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Vaughan VC, Martin P. Multidisciplinary approaches to cancer cachexia: current service models and future perspectives. Expert Rev Anticancer Ther 2022; 22:737-749. [PMID: 35699257 DOI: 10.1080/14737140.2022.2088516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cancer cachexia remains a complex unmet need in oncology, despite its high prevalence and high impact. Patients with cachexia experience numerous complications, including reduced tolerance and effectiveness of anti-cancer therapy, reduced mobility, and reduced functional status, leading to decreased quality of life and survival. AREAS COVERED As the field moves toward greater consensus of definitions and measurements, we highlight tools currently available for identification and staging of cachexia, and the barriers that people with cancer face in timely identification and management of cachexia. Multidisciplinary cachexia service models have emerged to address practice gaps and needs identified by patients and clinicians. Person-centred approaches to cachexia care demonstrate promising improvements in patient outcomes, but controlled trials of service models are lacking. EXPERT OPINION While significant advances have been made in the understanding of cachexia, future trials of clinical service models require standardisation of definitions and outcome measures, with more robust controlled studies to establish the efficacy of proposed best practice. We remain excited with the potential benefit of these innovative models and continue to advocate for implementation of dedicated multidisciplinary cachexia teams to ensure patients and their families receive the right support, in the right place, at the right time.
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Affiliation(s)
| | - Peter Martin
- School of Medicine, Deakin University, Waurn Ponds, Australia.,Barwon Health, Barwon Health Cachexia & Nutrition Support Service, Geelong, Australia
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2
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Critical Competences for the Management of Post-Operative Course in Patients with Digestive Tract Cancer: The Contribution of MADIT Methodology for a Nine-Month Longitudinal Study. Behav Sci (Basel) 2022; 12:bs12040101. [PMID: 35447673 PMCID: PMC9029589 DOI: 10.3390/bs12040101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
There is a high postoperative morbidity rate after cancer surgery, that impairs patients’ self-management, job condition and economic strength. This paper describes the results of a peculiar psychological intervention on patients undergoing surgery for esophageal, gastric and colorectal cancer. The intervention aimed to enhance patients’ competences in the management of postoperative daily life. A narrative approach (M.A.D.I.T.—Methodology for the Analysis of Computerised Text Data) was used to create a questionnaire, Health and Employment after Gastro-Intestinal Surgery—Dialogical Questionnaire, HEAGIS-DQ, that assesses four competences. It was administered to 48 participants. Results were used as guidance for specific intervention, structured on patients’ competence profiles. The intervention lasted nine months after surgery and was structured in weekly to monthly therapeutic sessions. Quality of Life questionnaires were administered too. At the end of the intervention, 94% of patients maintained their job and only 10% of patients asked for financial support. The mean self-perception of health-related quality of life was 71.2. The distribution of three of four competences increased after nine months (p < 0.05). Despite economic difficulties due to lasting symptoms after surgery, and to the current pandemic scenario, a structured intervention with patients let them to resume their jobs and continue activities after surgery.
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Deftereos I, Hitch D, Butzkueven S, Carter V, Fetterplace K, Fox K, Ottaway A, Pierce K, Steer B, Varghese J, Kiss N, Yeung JM. Implementing a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a mixed-methods analysis of implementation using the Consolidated Framework for Implementation Research. BMC Health Serv Res 2022; 22:256. [PMID: 35209897 PMCID: PMC8876395 DOI: 10.1186/s12913-022-07466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Implementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR). Methods This was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4–8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data. Results Qualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points). Conclusions The nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. .,Department of Nutrition and Dietetics, Western Health, Melbourne, Australia.
| | - Danielle Hitch
- Allied Health, Western Health, Melbourne, Australia.,Occupational Therapy, Deakin University, Geelong, Australia
| | | | - Vanessa Carter
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Fox
- Department of Nutrition and Dietetics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Aurora Ottaway
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Kathryn Pierce
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jessie Varghese
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Justin M Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia.,Department of Colorectal Surgery, Western Health, Melbourne, Australia.,Sunshine Hospital, Level 3, WCHRE Building, 176 Furlong Rd, St Albans, VIC, 3021, Australia
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Latif J, Elizabeth Weekes C, Julian A, Frost G, Murphy J, Abigail Tronco-Hernandez Y, Hickson M. Strategies to ensure continuity of nutritional care in patients with COVID-19 infection on discharge from hospital: A rapid review. Clin Nutr ESPEN 2022; 47:106-116. [PMID: 35063190 PMCID: PMC8603263 DOI: 10.1016/j.clnesp.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022]
Abstract
Background & aims The risk of malnutrition in people with COVID-19 is high; prevalence is reported as 37% in general medical inpatients, 53% in elderly inpatients and 67% in ICU. Thus, nutrition is a crucial element of assessment and treatment. This rapid review aimed to evaluate what evidence is available to inform evidence-based decision making on the nutritional care of patients hospitalised with COVID-19 infection. Methods Cochrane Rapid Reviews guidance was followed; the protocol was registered (CRD42020208448). Studies were selected that included patients with COVID-19, pneumonia, respiratory distress syndrome and acute respiratory failure, in hospital or the community, and which examined nutritional support. All types of studies were eligible for inclusion except non-systematic reviews, commentaries, editorials and single case studies. Six electronic databases were searched: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PubMed, CINAHL and MedRxiv. Results Twenty-six articles on COVID-19 were retrieved, including 11 observational studies, five guidelines and 10 opinion articles. Seven further articles on pneumonia included three RCTs, one unblinded trial, three observational studies, and one systematic review on rehabilitation post-ICU admission for respiratory illness. The evidence from these articles is presented narratively and used to guide the nutritional and dietetic care process. Conclusions Older patients with COVID-19 infection are at risk of malnutrition and addressing this may be important in recovery. The use of nutritional management strategies applicable to other acute conditions are recommended. However, traditional screening and implementation techniques need to be modified to ensure infection control measures can be maintained. The most effective nutritional interventions require further research and more detailed guidance on nutritional management post-discharge to support long-term recovery is needed.
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Abstract
Objective: To systematically review the problem of appetite loss after major abdominal surgery. Summary of Background Data: Appetite loss is a common problem after major abdominal surgery. Understanding of etiology and treatment options is limited. Methods: We searched Medline, Cochrane Central Register of Controlled Trials, and Web of Science for studies describing postoperative appetite loss. Data were extracted to clarify definition, etiology, measurement, surgical influence, pharmacological, and nonpharmacological treatment. PROSPERO registration ID: CRD42021224489. Results: Out of 6144 articles, we included 165 studies, 121 of which were also analyzed quantitatively. A total of 19.8% were randomized, controlled trials (n = 24) and 80.2% were nonrandomized studies (n = 97). The studies included 20,506 patients undergoing the following surgeries: esophageal (n = 33 studies), gastric (n = 48), small bowel (n = 6), colon (n = 27), rectal (n = 20), hepatobiliary (n = 6), and pancreatic (n = 13). Appetite was mostly measured with the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ C30, n = 54). In a meta-analysis of 4 randomized controlled trials gum chewing reduced time to first hunger by 21.2 hours among patients who had bowel surgery. Other reported treatment options with positive effects on appetite but lower levels of evidence include, among others, intravenous ghrelin administration, the oral Japanese herbal medicine Rikkunshito, oral mosapride citrate, multidisciplin-ary-counseling, and watching cooking shows. No studies investigated the effect of well-known appetite stimulants such as cannabinoids, steroids, or megestrol acetate on surgical patients. Conclusions: Appetite loss after major abdominal surgery is common and associated with increased morbidity and reduced quality of life. Recent studies demonstrate the influence of reduced gastric volume and ghrelin secretion, and increased satiety hormone secretion. There are various treatment options available including level IA evidence for postoperative gum chewing. In the future, surgical trials should include the assessment of appetite loss as a relevant outcome measure.
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Chen MF, Hsieh CC, Chen PT, Lu MS. Role of Nutritional Status in the Treatment Outcome for Esophageal Squamous Cell Carcinoma. Nutrients 2021; 13:2997. [PMID: 34578883 PMCID: PMC8466664 DOI: 10.3390/nu13092997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Undernourishment is reported to impair treatment response, further leading to poor prognosis for cancer patients. We aimed to investigate the role of nutritional status on the prognosis of squamous cell carcinoma (SCC) of the esophagus, and its correlation with anticancer immune responsiveness. We retrospectively reviewed 340 esophageal-SCC patients who completed curative treatment and received a nutrition evaluation by the Patient-Generated Subjective Global Assessment (PGSGA) score at the beginning and completion of neoadjuvant treatment at our hospital. The correlation between the nutritional status and various clinicopathological parameters and prognosis were examined. In addition, the role of nutritional status in the regulation of the anticancer immune response was also assessed in cancer patients and in a 4-nitroquinoline 1-oxide (4NQO)-induced esophageal tumor model. Our data revealed that malnutrition (patients with a high PGSGA score) was associated with advanced stage and reduced survival rate. Patients in the group with a high PGSGA score were correlated with the higher neutrophil-to-lymphocyte ratio, higher proportion of myeloid-derived-suppressor cells (MDSC) and increased IL-6 level. Furthermore, surgical resection brought the survival benefit to patients in the low PGSGA group, but not for the malnourished patients after neoadjuvant treatment. Using a 4NQO-induced tumor model, we found that nutrition supplementation decreased the rate of invasive tumor formation and attenuated the immune-suppressive microenvironment. In conclusion, malnutrition was associated with poor prognosis in esophageal-SCC patients. Nutritional status evaluated by PGSGA may be useful to guide treatment decisions in clinical practice. Nutritional supplementation is suggested to improve prognosis, and it might be related to augmented anticancer immune response.
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Affiliation(s)
- Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Ching-Chuan Hsieh
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of General Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Ping-Tsung Chen
- Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Ming-Shian Lu
- Department of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
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7
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The Effectiveness of Nutrition Interventions Combined with Exercise in Upper Gastrointestinal Cancers: A Systematic Review. Nutrients 2021; 13:nu13082842. [PMID: 34445002 PMCID: PMC8400981 DOI: 10.3390/nu13082842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022] Open
Abstract
Malnutrition and muscle wasting are associated with impaired physical functioning and quality of life in oncology patients. Patients diagnosed with upper gastrointestinal (GI) cancers are considered at high risk of malnutrition and impaired function. Due to continuous improvement in upper GI cancer survival rates, there has been an increased focus on multimodal interventions aimed at minimizing the adverse effects of cancer treatments and enhancing survivors’ quality of life. The present study aimed to evaluate the effectiveness of combined nutritional and exercise interventions in improving muscle wasting, physical functioning, and quality of life in patients with upper GI cancer. A comprehensive search was conducted in MEDLINE, EMBASE, Web of Science, Cochrane Library, and CINHAL. Of the 4780 identified articles, 148 were selected for full-text review, of which 5 studies met the inclusion criteria. Whilst reviewed studies showed promising effects of multimodal interventions on physical functioning, no significant differences in postoperative complications and hospital stay were observed. Limited available evidence showed conflicting results regarding the effectiveness of these interventions on preserving muscle mass and improving health-related quality of life. Further studies examining the impact of nutrition and exercise interventions on upper GI patient outcomes are required and would benefit from reporting a core outcome set.
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Reijneveld EAE, Bor P, Dronkers JJ, Argudo N, Ruurda JP, Veenhof C. Impact of curative treatment on the physical fitness of patients with esophageal cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 48:391-402. [PMID: 34426032 DOI: 10.1016/j.ejso.2021.08.015] [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: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Esophageal cancer and curative treatment have a significant impact on the physical fitness of patients. Knowledge about the course of physical fitness during neoadjuvant therapy and esophagectomy is helpful to determine the needs for interventions during and after curative treatment. This study aims to review the current evidence on the impact of curative treatment on the physical fitness of patients with esophageal cancer. METHODS A systematic literature search of PubMed, Embase, Cinahl and the Cochrane Library was conducted up to March 29, 2021. We included observational studies investigating the change of physical fitness (including exercise capacity, muscle strength, physical activity and activities of daily living) from pre-to post-neoadjuvant therapy and/or from pre-to post-esophagectomy. Quality of the studies was assessed and a meta-analysis was performed using standardized mean differences. RESULTS Twenty-seven articles were included. After neoadjuvant therapy, physical fitness decreased significantly. In the first three months after surgery, physical fitness was also significantly decreased compared to preoperative values. Subgroup analysis showed a restore in exercise capacity three months after surgery in patients who followed an exercise program. Six months after surgery, there was limited evidence that exercise capacity restored to preoperative values. CONCLUSION Curative treatment seems to result in a decrease of physical fitness in patients with esophageal cancer, up to three months postoperatively. Six months postoperatively, results were conflicting. In patients who followed a pre- or postoperative exercise program, the postoperative impact of curative treatment seems to be less.
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Affiliation(s)
- Elja A E Reijneveld
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Petra Bor
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaap J Dronkers
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Núria Argudo
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Spain
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Cindy Veenhof
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht, the Netherlands
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9
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Nakagaki M, Gavin NC, Hayes T, Fichera R, Stewart C, Naumann L, Brennan J, Perry N, Foley E, Crofton E, Brown C, Leutenegger J, Kennedy GA. Implementation and evaluation of a nurse-allied health clinic for patients after haematopoietic stem cell transplantation. Support Care Cancer 2021; 30:647-657. [PMID: 34363493 DOI: 10.1007/s00520-021-06461-w] [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: 05/27/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Patients who undergo haematopoietic stem cell transplantation (HSCT) often have multiple health issues following hospital discharge. In many centres, outpatient follow-up is solely conducted by specialist physicians. We aimed to implement and describe the outcomes of a nurse-allied health multidisciplinary clinic. METHODS The clinic consisted of six disciplines-nursing, pharmacy, dietetics, physiotherapy, occupational therapy and social work. All allogeneic and high risk autologous HSCT patients were reviewed at 2 weeks after discharge and on day 100 post HSCT, with additional reviews as needed. Occasions of service, interventions, readmission data and physician satisfaction survey were collected prior to and after implementation. Additionally, patient feedback and quality of life survey (FACT-BMT) were collected during the first 6 months. RESULTS From July to December 2019, 57 patients were reviewed in the clinic (475 reviews, average 8.3 reviews per patient). Common interventions included the following: exercise programs by physiotherapist (n = 111), diet prescription (n = 103), counselling by social worker (n = 53), medication lists provision (n = 51), fatigue management (n = 43) and nurse education (n = 22). The clinic did not reduce patients' readmission rate; however, positive feedback from patients and physicians were reported. FACT-BMT results demonstrated that there are unmet needs, particularly fatigue management, sexual education and support, body images, back to work support and quality of life improvement. From discharge to day 100, there was no significant improvement in quality of life. CONCLUSIONS This clinic provides an innovative approach to patient-centred care in HSCT. It has been well received by patients who were supported by multidisciplinary interventions.
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Affiliation(s)
- Midori Nakagaki
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Nicole C Gavin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Therese Hayes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rebecca Fichera
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Caroline Stewart
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Leonie Naumann
- Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Justine Brennan
- Social Work, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Natasha Perry
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Emma Foley
- Occupational Therapy, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Erin Crofton
- Occupational Therapy, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Christie Brown
- Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jenni Leutenegger
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Glen A Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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10
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Tsai YT, Lai CH, Huang TH, Hsieh CC, Huang EI, Lee YC, Yeh HK, Tsai MS, Chang GH, Hsu CM. Association of malnutrition with postoperative complication risk after curative surgery for oral cancer: Observational study. Medicine (Baltimore) 2020; 99:e23860. [PMID: 33350779 PMCID: PMC7769301 DOI: 10.1097/md.0000000000023860] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/21/2020] [Indexed: 02/02/2023] Open
Abstract
Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | - Tzu-Hao Huang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | | | | | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung
| | - Hsuan-Keng Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery
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11
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Physical activity and exercise training in cancer patients. Clin Nutr ESPEN 2020; 40:1-6. [DOI: 10.1016/j.clnesp.2020.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022]
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Kiss N, Loeliger J, Findlay M, Isenring E, Baguley BJ, Boltong A, Butler A, Deftereos I, Eisenhuth M, Fraser SF, Fichera R, Griffin H, Hayes S, Jeffery E, Johnson C, Lomma C, van der Meij B, McIntyre C, Nicholls T, Pugliano L, Skinner T, Stewart J, Bauer J. Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia. Nutr Diet 2020; 77:416-425. [PMID: 32803904 PMCID: PMC7540290 DOI: 10.1111/1747-0080.12631] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/30/2022]
Abstract
This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer‐related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence‐based guidelines, systematic reviews and meta‐analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as “at risk” of malnutrition or with a high‐risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment; people identified as “at risk” of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer‐related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer‐related malnutrition and sarcopenia should be individualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer‐related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenelle Loeliger
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Anna Boltong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Butler
- GP Liaison, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery Western Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition and Dietetics, Western Health, Melbourne, Victoria, Australia
| | - Michelle Eisenhuth
- Nutrition and Dietetics Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Fichera
- Nutrition and Dietetics Departments, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hayley Griffin
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Jeffery
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Catherine Johnson
- Gastrointestinal Cancer Service, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Chris Lomma
- Medical Oncology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Barbara van der Meij
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Dietetics and Food Services, Mater Health, Brisbane, Queensland, Australia
| | - Carolyn McIntyre
- School of Medical and Health Science, Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Tracey Nicholls
- Department of ENT Otolaryngology Head and Neck Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lina Pugliano
- Medical Oncology, Northern Cancer Institute, Sydney, New South Wales, Australia
| | - Tina Skinner
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Jane Stewart
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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Cao J, Xu H, Li W, Guo Z, Lin Y, Shi Y, Hu W, Ba Y, Li S, Li Z, Wang K, Wu J, He Y, Yang J, Xie C, Zhou F, Song X, Chen G, Ma W, Luo S, Chen Z, Cong M, Ma H, Zhou C, Wang W, Qi Luo, Shi Y, Qi Y, Jiang H, Guan W, Chen J, Chen J, Fang Y, Zhou L, Feng Y, Tan R, Ou J, Zhao Q, Wu J, Xin Lin, Yang L, Fu Z, Wang C, Deng L, Li T, Song C, Shi H. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer. Curr Probl Cancer 2020; 45:100638. [PMID: 32829957 DOI: 10.1016/j.currproblcancer.2020.100638] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/25/2020] [Accepted: 07/17/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors. METHODS A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status. RESULTS PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition. CONCLUSION Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.
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Affiliation(s)
- Jingjing Cao
- Department of Preventive Medicine, Heze Medical College, Heze, Shandong 274000, China
| | - Hongxia Xu
- Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing 400042, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin 130021 China
| | - Zengqing Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian 350014, China
| | - Yuan Lin
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yingying Shi
- Department of Surgery, The First Affiliated Hospital of SunYat-sen University, Guangzhou, Guangdong 510080, China
| | - Wen Hu
- Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Ba
- Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Suyi Li
- Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui 230031, China
| | - Zengning Li
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Kunhua Wang
- Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jing Wu
- Zhongshan Chenxinghai Hospital (Affiliated Zhongshan Chenxinghai Hospital of Guangdong Medical University), Zhongshan, Guangdong 528400, China; Department of Clinical Nutrition, The First People's Hospital of Kashi, Xinjiang 844000, China
| | - Ying He
- Department of Clinical Nutrition, Chongqing General Hospital, Chongqing 400014, China
| | - Jiajun Yang
- Department of Colorectal and Anal Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong 516001, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Fuxiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Xinxia Song
- Department of Oncology, Xingtai People's Hospital, Hebei Medical University, Xingtai, Hebei 054031, China
| | - Gongyan Chen
- The First Department of the Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang 150085, China
| | - Wenjun Ma
- Department of Nutrition, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Suxia Luo
- Department of Oncology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Zihua Chen
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Minghua Cong
- Comprehensive Oncology Department, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Hu Ma
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Chunling Zhou
- The Fourth Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Wei Wang
- Cancer Center, The First People's Hospital of Foshan, Foshan, Guangdong 528000, China
| | - Qi Luo
- Department of Gastrointestinal Tumor Surgery, The First Affiliated Hospital, Xiamen University, Xiamen, Fujian 361003, China
| | - Yongmei Shi
- Department of Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yumei Qi
- Department of Nutrition, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Haiping Jiang
- Department of Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Wenxian Guan
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Junqiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Jiaxin Chen
- Department of Radiation and Medical Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
| | - Yu Fang
- Department of Clinical Nutrition, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Lan Zhou
- Department of Nutrition, Third Affiliated Hospital of Kunming Medical College, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, China
| | - Yongdong Feng
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Rongshao Tan
- Department of Nutrition, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510220, China
| | - Junwen Ou
- Department of Clinical Nutrition, Clifford Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510632, China
| | - Qingchuan Zhao
- Department of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi 710032, China
| | - Jianxiong Wu
- Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xin Lin
- Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing 400042, China
| | - Liuqing Yang
- Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, The 9th Clinical College, PKU. No.10 Tieyi Road, Haidian Dist, Beijing 100038, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Chang Wang
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin 130021 China
| | - Li Deng
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin 130021 China
| | - Tao Li
- Department of Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, China.
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, PR China.
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, The 9th Clinical College, PKU. No. 10 Tieyi Road, Haidian Dist, Beijing 100038, China.
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14
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Ray H, Beaumont A, Loeliger J, Martin A, Marston C, Gough K, Bordia S, Ftanou M, Kiss N. Implementation of a Multidisciplinary Allied Health Optimisation Clinic for Cancer Patients with Complex Needs. J Clin Med 2020; 9:E2431. [PMID: 32751451 PMCID: PMC7465605 DOI: 10.3390/jcm9082431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
This study examined the feasibility of implementing a multidisciplinary allied health model of care (MOC) for cancer patients with complex needs. The MOC in this retrospective study provided up to eight weeks of nutritional counselling, exercise prescription, fatigue management and psychological support. Implementation outcomes (acceptability, adoption, fidelity and appropriateness) were evaluated using nine patient interviews, and operational data and medical records of 185 patients referred between August 2017 and December 2018. Adoption, including intention to try and uptake, were acceptable: 88% of referred patients agreed to screening and 71% of eligible patients agreed to clinic participation. Fidelity was mixed, secondary to inpatient admissions and disease progression interrupting patient participation. Clinician compliance with outcome assessment was variable at program commencement (dietetic, 95%; physiotherapy, 91%; occupational therapy, 33%; quality of life, 23%) and low at program completion (dietetic, 32%; physiotherapy, 13%; occupational therapy, 10%; quality of life, 11%) mainly due to non-attendance. Patient interviews revealed high satisfaction and perceived appropriateness. Adoption of the optimisation clinic was acceptable. Interview responses suggest patients feel the clinic is both acceptable and appropriate. This indicates a multidisciplinary model is an important aspect of comprehensive, timely and effective care. However, fidelity was low, secondary to the complexities of the patient cohort.
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Affiliation(s)
- Hannah Ray
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Anna Beaumont
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Jenelle Loeliger
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Alicia Martin
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Celia Marston
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Karla Gough
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (K.G.); (S.B.)
| | - Shilpa Bordia
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (K.G.); (S.B.)
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia;
| | - Nicole Kiss
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria 3220, Australia
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15
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Tully R, Loughney L, Bolger J, Sorensen J, McAnena O, Collins CG, Carroll PA, Arumugasamy M, Murphy TJ, Robb WB. The effect of a pre- and post-operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised controlled trial. Trials 2020; 21:638. [PMID: 32660526 PMCID: PMC7359259 DOI: 10.1186/s13063-020-04311-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in peri-operative oncological treatment, surgery and peri-operative care have improved survival for patients with oesophagogastric cancers. Neoadjuvant cancer treatment (NCT) reduces physical fitness, which may reduce both compliance and tolerance of NCT as well as compromising post-operative outcomes. This is particularly detrimental in a patient group where malnutrition is common and surgery is demanding. The aim of this trial is to assess the effect on physical fitness and clinical outcomes of a comprehensive exercise training programme in patients undergoing NCT and surgical resection for oesophagogastric malignancies. METHODS The PERIOP-OG trial is a pragmatic, multi-centre, randomised controlled trial comparing a peri-operative exercise programme with standard care in patients with oesophagogastric cancers treated with NCT and surgery. The intervention group undergo a formal exercise training programme and the usual care group receive standard clinical care (no formal exercise advice). The training programme is initiated at cancer diagnosis, continued during NCT, between NCT and surgery, and resumes after surgery. All participants undergo assessments at baseline, post-NCT, pre-surgery and at 4 and 10 weeks after surgery. The primary endpoint is cardiorespiratory fitness measured by demonstration of a 15% difference in the 6-min walk test assessed at the pre-surgery timepoint. Secondary endpoints include measures of physical health (upper and lower body strength tests), body mass index, frailty, activity behaviour, psychological and health-related quality of life outcomes. Exploratory endpoints include a health economics analysis, assessment of clinical health by post-operative morbidity scores, hospital length of stay, nutritional status, immune and inflammatory markers, and response to NCT. Rates of NCT toxicity, tolerance and compliance will also be assessed. DISCUSSION The PERIOP-OG trial will determine whether, when compared to usual care, exercise training initiated at diagnosis and continued during NCT, between NCT and surgery and then during recovery, can maintain or improve cardiorespiratory fitness and other physical, psychological and clinical health outcomes. This trial will inform both the prescription of exercise regimes as well as the design of a larger prehabilitation and rehabilitation trial to investigate whether exercise in combination with nutritional and psychological interventions elicit greater benefits. TRIAL REGISTRATION ClinicalTrials.gov: NCT03807518 . Registered on 1 January 2019.
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Affiliation(s)
- Roisin Tully
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland
| | - Lisa Loughney
- The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland.,ExWell Medical, Santry Sports Link, Dublin, Ireland
| | - Jarlath Bolger
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland
| | - Jan Sorensen
- The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland
| | - Oliver McAnena
- Department of Upper GI Surgery, University Hospital, Galway, Ireland
| | - Chris G Collins
- Department of Upper GI Surgery, University Hospital, Galway, Ireland
| | - Paul A Carroll
- Department of Upper GI Surgery, University Hospital, Galway, Ireland
| | - Mayilone Arumugasamy
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland
| | - Tomas J Murphy
- Department of Upper GI Surgery, Mercy University Hospital, Cork, Ireland
| | - William B Robb
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland. .,The Royal College of Surgeons in Ireland, St. Stephens Green, Dublin, Ireland.
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16
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Bolger JC, Loughney L, Tully R, Cunningham M, Keogh S, McCaffrey N, Hickey W, Robb WB. Perioperative prehabilitation and rehabilitation in esophagogastric malignancies: a systematic review. Dis Esophagus 2019; 32:5519688. [PMID: 31206582 DOI: 10.1093/dote/doz058] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/30/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
Cancers of the esophagus and stomach are challenging to treat. With the advent of neoadjuvant therapies, patients frequently have a preoperative window with potential to optimize their status before major resectional surgery. It is unclear as to whether a prehabilitation or optimization program can affect surgical outcomes. This systematic review appraises the current evidence for prehabilitation and rehabilitation in esophagogastric malignancy. A literature search was performed according to PRISMA guidelines using PubMed, EMBASE, Cochrane Library, Google Scholar, and Scopus. Studies including patients undergoing esophagectomy or gastrectomy were included. Studies reporting on at least one of aerobic capacity, muscle strength, quality of life, morbidity, and mortality were included. Twelve studies were identified for inclusion, comprising a total of 937 patients. There was significant heterogeneity between studies, with a variety of interventions, timelines, and outcome measures reported. Inspiratory muscle training (IMT) consistently showed improvements in functional status preoperatively, with three studies showing improvements in respiratory complications with IMT. Postoperative rehabilitation was associated with improved clinical outcomes. There may be a role for prehabilitation among patients undergoing major resectional surgery in esophagogastric malignancy. A large randomized controlled trial is warranted to investigate this further.
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Affiliation(s)
- Jarlath C Bolger
- Beaumont Hospital.,School of Medicine, Royal College of Surgeons in Ireland
| | - Lisa Loughney
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Roisin Tully
- Beaumont Hospital.,School of Medicine, Royal College of Surgeons in Ireland
| | | | | | - Noel McCaffrey
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | - William B Robb
- Beaumont Hospital.,School of Medicine, Royal College of Surgeons in Ireland
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17
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Chang YL, Tsai YF, Hsu CL, Chao YK, Hsu CC, Lin KC. The effectiveness of a nurse-led exercise and health education informatics program on exercise capacity and quality of life among cancer survivors after esophagectomy: A randomized controlled trial. Int J Nurs Stud 2019; 101:103418. [PMID: 31670173 DOI: 10.1016/j.ijnurstu.2019.103418] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Esophagectomy is the primary surgical treatment for esophageal cancer. However, patients often experience a decrease in physical activity, poor nutrition, and a reduction in quality of life following surgery. OBJECTIVES The aim of this study was to examine the effects of an exercise and nursing education health informatics program on quality of life, exercise capacity, and nutrition among patients following esophagectomy for esophageal cancer. DESIGN A randomized controlled trial. SETTINGS AND METHODS Patients who had undergone an esophagectomy for cancer were recruited by purposive sampling from a medical center in Taiwan. Patients who met inclusion criteria and agreed to participate (N = 88) were randomly assigned to an exercise informatics program (intervention group, n = 44) or usual post-surgery care (control group, n = 44). Quality of life was assessed at baseline and 1, 3, and 6 months after discharge. Secondary outcomes of nutrition (albumin, body mass index), and exercise capacity (maximal oxygen uptake, the six-minute walking test) were conducted at baseline and 3 months following discharge. Differences in quality of life, nutrition and exercise capacity between the two groups were analyzed using generalized estimating equations. RESULTS Analysis demonstrated significant improvements in outcome measures following hospital discharge for the intervention group compared to controls. Measures of quality of life were significantly better for the intervention group and varied with time following discharge. Functional scores for physical (1 and 3 months), role (1, 3, and 6 months), emotional (1 month), social (3 months) and global health (3 months) were significantly higher than controls. Cancer-related subscales improved for insomnia (1 and 3 months) and nausea/vomiting (3 and 6 months). Esophageal cancer-specific symptoms improved for dry mouth (1 month), dysphagia (3 months), and loss of taste (1 and 6 months). Three months following discharge, levels of albumin were significantly higher for the intervention group compared to controls (β=0.32, 95% CI 0.09, 0.54, p < .01); body mass index did not differ between groups. Exercise capacity was also significantly better; the intervention group had higher maximal oxygen consumption (β=2.61, 95% CI 1.54, 3.69, p < .001) and greater distance on the six-minute walking test (β=83.30, 95% CI 52.60, 113.99, p < .001). CONCLUSION The intervention group experienced significant improvements in nutrition, exercise capacity, and variables related to quality of life. These findings suggest a nurse-led exercise and health education informatics program should be implemented for survivors of esophagectomy prior to hospital discharge.
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Affiliation(s)
- Yu-Ling Chang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung, Taiwan.
| | - Chien-Lung Hsu
- Department of Information Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan.
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Chih-Chin Hsu
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
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18
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Huang TH, Hsieh CC, Kuo LM, Chang CC, Chen CH, Chi CC, Liu CH. Malnutrition associated with an increased risk of postoperative complications following hepatectomy in patients with hepatocellular carcinoma. HPB (Oxford) 2019; 21:1150-1155. [PMID: 30765200 DOI: 10.1016/j.hpb.2019.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to analyze the nutritional risk factors for postoperative complications following hepatic resection for hepatocellular carcinoma (HCC). METHODS The preoperative nutritional status of patients with HCC who underwent hepatic resection was evaluated using the scored Patient-Generated Subjective Global Assessment (PG-SGA). The perioperative variables were compared between well-nourished and malnourished patients. Regression analysis was employed to identify the risk factors for postoperative complications. RESULTS The overall operative mortality and morbidity of 287 patients who underwent resection for HCC were 1.7% and 44.3%, respectively. Upon admission, 96 (33.4%) study participants were malnourished, which was associated with a significantly higher PG-SGA score (P < 0.001), higher frequency of comorbidity (P < 0.001), more postoperative complications (P < 0.001) and a longer length of hospital stay (P < 0.001). In addition, major complications (Clavien-Dindo classification ≥ IIIa) occurred significantly more frequently in the malnourished group (P < 0.01). Age ≥70 years (risk ratio [RR] = 2.50, P = 0.008) and PG-SGA score ≥ 4 ([RR] = 9.85, P < 0.001) were significant risk factors for postoperative complications. CONCLUSIONS The PG-SGA score is an effective tool for predicting postoperative complications in patients with HCC following hepatic resection.
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Affiliation(s)
- Tzu-Hao Huang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan.
| | - Ching-Chuan Hsieh
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan; Department of Nutrition, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
| | - Liang-Mou Kuo
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
| | - Cheng-Chih Chang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
| | - Chun-Han Chen
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan
| | - Chin-Hua Liu
- Department of Nutrition, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
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19
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Hall CC, Cook J, Maddocks M, Skipworth RJE, Fallon M, Laird BJ. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Support Care Cancer 2019; 27:2371-2384. [PMID: 30944994 PMCID: PMC6541700 DOI: 10.1007/s00520-019-04749-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/15/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The optimal components for rehabilitation in patients with incurable cancer are unclear. However, principles of exercise and nutrition-based interventions used in cancer cachexia may be applied usefully to this population of cancer patients. This systematic review examines current evidence for rehabilitation combining exercise and nutritional support in patients with incurable cancer. METHODS MEDLINE, EMBASE and Cochrane databases were searched. Eligible studies included patients with incurable cancer and rehabilitation programmes combining exercise and nutritional interventions. Studies of cancer survivors, curative treatments, reviews, case note reviews, protocols and abstracts were excluded. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied to patient-important outcomes. RESULTS Of the 2424 search results, 67 abstracts were reviewed and 24 full texts examined. Eight studies (n = 685) were included comprising two randomised control trials, three prospective, one exploratory and two secondary analyses. All examined multi-modal outpatient programmes. GRADE analysis revealed moderate evidence (B) for improvements in depression and physical endurance, low-quality evidence (C) for quality of life and fatigue and very low-quality evidence (D) for overall function and nutritional status. CONCLUSION There are limited data for multi-modal rehabilitation programmes combining exercise and nutritional interventions in patients with incurable cancer. However, studies to date report improvements in multiple domains, most notably physical endurance and depression scores. This supports the concept that multi-modal rehabilitation incorporating principles of cachexia management may be appropriate for the wider group of patients with incurable cancer. Further, high-quality studies are needed to define the optimal approach and outcome measures.
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Affiliation(s)
- Charlie C Hall
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK. .,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
| | - Jane Cook
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, London, UK
| | | | - Marie Fallon
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Barry J Laird
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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20
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Bull J, Oster C, Flight I, Wilson C, Koczwara B, Watson DI, Bright T. The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers. Eur J Cancer Care (Engl) 2019; 28:e12996. [PMID: 30675740 DOI: 10.1111/ecc.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation. METHODS We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis. RESULTS The overarching theme was "Getting back to normal." Diagnosis of disease signified a disruption to the normal trajectory of patients' lives and the post-treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post-treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre-treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden. CONCLUSION A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.
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Affiliation(s)
- Jeff Bull
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Candice Oster
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,La Trobe University/Olivia Newton John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Tim Bright
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
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Early Skeletal Muscle Loss in Non-Small Cell Lung Cancer Patients Receiving Chemoradiation and Relationship to Survival. Support Care Cancer 2018; 27:2657-2664. [PMID: 30478673 DOI: 10.1007/s00520-018-4563-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 11/20/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Sarcopenia is associated with reduced survival in cancer. Currently, data on sarcopenia at presentation and muscle loss throughout treatment are unknown in patients receiving chemoradiation therapy (CRT) for non-small cell lung cancer (NSCLC). This study evaluated skeletal muscle changes in NSCLC patients receiving CRT and relationship with survival. METHODS Secondary analysis of 41 patients with NSCLC treated with CRT assessed for skeletal muscle area and muscle density by computed tomography pre-treatment and 3 months post-treatment. Images at week 4 of treatment were available for 32 (78%) patients. Linear mixed models were applied to determine changes in skeletal muscle over time and related to overall survival using Kaplan-Meier plots. RESULTS Muscle area and muscle density decreased significantly by week 4 of CRT (- 6.6 cm2, 95% CI - 9.7 to - 3.1, p < 0.001; - 1.3 HU, 95% CI - 1.9 to - 0.64, p < 0.001, respectively), with minimal change between week 4 of CRT and 3 months post-CRT follow-up (- 0.2 cm2, 95% CI - 3.6-3.1, p = 0.91; - 0.27, 95% CI - 0.91-0.36, p = 0.36, respectively). Sarcopenia was present in 25 (61%) and sarcopenic obesity in 6 (14%) of patients prior to CRT, but not associated with poorer survival. Median survival was shorter in patients with low muscle density prior to treatment although not statistically significant (25 months + 8.3 vs 53 months + 13.0, log-rank p = 0.17). CONCLUSION Significant loss of muscle area and muscle density occurs in NSCLC patients early during CRT. A high proportion of patients are sarcopenic prior to CRT; however, this was not significantly associated with poorer survival.
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O’Neill L, Moran J, Guinan EM, Reynolds JV, Hussey J. Physical decline and its implications in the management of oesophageal and gastric cancer: a systematic review. J Cancer Surviv 2018; 12:601-618. [DOI: 10.1007/s11764-018-0696-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/08/2018] [Indexed: 12/14/2022]
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Peñas-Felizzola OL, Parra-Esquivel EI, Gómez-Galindo AM. [Occupational therapy in oncology: experiences in academic practices and literature review]. Rev Salud Publica (Bogota) 2018; 20:45-52. [PMID: 30183884 DOI: 10.15446/rsap.v20n1.62227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/15/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To inquire about the training of occupational therapists in oncology in a university program, and to identify updated literature as evidence for training and professional practice. MATERIALS AND METHODS Cross-sectional exploratory study, with a sample of 29 students of occupational therapy from the National University of Colombia. Systematic review of literature 2010-2015 on occupational therapy interventions in oncology. Results In the survey, less than a quarter of the students reported having received training on clinical management of this diagnosis, and on the intervention of the occupational therapist with such cases (24.1%). Little more than this percentage (27.6%), has had users with cancer in their academic practices. In the literature review no national publications were found, although there were unpublished products from Colombian universities. Fifty-four international publications were recovered, especially in rehabilitation, it followed by psychosocial and socio-occupational areas. The palliative care, the multidisciplinarity, the subjective experience of the patient in relation to the diagnosis and treatment, the humanized and integral care from the different areas of the therapeutic task and work with caregivers are considered as relevant issues in the oncological patient's approach. CONCLUSIONS Reference points are made for the occupational therapy curriculum development and for professional updating processes, which are both competence of the academy and of the guild. It is important to intervene in cancer not only during, but in the preparation to treatment and subsequently with survivors. Professional publications should be encouraged, making sure they provide powerful evidence of the impact of occupational therapy and oncological rehabilitation.
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Affiliation(s)
- Olga L Peñas-Felizzola
- OP: TO. Esp. Análisis de Políticas Públicas. M. Sc. Salud Pública. Ph. D.(c) Estudios Políticos. Profesora, Departamento de la Ocupación Humana, Universidad Nacional de Colombia. Bogotá, Colombia.
| | - Eliana I Parra-Esquivel
- EP: TO. Certificada en Integración Sensorial, M. Sc. Educación. Ph. D.(c) Educación. Profesora, Departamento de la Ocupación Humana, Universidad Nacional de Colombia. Bogotá, Colombia.
| | - Ana M Gómez-Galindo
- AG: TO. M. Sc. Educación. Profesora, Departamento de la Ocupación Humana. Universidad Nacional de Colombia. Bogotá, Colombia.
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Feldstain A, MacDonald N, Bhargava R, Chasen M. Reported distress in patients living with advanced cancer: changes pre-post interdisciplinary palliative rehabilitation. Support Care Cancer 2017; 25:3191-3197. [DOI: 10.1007/s00520-017-3728-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
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Cheville AL, Mustian K, Winters-Stone K, Zucker DS, Gamble GL, Alfano CM. Cancer Rehabilitation. Phys Med Rehabil Clin N Am 2017; 28:1-17. [DOI: 10.1016/j.pmr.2016.08.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Alfano CM, Cheville AL, Mustian K. Developing High-Quality Cancer Rehabilitation Programs: A Timely Need. Am Soc Clin Oncol Educ Book 2017; 35:241-9. [PMID: 27249704 DOI: 10.1200/edbk_156164] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The number of survivors of cancer in the United States, already 14.5 million, is growing with improved cancer treatment and aging of the population. Two-thirds of cancer survivors will be older than age 65 and are likely to enter cancer treatment already deconditioned and with multiple comorbidities. Survivors of cancer face numerous adverse consequences of cancer treatment that add to or exacerbate the effects of existing comorbidities and increase risk of functional decline. Many of these problems are amenable to rehabilitation interventions, but referral to cancer rehabilitation professionals is not a standard part of care. We present an expanded prospective model of surveillance, cancer rehabilitation assessment, and referral efforts using a multidisciplinary team approach. In this model, cancer rehabilitation begins at the time of cancer diagnosis and continues through and beyond cancer treatment. Physical impairments and psychosocial symptoms are assessed and treated, and lifestyle and exercise interventions are provided to optimize functioning, health, and quality of life. We present a stepped-care framework to guide decisions on when, how, and where to refer survivors to cancer rehabilitation specialists depending on safety requirements and needs. This model has the potential to result in early identification of symptoms and impairments, appropriate referral and timely treatment, and, in turn, will better address and minimize both acute and long-term cancer morbidity.
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Affiliation(s)
- Catherine M Alfano
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Andrea L Cheville
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Karen Mustian
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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Mitchell SA, Hoffman AJ, Clark JC, DeGennaro RM, Poirier P, Robinson CB, Weisbrod BL. Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. Clin J Oncol Nurs 2015; 18 Suppl:38-58. [PMID: 25427608 DOI: 10.1188/14.cjon.s3.38-58] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.
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Affiliation(s)
- Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Center, Bethesda, MD
| | - Amy J Hoffman
- College of Nursing, Michigan State University, East Lansing
| | - Jane C Clark
- Georgia Center for Oncology Research and Education in Atlanta
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Berger AM, Mitchell SA, Jacobsen PB, Pirl WF. Screening, evaluation, and management of cancer-related fatigue: Ready for implementation to practice? CA Cancer J Clin 2015; 65:190-211. [PMID: 25760293 DOI: 10.3322/caac.21268] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE Evidence regarding cancer-related fatigue (fatigue) has accumulated sufficiently such that recommendations for screening, evaluation, and/or management have been released recently by 4 leading cancer organizations. These evidence-based fatigue recommendations are available for clinicians, and some have patient versions; but barriers at the patient, clinician, and system levels hinder dissemination and implementation into practice. The underlying biologic mechanisms for this debilitating symptom have not been elucidated completely, hindering the development of mechanistically driven interventions. However, significant progress has been made toward methods for screening and comprehensively evaluating fatigue and other common symptoms using reliable and valid self-report measures. Limited data exist to support the use of any pharmacologic agent; however, several nonpharmacologic interventions have been shown to be effective in reducing fatigue in adults. Never before have evidence-based recommendations for fatigue management been disseminated by 4 premier cancer organizations (the National Comprehensive Cancer, the Oncology Nursing Society, the Canadian Partnership Against Cancer/Canadian Association of Psychosocial Oncology, and the American Society of Clinical Oncology). Clinicians may ask: Are we ready for implementation into practice? The reply: A variety of approaches to screening, evaluation, and management are ready for implementation. To reduce fatigue severity and distress and its impact on functioning, intensified collaborations and close partnerships between clinicians and researchers are needed, with an emphasis on system-wide efforts to disseminate and implement these evidence-based recommendations.
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Affiliation(s)
- Ann M Berger
- University of Nebraska Medical Center College of Nursing, Fred and Pamela Buffett Cancer Center, Omaha, NE
| | - Sandra A Mitchell
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Paul B Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
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Wang SJ, Zhu Y, Wang TQ. Effect of guided healthy exercise on rehabilitation in patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2015; 23:642-647. [DOI: 10.11569/wcjd.v23.i4.642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of guided healthy exercise on rehabilitation in patients with gastric cancer.
METHODS: One hundred patients receiving surgery for gastric cancer were divided into either an observation group or a control group, with 50 cases in each group. The control group received traditional nursing care, and the observation group received guided healthy exercise. After one month of intervention, depression was assessed using the Hamilton depression scale (HAMD), anxiety was assessed using the Hamilton depression scale (HAMA), the awareness of disease condition and attitude to treatment were assessed using the insight treatment attitude questionnaire (ITAQ), and hope levels were assessed using the Herth hope scale (HHS).
RESULTS: After intervention, HAMD and HAMA scores were significantly improved in both groups, and the improvement was more significant in the observation group (t = 6.852, 5.416, P < 0.05). The ITAQ score was also significantly improved in both groups, and the improvement was more significant in the observation group (t = 6.529, P < 0.05). The scores of positive attitude, positive behavior and relationship as well as the total HHS score were significantly higher in the observation group than in the control group (t = 8.529, 7.031, 12.947, 23.760, P < 0.05).
CONCLUSION: Guided healthy exercise in patients with gastric cancer can not only effectively improve depression and anxiety but also improve the patient's insight and hope.
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Chasen M, Bhargava R, MacDonald N. Rehabilitation for patients with advanced cancer. CMAJ 2014; 186:1071-5. [PMID: 25047989 DOI: 10.1503/cmaj.131402] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Martin Chasen
- Division of Palliative Care (Chasen, Bhargava), Élisabeth-Bruyère Hospital; Department of Medicine (Chasen, Bhargava), University of Ottawa; Bruyère Research Institute (Chasen, Bhargava, MacDonald); Department of Medicine (Chasen), The Ottawa Hospital, Ottawa, Ont.; Department of Oncology (MacDonald), McGill University, Montréal, Que.
| | - Ravi Bhargava
- Division of Palliative Care (Chasen, Bhargava), Élisabeth-Bruyère Hospital; Department of Medicine (Chasen, Bhargava), University of Ottawa; Bruyère Research Institute (Chasen, Bhargava, MacDonald); Department of Medicine (Chasen), The Ottawa Hospital, Ottawa, Ont.; Department of Oncology (MacDonald), McGill University, Montréal, Que
| | - Neil MacDonald
- Division of Palliative Care (Chasen, Bhargava), Élisabeth-Bruyère Hospital; Department of Medicine (Chasen, Bhargava), University of Ottawa; Bruyère Research Institute (Chasen, Bhargava, MacDonald); Department of Medicine (Chasen), The Ottawa Hospital, Ottawa, Ont.; Department of Oncology (MacDonald), McGill University, Montréal, Que
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Mayo NE, Moriello C, Scott SC, Dawes D, Auais M, Chasen M. Pedometer-facilitated walking intervention shows promising effectiveness for reducing cancer fatigue: a pilot randomized trial. Clin Rehabil 2014; 28:1198-209. [PMID: 24917586 DOI: 10.1177/0269215514536209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Mechanisms for cancer related fatigue suggest that exercise but “not too much and not too little” could be effective. This study aimed to investigate feasibility and estimate the potential effects of a walking exercise program in people with advanced cancer and fatigue. Design: A pilot randomized trial. Setting: McGill University Health Centre (MUHC), Montreal, Canada. Subjects: People with advanced cancer undergoing interdisciplinary assessment and rehabilitation with a fatigue level of 4 to 10 on a visual analogue scale. Interventions: An 8-week fatigue-adapted, walking intervention, facilitated using a pedometer (STEPS), and offered at the same time as or after rehabilitation. Measures: Measures of fatigue, physical function and well-being were administered at entry, and 8, 16 and 24 weeks. Generalized estimating equations (GEE) estimated the odds of response for people receiving the STEPS program in comparison to the odds of response in the controls (odds ratio, OR). Results: Twenty-six persons were randomized to three groups: during rehabilitation, after rehabilitation, and usual care. For the fatigue measures the OR for STEPS offered at any time using an intention-to-treat approach was 3.68 (95%CI: 1.05-12.88); for the physical function measures, the OR was 1.40 (95%CI: 0.41- 4.79) and 2.36 (95%CI: 0.66-8.51) for the well-being measures. Conclusion: Fifty percent of eligible people were able to participate. This small trial suggests that a personalized exercise program reduces fatigue and that 100 people are needed in a full strength trial.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University Health Center (MUHC), MUHC Research Institute, Canada
| | - Carolina Moriello
- Division of Clinical Epidemiology, McGill University Health Center (MUHC), MUHC Research Institute, Canada
| | - Susan C Scott
- Division of Clinical Epidemiology, McGill University Health Center (MUHC), MUHC Research Institute, Canada
| | - Diana Dawes
- Department of Family Practice, Faculty of Medicine,The University of British Columbia, Canada
| | - Mohammad Auais
- Ivey International Centre for Health Innovation, University of Western Ontario, London, Ontario, Canada
| | - Martin Chasen
- Division of Palliative Care, University of Ottawa, Canada
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Gagnon B, Murphy J, Eades M, Lemoignan J, Jelowicki M, Carney S, Amdouni S, Di Dio P, Chasen M, Macdonald N. A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer. ACTA ACUST UNITED AC 2013; 20:310-8. [PMID: 24311946 DOI: 10.3747/co.20.1612] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cancer can affect many dimensions of a patient's life, and in turn, it should be targeted using a multimodal approach. We tested the extent to which an interdisciplinary nutrition-rehabilitation program can improve the well-being of patients with advanced cancer. METHODS Between January 10, 2007, and September 29, 2010, 188 patients with advanced cancer enrolled in the 10-12-week program. Body weight, physical function, symptom severity, fatigue dimensions, distress level, coping ability, and overall quality of life were assessed at the start and end of the program. RESULTS Of the enrolled patients, 70% completed the program. Patients experienced strong improvements in the physical and activity dimensions of fatigue (effect sizes: 0.8-1.1). They also experienced moderate reductions in the severity of weakness, depression, nervousness, shortness of breath, and distress (effect sizes: 0.5-0.7), and moderate improvements in Six Minute Walk Test distance, maximal gait speed, coping ability, and quality of life (effect sizes: 0.5-0.7) Furthermore, 77% of patients either maintained or increased their body weight. CONCLUSIONS Interdisciplinary nutrition-rehabilitation can be advantageous for patients with advanced cancer and should be considered an integrated part of standard palliative care.
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Affiliation(s)
- B Gagnon
- Department of Family Medicine and Emergency Medicine, Université Laval, Centre de recherché du Le Centre hospitalier universitaire de Québec, Quebec City, QC
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Marshall S, Bauer J, Isenring E. The consequences of malnutrition following discharge from rehabilitation to the community: a systematic review of current evidence in older adults. J Hum Nutr Diet 2013; 27:133-41. [DOI: 10.1111/jhn.12167] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Marshall
- Centre for Dietetics Research; School of Human Movement Studies; University of Queensland; Brisbane Qld Australia
| | - J. Bauer
- Centre for Dietetics Research; School of Human Movement Studies; University of Queensland; Brisbane Qld Australia
| | - E. Isenring
- Centre for Dietetics Research; School of Human Movement Studies; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Woolloongabba Qld Australia
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Watkins F, Tulloch S, Bennett C, Webster B, McCarthy C. A multimodal, interdisciplinary programme for the management of cachexia and fatigue. Int J Palliat Nurs 2012; 18:85-90. [PMID: 22399046 DOI: 10.12968/ijpn.2012.18.2.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fatigue and cachexia are common symptoms of advanced disease that have a significant impact on quality of life for palliative care clients. Management of cachexia and fatigue is often overlooked, but growing understanding of the multidimensional nature of fatigue and muscle wasting has led to interest in a model of care based on multimodal therapy that has been successfully implemented in specialized multidisciplinary hospital-based clinics in the oncology/palliative care setting. This article reports on an innovative incorporation of features of this model into a client-centred, interdisciplinary programme that aims to manage the effects of cachexia and fatigue and to improve quality of life for palliative care clients in their home setting. This Cachexia and Fatigue Management Programme (CFMP) involves the use of an anti-inflammatory agent, high protein intake, and an individually tailored resistance exercise regimen to counteract muscle wasting and fatigue. The article provides an overview of the role of multimodal therapies in the management of cachexia and fatigue before moving on to discuss the development of the CFMP, its features, and potential benefits for palliative care clients, caregivers, and health services.
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Affiliation(s)
- Frances Watkins
- Adelaide Hills Community Health Service, South Australia, Australia
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Bauer J, Egan E, Clavarino A. The scored patient-generated subjective global assessment is an effective nutrition assessment tool in subjects with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.eclnm.2010.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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