McGill University, Montreal, QC, Canada
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130
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Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B. Surgical Prehabilitation in Patients with Cancer. Phys Med Rehabil Clin N Am 2017; 28:49-64. [DOI: 10.1016/j.pmr.2016.09.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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131
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Maciver AH, Al-Sukhni E, Esquivel J, Skitzki JJ, Kane JM, Francescutti VA. Current Delivery of Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery (CS/HIPEC) and Perioperative Practices: An International Survey of High-Volume Surgeons. Ann Surg Oncol 2016; 24:923-930. [DOI: 10.1245/s10434-016-5692-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 12/19/2022]
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132
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Stout NL, Silver JK, Raj VS, Rowland J, Gerber L, Cheville A, Ness KK, Radomski M, Nitkin R, Stubblefield MD, Morris GS, Acevedo A, Brandon Z, Braveman B, Cunningham S, Gilchrist L, Jones L, Padgett L, Wolf T, Winters-Stone K, Campbell G, Hendricks J, Perkin K, Chan L. Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group. Arch Phys Med Rehabil 2016; 97:2006-2015. [DOI: 10.1016/j.apmr.2016.05.002] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
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133
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Lee SJC, Clark MA, Cox JV, Needles BM, Seigel C, Balasubramanian BA. Achieving Coordinated Care for Patients With Complex Cases of Cancer: A Multiteam System Approach. J Oncol Pract 2016; 12:1029-1038. [PMID: 27577621 PMCID: PMC5356468 DOI: 10.1200/jop.2016.013664] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with cancer with multiple chronic conditions pose a unique challenge to how primary care and specialty care teams provide well-coordinated, patient-centered care. Effectiveness of these care teams in providing optimal health care depends on the extent to which they coordinate their goals and knowledge as components of a multiteam system (MTS). This article outlines challenges of care coordination in the context of an MTS, illustrated through the care experience of "Mr Fuentes," a patient in the Dallas County integrated safety-net system, Parkland. As a continuing patient with chronic illnesses, the patient being discussed is managed through one of the Parkland community-oriented primary care clinics. However, a cancer diagnosis triggered an additional need for augmented coordination between his different provider teams. Further research and practice should investigate the relationships of MTS coordination for shared care management, transfer to and from specialty care, treatment compliance, barriers to care, and health outcomes of chronic comorbid conditions, as well as cancer control and surveillance.
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Affiliation(s)
- Simon J. Craddock Lee
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Mark A. Clark
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - John V. Cox
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Burton M. Needles
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Carole Seigel
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Bijal A. Balasubramanian
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
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134
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King A. The next challenge for psycho-oncology in the UK: targeting service quality and outcomes. Future Oncol 2016; 12:2811-2816. [PMID: 27750443 DOI: 10.2217/fon-2016-0395] [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: 11/21/2022] Open
Abstract
The acceptance and provision of psychosocial cancer care in the UK is moving forward positively, aided by patient advocacy and psychologically minded healthcare policies. The unfolding challenge now is of targeting the quality and outcomes of clinical psycho-oncology services. This report outlines the clinically led development of UK-focused guidance to challenge psycho-oncology services to achieve and demonstrate their potential. It discusses how the guidance was particularly framed to encourage small, low-resource services, and outlines the potential benefits for patients. Overall, setting ourselves the challenge of quality on the same terms as physical healthcare, we can shape a direct path to achieving parity of esteem in mental with physical healthcare.
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Affiliation(s)
- Alex King
- Imperial College Healthcare NHS Trust, London, UK
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135
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Chen BP, Awasthi R, Sweet SN, Minnella EM, Bergdahl A, Santa Mina D, Carli F, Scheede-Bergdahl C. Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support Care Cancer 2016; 25:33-40. [DOI: 10.1007/s00520-016-3379-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/08/2016] [Indexed: 01/12/2023]
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136
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Malietzis G, Currie AC, Athanasiou T, Johns N, Anyamene N, Glynne-Jones R, Kennedy RH, Fearon KCH, Jenkins JT. Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg 2016; 103:572-80. [PMID: 26994716 DOI: 10.1002/bjs.10075] [Citation(s) in RCA: 203] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/28/2015] [Accepted: 11/05/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Muscle depletion is characterized by reduced muscle mass (myopenia), and increased infiltration by intermuscular and intramuscular fat (myosteatosis). This study examined the role of particular body composition profiles as prognostic markers for patients with colorectal cancer undergoing curative resection. METHODS Patients with colorectal cancer undergoing elective surgical resection between 2006 and 2011 were included. Lumbar skeletal muscle index (LSMI), visceral adipose tissue (VAT) surface area and mean muscle attenuation (MA) were calculated by analysis of CT images. Reduced LSMI (myopenia), increased VAT (visceral obesity) and low MA (myosteatosis) were identified using predefined sex-specific skeletal muscle index values. Univariable and multivariable Cox regression models were used to determine the role of different body composition profiles on outcomes. RESULTS Some 805 patients were identified, with a median follow-up of 47 (i.q.r. 24·9-65·6) months. Multivariable analysis identified myopenia as an independent prognostic factor for disease-free survival (hazard ratio (HR) 1·53, 95 per cent c.i. 1·06 to 2·39; P = 0·041) and overall survival (HR 1·70, 1·25 to 2·31; P < 0·001). The presence of myosteatosis was associated with prolonged primary hospital stay (P = 0·034), and myopenic obesity was related to higher 30-day morbidity (P = 0·019) and mortality (P < 0·001) rates. CONCLUSION Myopenia may have an independent prognostic effect on cancer survival for patients with colorectal cancer. Muscle depletion may represent a modifiable risk factor in patients with colorectal cancer and needs to be targeted as a relevant endpoint of health recommendations.
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Affiliation(s)
- G Malietzis
- Department of Surgery, St Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - A C Currie
- Department of Surgery, St Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - T Athanasiou
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N Johns
- Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - N Anyamene
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - R Glynne-Jones
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - R H Kennedy
- Department of Surgery, St Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - K C H Fearon
- Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - J T Jenkins
- Department of Surgery, St Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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137
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Mijderwijk H, Stolker RJ, Duivenvoorden HJ, Klimek M, Steyerberg EW. Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making. Can J Anaesth 2016; 63:1022-32. [PMID: 27282374 DOI: 10.1007/s12630-016-0673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/22/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Ambulatory surgery patients are at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated a clinical prediction model to identify patients who were vulnerable to these psychological outcome parameters. METHODS We prospectively assessed 383 mixed ambulatory surgery patients for psychological vulnerability, defined as the presence of anxiety (state/trait), aggression (state/trait), fatigue, and depression seven days after surgery. Three psychological vulnerability categories were considered-i.e., none, one, or multiple poor scores, defined as a score exceeding one standard deviation above the mean for each single outcome according to normative data. The following determinants were assessed preoperatively: sociodemographic (age, sex, level of education, employment status, marital status, having children, religion, nationality), medical (heart rate and body mass index), and psychological variables (self-esteem and self-efficacy), in addition to anxiety, aggression, fatigue, and depression. A prediction model was constructed using ordinal polytomous logistic regression analysis, and bootstrapping was applied for internal validation. The ordinal c-index (ORC) quantified the discriminative ability of the model, in addition to measures for overall model performance (Nagelkerke's R (2) ). RESULTS In this population, 137 (36%) patients were identified as being psychologically vulnerable after surgery for at least one of the psychological outcomes. The most parsimonious and optimal prediction model combined sociodemographic variables (level of education, having children, and nationality) with psychological variables (trait anxiety, state/trait aggression, fatigue, and depression). Model performance was promising: R (2) = 30% and ORC = 0.76 after correction for optimism. CONCLUSION This study identified a substantial group of vulnerable patients in ambulatory surgery. The proposed clinical prediction model could allow healthcare professionals the opportunity to identify vulnerable patients in ambulatory surgery, although additional modification and validation are needed. (ClinicalTrials.gov number, NCT01441843).
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Affiliation(s)
- Herjan Mijderwijk
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hugo J Duivenvoorden
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Theunissen M, Peters ML, Schepers J, Maas JW, Tournois F, van Suijlekom HA, Gramke HF, Marcus MA. Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery. Medicine (Baltimore) 2016; 95:e3980. [PMID: 27367998 PMCID: PMC4937912 DOI: 10.1097/md.0000000000003980] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Chronic postsurgical pain (CPSP) is 1 important aspect of surgical recovery. To improve perioperative care and postoperative recovery knowledge on predictors of impaired recovery is essential. The aim of this study is to assess predictors and epidemiological data of CPSP, physical functioning (SF-36PF, 0-100), and global surgical recovery (global surgical recovery index, 0-100%) 3 and 12 months after hysterectomy for benign indication.A prospective multicenter cohort study was performed. Sociodemographic, somatic, and psychosocial data were assessed in the week before surgery, postoperatively up to day 4, and at 3- and 12-month follow-up. Generalized linear model (CPSP) and linear-mixed model analyses (SF-36PF and global surgical recovery index) were used. Baseline data of 468 patients were collected, 412 (88%) patients provided data for 3-month evaluation and 376 (80%) patients for 12-month evaluation.After 3 and 12 months, prevalence of CPSP (numeric rating scale ≥ 4, scale 0-10) was 10.2% and 9.0%, respectively, SF-36PF means (SD) were 83.5 (20.0) and 85.9 (20.2), global surgical recovery index 88.1% (15.6) and 93.3% (13.4). Neuropathic pain was reported by 20 (5.0%) patients at 3 months and 14 (3.9%) patients at 12 months. Preoperative pain, surgery-related worries, acute postsurgical pain on day 4, and surgery-related infection were significant predictors of CPSP. Baseline level, participating center, general psychological robustness, indication, acute postsurgical pain, and surgery-related infection were significant predictors of SF-36PF. Predictors of global surgical recovery were baseline expectations, surgery-related worries, American Society of Anesthesiologists classification, type of anesthesia, acute postsurgical pain, and surgery-related infection.Several predictors were identified for CPSP, physical functioning, and global surgical recovery. Some of the identified factors are modifiable and optimization of patients' preoperative pain status and psychological condition as well as reduction of acute postsurgical pain and surgery-related infection may lead to improvement of outcome.
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Affiliation(s)
- Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht UMC+
- Correspondence: Maurice Theunissen, Department of Anesthesiology and Pain Management, Maastricht UMC+, PO Box 5800, 6202 AZ Maastricht, The Netherlands ()
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht
| | - Jan Schepers
- Department of Clinical Psychological Science, Maastricht University, Maastricht
| | | | - Fleur Tournois
- Department of Gynaecology, Maastricht UMC+, Maastricht/Orbis Medical Center, Sittard-Geleen
| | - Hans A. van Suijlekom
- Department of Anesthesiology and Pain Management, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Marco A.E. Marcus
- Department of Anesthesiology and Pain Management, Maastricht UMC+
- Department of Anesthesiology, ICU, and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
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Wright S, Wiechula R, McLiesh P. The effectiveness of prehabilitation for adults having elective surgery: a systematic review protocol. ACTA ACUST UNITED AC 2016; 14:78-92. [DOI: 10.11124/jbisrir-2016-2460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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140
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Abstract
The purpose of this brief summary is to introduce the concept of cancer prehabilitation and the role of oncology nurses in prehabilitation care. Cancer prehabilitation has been defined by Sliver and Baima (2013) as "a process on the cancer continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment." The evidence supports the notion that prehabilitation programs can improve physical and psychological health outcomes and decrease overall health care costs. The care model for cancer prehabilitation should include timely and efficient assessment throughout the care continuum with a focus on improving outcomes in cancer at every stage. During the cancer journey, three types of assessment with different aims are included: (1) prehabilitation assessment pretreatment, (2) rehabilitation assessment at early post treatment, and (3) health promotion assessment at the end of treatment. Specific prehabilitation assessment and interventions for treatment-related complications or major side-effects should be considered. Teaching, counseling, discharge planning, and coordination should also be part of an oncology nurse's role in cancer prehabilitation. It is suggested that cancer care managers or navigators be trained in the assessment of their patients' physical and psychological status once the cancer diagnosis has been identified and the patient has decided to receive active treatment, especially for those waiting for surgery at home. Oncology nurses could increase their competence with prehabilitation care by gaining knowledge about cancer-related treatments and their outcomes for specific cancers and by strengthening the ability to assess the functional status and psychological distress of their patients.
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