1
|
Zębalski MA, Parysek K, Krzywon A, Nowosielski K. LUNA EMG as a Marker of Adherence to Prehabilitation Programs and Its Effect on Postoperative Outcomes among Patients Undergoing Cytoreductive Surgery for Ovarian Cancer and Suspected Ovarian Tumors. Cancers (Basel) 2024; 16:2493. [PMID: 39061133 PMCID: PMC11275191 DOI: 10.3390/cancers16142493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Prehabilitation is a novel strategy in preoperative management. The aim of this study was to investigate the effect of prehabilitation programs on peri- and postoperative outcomes and to verify if LUNA EMG has the capacity to monitor compliance with prehabilitation programs. METHODS A total of seventy patients with suspected ovarian cancer were recruited between April 2021 and September 2022 and were divided into a prehabilitation group (36 patients) or a control group (34 patients). A LUNA EMG device was utilized to monitor muscle strength and tension. RESULTS Within the prehabilitation group, we observed a significant increase in the 6-Minute Walk Test distance by 17 m (median, IQR: 0-42.5, p < 0.001) and a significant increase in muscle strength measured with LUNA EMG. In comparison to the control group, the prehabilitation group showed fewer complications according to the Clavien-Dindo classification (47.2% vs. 20.6%, p = 0.02) and shorter postoperative hospital stays (median 5.0 days [IQR: 4.0-6.2] vs. 7.0 days [IQR: 6.0-10.0], p < 0.001). CONCLUSION Prehabilitation has a positive effect on physical capacity and muscle strength and is associated with a reduction in the number of complications after surgery. LUNA EMG can be a useful tool for monitoring patients' adherence to prehabilitation programs.
Collapse
Affiliation(s)
- Marcin Adam Zębalski
- Department of Gynecology, Obstetrics and Gynecological Oncology, University Clinical Center of the Medical University of Silesia, 40-752 Katowice, Poland;
| | - Krzysztof Parysek
- Department of Movement Rehabilitation and Physical Therapy, University Clinical Center of the Medical University of Silesia, 40-752 Katowice, Poland;
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Krzysztof Nowosielski
- Department of Gynecology, Obstetrics and Gynecological Oncology, University Clinical Center of the Medical University of Silesia, 40-752 Katowice, Poland;
| |
Collapse
|
2
|
Collins A, Jacob A, Moss E. Robotic-assisted surgery in high-risk surgical patients with endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2024; 92:102421. [PMID: 37980868 DOI: 10.1016/j.bpobgyn.2023.102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023]
Abstract
Many patients diagnosed with an endometrial cancer are at high-risk for surgery due to factors such as advanced age, raised body mass index or frailty. Minimally-invasive surgery, in particular robotic-assisted, is increasingly used in the surgical management of endometrial cancer however, there are a lack of clinical trials investigating outcomes in high-risk patient populations. This article will review the current evidence and identify areas of uncertainty where future research is needed.
Collapse
Affiliation(s)
- Anna Collins
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK; Deparatment of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
| | - Annie Jacob
- Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
| | - Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK; Deparatment of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK.
| |
Collapse
|
3
|
Drewniok N, Kiselev J, Daum N, Mörgeli R, Spies C, Schaller SJ. Concepts for exercise therapy in prehabilitation for elderly people with frailty or pre-frailty prior to elective surgery. A scoping review. J Bodyw Mov Ther 2023; 36:74-82. [PMID: 37949603 DOI: 10.1016/j.jbmt.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/19/2023] [Accepted: 05/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Frailty is a state of reduced functional capacities in older people that can be reversed through multimodal therapy concepts. The effect of preoperative prehabilitation on frailty has been examined, but the heterogeneity of exercise regimens has prevented conclusive evidence. This scoping review analyses prehabilitation interventions, particularly exercise methods, published in trials for prefrail and frail elderly patients. METHOD We identified studies evaluating prehabilitation for frail elderly using the framework of Arksey and O'Malley. Five scientific databases were searched until March 2022. Articles were screened by two independent reviewers. Data extraction included, but was not limited to, study design, intervention protocol of the prehabilitation including exercise therapy and additional interventions, and safety of the reported exercise concepts. RESULTS Nineteen studies were included, offering an insight into the utilized prehabilitation concepts for exercise. All study interventions were based around exercise programs, potentially with complementary interventions. Twelve studies based their exercise programs on a combination of endurance and strength training. Breathing exercises were prescribed in five studies, flexibility routines in five, and one study included balance training. Further interventions included nutritional counselling/supplementation in nine studies, smoking/alcohol cessation in five, in addition to two physiological and three medical/pharmaceutical interventions. DISCUSSION Prehabilitation for the frail elderly is safe and feasible. The general concept of prehabiliation for frail patients is promising. An exercise program should focus on improving the patient's endurance and strength, considering the positive effects that can be provided by breathing exercises and other additional interventions, such as nutritional support or lifestyle counselling.
Collapse
Affiliation(s)
- Nils Drewniok
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Jörn Kiselev
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Nils Daum
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Rudolf Mörgeli
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Claudia Spies
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Stefan J Schaller
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany.
| |
Collapse
|
4
|
Jain SR, Kandarpa VL, Yaow CYL, Tan WJ, Ho LML, Sivarajah SS, Ng JL, Chong CXZ, Aw DKL, Foo FJ, Koh FHX. The Role and Effect of Multimodal Prehabilitation Before Major Abdominal Surgery: A Systemic Review and Meta-Analysis. World J Surg 2023; 47:86-102. [PMID: 36184673 DOI: 10.1007/s00268-022-06761-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND For patients undergoing abdominal surgery, multimodal prehabilitation, including nutrition and exercise interventions, aims to optimize their preoperative physical and physiological capacity. This meta-analysis aims to explore the impact of multimodal prehabilitation on surgical and functional outcomes of abdominal surgery. METHODS Medline, Embase and CENTRAL were searched for articles about multimodal prehabilitation in major abdominal surgery. Primary outcomes were postoperative complications with a Clavien-Dindo score ≥3, and functional outcomes, measured by the 6-Minute Walking Test (6MWT). Secondary outcome measures included the quality-of-life measures. Pooled risk ratio (RR) and 95% confidence interval (CI) were estimated, with DerSimonian and Laird random effects used to account for heterogeneity. RESULTS Twenty-five studies were included, analysing 4,210 patients across 13 trials and 12 observational studies. Patients undergoing prehabilitation had significantly fewer overall complications (RR = 0.879, 95% CI 0.781-0.989, p = 0.034). There were no significant differences in the rates of wound infection, anastomotic leak and duration of hospitalization. The 6MWT improved preoperatively in patients undergoing prehabilitation (SMD = 33.174, 95% CI 12.674-53.673, p = 0.005), but there were no significant differences in the 6MWT at 4 weeks (SMD = 30.342, 95% CI - 2.707-63.391, p = 0.066) and 8 weeks (SMD = 24.563, 95% CI - 6.77-55.900, p = 0.104) postoperatively. CONCLUSIONS As preoperative patient optimization shifts towards an interdisciplinary approach, evidence from this meta-analysis shows that multimodal prehabilitation improves the preoperative functional capacity and reduces postoperative complication rates, suggesting its potential in effectively optimizing the abdominal surgery patient. However, there is a large degree of heterogenicity between the prehabilitation interventions between included articles; hence results should be interpreted with caution.
Collapse
Affiliation(s)
- Sneha Rajiv Jain
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Vasundhara Lakshmi Kandarpa
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Winson JianHong Tan
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Leonard Ming Li Ho
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Sharmini Su Sivarajah
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jia Lin Ng
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Cheryl Xi Zi Chong
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Darius Kang Lie Aw
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Frederick Hong Xiang Koh
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore.
| |
Collapse
|
5
|
Saggu RK, Barlow P, Butler J, Ghaem-Maghami S, Hughes C, Lagergren P, McGregor AH, Shaw C, Wells M. Considerations for multimodal prehabilitation in women with gynaecological cancers: a scoping review using realist principles. BMC Womens Health 2022; 22:300. [PMID: 35854346 PMCID: PMC9294794 DOI: 10.1186/s12905-022-01882-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is increasing recognition that prehabilitation is important as a means of preparing patients physically and psychologically for cancer treatment. However, little is understood about the role and optimal nature of prehabilitation for gynaecological cancer patients, who usually face extensive and life-changing surgery in addition to other treatments that impact significantly on physiological and psychosexual wellbeing. REVIEW QUESTION This scoping review was conducted to collate the research evidence on multimodal prehabilitation in gynaecological cancers and the related barriers and facilitators to engagement and delivery that should be considered when designing a prehabilitation intervention for this group of women. METHODS Seven medical databases and four grey literature repositories were searched from database inception to September 2021. All articles, reporting on multimodal prehabilitation in gynaecological cancers were included in the final review, whether qualitative, quantitative or mixed-methods. Qualitative studies on unimodal interventions were also included, as these were thought to be more likely to include information about barriers and facilitators which could also be relevant to multimodal interventions. A realist framework of context, mechanism and outcome was used to assist interpretation of findings. RESULTS In total, 24 studies were included in the final review. The studies included the following tumour groups: ovarian only (n = 12), endometrial only (n = 1), mixed ovarian, endometrial, vulvar (n = 5) and non-specific gynaecological tumours (n = 6). There was considerable variation across studies in terms of screening for prehabilitation, delivery of prehabilitation and outcome measures. Key mechanisms and contexts influencing engagement with prehabilitation can be summarised as: (1) The role of healthcare professionals and organisations (2) Patients' perceptions of acceptability (3) Factors influencing patient motivation (4) Prehabilitation as a priority (5) Access to prehabilitation. IMPLICATIONS FOR PRACTICE A standardised and well evidenced prehabilitation programme for women with gynaecological cancer does not yet exist. Healthcare organisations and researchers should take into account the enablers and barriers to effective engagement by healthcare professionals and by patients, when designing and evaluating prehabilitation for gynaecological cancer patients.
Collapse
Affiliation(s)
- Rhia Kaur Saggu
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, Charing Cross Hospital, 13th Floor Laboratory Block, Fulham Palace Road, London, W6 8RF, UK.
| | - Phillip Barlow
- Medical Library, Chelsea and Westminster Campus, Imperial College London, Fulham Road, London, UK
| | - John Butler
- Gynaecological Unit, The Royal Marsden Hospital, Fulham Road, London, UK
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
| | - Cathy Hughes
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, University of Surrey, Guildford, UK
| | - Pernilla Lagergren
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alison H McGregor
- Musculoskeletal Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Clare Shaw
- Royal Marsden and Institute of Cancer Research Biomedical Research Centre, London and Sutton, UK
| | - Mary Wells
- Department of Surgery and Oncology, Nursing Directorate, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, UK
| |
Collapse
|
6
|
AlHilli MM, Schold JD, Kelley J, Tang AS, Michener CM. Preoperative assessment using the five-factor modified frailty index: A call for standardized preoperative assessment and prehabilitation services in gynecologic oncology. Gynecol Oncol 2022; 166:379-388. [PMID: 35863992 DOI: 10.1016/j.ygyno.2022.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/26/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate if the 5-factor modified frailty index (mFI) is associated with postoperative complications, readmissions or non-home discharge in gynecologic cancer patients undergoing surgery. METHODS Patients with a diagnosis of gynecologic cancer (cervical, uterine, or ovarian cancer) who underwent surgery between 2014 and 2018 were identified through the National Surgical Quality Improvement Program (NSQIP) database. The 5-factor mFI was applied and patients classified into 6 categories (mFI groups 0,1,2, 3, 4 and 5). The incidence of 30-day complications, readmissions and non-home discharge was evaluated. Multivariable logistic regression models were used to determine the association between mFI category and readmissions/ complications. Adjusted probabilities of events were calculated based on patient characteristics. RESULTS At total of 31,181 gynecologic cancer cases were included in the analysis: N = 2968 (9.4%) cervical, N = 20,862 (66.4%) uterine, and N = 7351 (23.4%) ovarian cancers. Of all patients, 46.1% were in category 0, 36.5% category 1, and 1% category 3-5. Factors associated with increased mFI included older age, African American race, laparoscopic surgery and obesity. A significant dose-response relationship between higher mFI and readmission and 30-day complications was noted on adjusted multivariable analysis (adjusted OR 2.37 (1.65-3.45) and 2.10 (1.59-2.75) for readmissions and complications, respectively, in mFI category 3-5). These associations were consistent within each cancer type. CONCLUSIONS The 5-factor mFI universally predicts postoperative readmissions, 30-day complications and non-home discharge in patients with gynecologic cancer. Incorporation of mFI into routine preoperative assessment can identify patients for non-surgical treatments, prehabiliatation and short term home assessments.
Collapse
Affiliation(s)
- Mariam M AlHilli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA.
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Johanna Kelley
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Anne S Tang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chad M Michener
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
7
|
Dhanis J, Keidan N, Blake D, Rundle S, Strijker D, van Ham M, Pijnenborg JMA, Smits A. Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity? Cancers (Basel) 2022; 14:3448. [PMID: 35884512 PMCID: PMC9351657 DOI: 10.3390/cancers14143448] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
The literature evaluating the effect of prehabilitation programmes on postoperative outcomes and quality of life of patients with gynaecological cancer undergoing surgery was reviewed. Databases including Pubmed, Medline, EMBASE (Ovid) and PsycINFO were systematically searched to identify studies evaluating the effect of prehabilitation programmes on patients with gynaecological cancer. Both unimodal and multimodal prehabilitation programmes were included encompassing physical exercise and nutritional and psychological support. Primary outcomes were surgical complications and quality of life. Secondary outcomes were anthropometric changes and adherence to the prehabilitation programme. Seven studies fulfilled the inclusion criteria, comprising 580 patients. Included studies were nonrandomised prospective studies (n = 4), retrospective studies (n = 2) and one case report. Unimodal programmes and multimodal programmes were included. In patients with ovarian cancer, multimodal prehabilitation resulted in significantly reduced hospital stay and time to chemotherapy. In patients with endometrial and cervical cancer, prehabilitation was associated with significant weight loss, but had no significant effects on surgical complications or mortality. No adverse events of the programmes were reported. Evidence on the effect of prehabilitation for patients with gynaecological cancer is limited. Future studies are needed to determine the effects on postoperative complications and quality of life.
Collapse
Affiliation(s)
- Joëlle Dhanis
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
- Faculty of Medical Sciences, Radboud University, 6526 GA Nijmegen, The Netherlands
| | - Nathaniel Keidan
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Dominic Blake
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Stuart Rundle
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Dieuwke Strijker
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Maaike van Ham
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
| | - Johanna M. A. Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
| | - Anke Smits
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| |
Collapse
|
8
|
Shin SP, Koh DH. Clinical Impact of Sarcopenia on Cholangiocarcinoma. Life (Basel) 2022; 12:815. [PMID: 35743846 PMCID: PMC9224765 DOI: 10.3390/life12060815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Sarcopenia is considered an important factor affecting the prognosis of cancer patients. Only complete surgical resection confers the chance of curing cholangiocarcinoma with sarcopenia. However, the prognosis is poor, even for patients who undergo surgical resection. Data from 13 trials of patients with sarcopenia and intrahepatic cholangiocarcinoma (ICC) or perihilar cholangiocarcinoma (PHC) were collected and reviewed. During all trials, sarcopenia was assessed using the psoas muscle or total skeletal muscle at the L3 level on cross-sectional images. The data showed heterogeneity among the subjects and treatment options and discrepancies in methods of measuring muscle mass and setting the cut-off level. Despite conflicting results regarding morbidity, mortality, and recurrence, sarcopenia may be associated with poor overall survival and recurrence-free survival (RFS) for ICC patients. The impact of sarcopenia on the morbidity of ICC patients remains unclear. The impact of PHC on morbidity, mortality, and RFS is also unclear. Further well-designed studies are needed to elucidate the effects of sarcopenia on ICC and PHC.
Collapse
Affiliation(s)
- Suk-Pyo Shin
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon-si 24253, Gangwon-do, Korea;
| | - Dong-Hee Koh
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea
| |
Collapse
|
9
|
Combining prehabilitation with enhanced recovery programs in gynecological surgery. J Gynecol Obstet Hum Reprod 2022; 51:102376. [DOI: 10.1016/j.jogoh.2022.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
|
10
|
Advocating for prehabilitation for patients undergoing gynecology-oncology surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1875-1881. [DOI: 10.1016/j.ejso.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 12/18/2022]
|
11
|
Diaz-Feijoo B, Agusti-Garcia N, Sebio R, López-Hernández A, Sisó M, Glickman A, Carreras-Dieguez N, Fuste P, Marina T, Martínez-Egea J, Aguilera L, Perdomo J, Pelaez A, López-Baamonde M, Navarro-Ripoll R, Gimeno E, Campero B, Torné A, Martinez-Palli G, Arguis MJ. Feasibility of a Multimodal Prehabilitation Programme in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: A Pilot Study. Cancers (Basel) 2022; 14:cancers14071635. [PMID: 35406407 PMCID: PMC8997099 DOI: 10.3390/cancers14071635] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Multimodal prehabilitation programmes represent an innovative approach to promoting surgical recovery by improving the physiological and psychological baseline resilience in conjunction with nutritional optimisation in order to reduce the stress to which the patient is subjected during surgery. These programmes are becoming widespread in different fields of surgery, but in major gynaecological surgery for ovarian cancer, there is still no clear consensus. In this study, we aimed to assess the feasibility of these interventions and their impact on postoperative outcomes in women with advanced ovarian cancer. All patients received perioperative care in accordance with Enhanced Recovery After Surgery guidelines. This pilot study showed that multimodal prehabilitation before surgery is feasible and safe, since we observed good adherence without any major adverse effects in this vulnerable population. Additionally, we found that prehabilitation reduced hospital length of stay and the time from surgery to adjuvant chemotherapy. Abstract Introduction: Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We aimed to evaluate the feasibility and postoperative impact of a multimodal prehabilitation programme in AOC patients undergoing surgery. Methods: This single-centre, before-and-after intervention pilot study included 34 patients in two cohorts: the prehabilitation cohort prospectively included 15 patients receiving supervised exercise, nutritional optimisation, and psychological preparation from December 2019 to January 2021; the control cohort included 19 consecutive patients between January 2018 and November 2019. Enhanced Recovery After Surgery guidelines were followed. Results: The overall adherence to the multimodal prehabilitation programme was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimisation, and 80% adherence to psychological preparation. The median hospital stay was shorter in the prehabilitation cohort (5 (IQR, 4–6) vs. 7 days (IQR, 5–9) in the control cohort, p = 0.04). Differences in postoperative complications using the comprehensive complication index (CCI) were not significant (CCI score: 9.3 (SD 12.12) in the prehabilitation cohort vs. 16.61 (SD 16.89) in the control cohort, p = 0.08). The median time to starting chemotherapy was shorter in the prehabilitation cohort (25 (IQR, 23–25) vs. 35 days (IQR, 28–45) in the control cohort, p = 0.03). Conclusions: A multimodal prehabilitation programme before cytoreductive surgery is feasible in AOC patients with no major adverse effects, and results in significantly shorter hospital stays and time to starting chemotherapy.
Collapse
Affiliation(s)
- Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
- Correspondence: ; Tel.: +34-93-227-5400; Fax: +34-93-2275454
| | - Nuria Agusti-Garcia
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Raquel Sebio
- Department of Rehabilitation, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (R.S.); (E.G.)
| | - Antonio López-Hernández
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Marina Sisó
- Nutrition and Clinical Dietetics, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (M.S.); (B.C.)
| | - Ariel Glickman
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Nuria Carreras-Dieguez
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Pere Fuste
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Tiermes Marina
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Judit Martínez-Egea
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Laura Aguilera
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Juan Perdomo
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Amaia Pelaez
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Manuel López-Baamonde
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Ricard Navarro-Ripoll
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Elena Gimeno
- Department of Rehabilitation, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (R.S.); (E.G.)
| | - Betina Campero
- Nutrition and Clinical Dietetics, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (M.S.); (B.C.)
| | - Aureli Torné
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Graciela Martinez-Palli
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - María J. Arguis
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| |
Collapse
|
12
|
Is there evidence behind pre- or perioperative cognitive training in gynaecological patients on the prevention of perioperative cognitive dysfunction? A review. Arch Gynecol Obstet 2021; 306:937-942. [PMID: 34874493 PMCID: PMC9470716 DOI: 10.1007/s00404-021-06315-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022]
Abstract
Purpose Perioperative cognitive dysfunction can be observed in all age groups of patients. Sometimes, this is more stressful to the patient than the actual surgical wound. Enhanced recovery after surgery pathways screen for patients at risk and lead to early post-surgical intervention. To prevent cognitive dysfunction, a prehabilitation approach might be useful. Methods This systematic literature review provides an overview on the current knowledge on prehabilitation for cognitive dysfunction for gynaecological patients by searching the National Library of Medicine (PubMed) in February 2020 to identify publications regarding presurgical cognitive training with three different search terms. Results 501 articles were identified and after screening for eligibility five were left for further analysis. Generally, cognitive function is split into several cognitive aspects like anxiety or memory, speed, attention, flexibility or problem-solving functions. Each of these aspects can/need to be trained to show an improvement after general anaesthesia. Training possibilities range from relaxation methods via music, one-on-one personal training sessions to electronically supported training units. Conclusion Prehabilitation of the cognitive function can be split in different cognitive domains. Each of these domains seem to be influenced by training. The training itself can be based on applications or known relaxation methods or even old-fashioned board games. The evidence is, however, still low and there is a need for further studies.
Collapse
|
13
|
Monteiro MGCT, de Morais Gouveia GP. Physiotherapy in the management of gynecological cancer patient: A systematic review. J Bodyw Mov Ther 2021; 28:354-361. [PMID: 34776164 DOI: 10.1016/j.jbmt.2021.06.027] [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: 10/08/2020] [Revised: 06/01/2021] [Accepted: 06/21/2021] [Indexed: 01/05/2023]
Abstract
AIM to evaluate the effectiveness of physiotherapy as an adjunct treatment in patients with gynecological cancer. METHOD systematic review carried out in the PubMed, MEDLINE, via VHL, Cochrane and SciELO, in the last ten years. A search strategy was based on the PICO method and the PRISMA flowchart using Boolean descriptors and operators: "gynecological cancer or neoplasms of female genital organs" and "physiotherapy or physiotherapy modalities" and "rehabilitation or quality of life" in languages Portuguese, English, and Spanish. RESULTS 405 articles were found, and after eligibility criteria, only 5 studies were selected for review. Evidence of a monitored physical exercise, photobiomodulation and pelvic floor rehabilitation program as physiotherapeutic resources in the management of gynecological cancer. CONCLUSION Physiotherapy dominates techniques and appears to be beneficial for the main complications arising from the treatment or post-treatment of gynecological cancer and has sought to accompany the knowledge and care of the patient, through scientific research.
Collapse
|
14
|
van der Zanden V, van der Zaag-Loonen HJ, Paarlberg KM, Meijer WJ, Mourits MJE, van Munster BC. PREsurgery thoughts - thoughts on prehabilitation in oncologic gynecologic surgery, a qualitative template analysis in older adults and their healthcare professionals. Disabil Rehabil 2021; 44:5930-5940. [PMID: 34283686 DOI: 10.1080/09638288.2021.1952319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to reveal information that can be used for composing a prehabilitation program tailored to elderly gynecological oncological patients and is applicable to healthcare professionals. We investigated possible content and indications for prehabilitation, and what potential barriers might exist. MATERIALS AND METHODS Because of the primary exploratory study aim, inductive thematic template analysis on semi-structured interviews with gynecologic oncological patients aged ≥60 years and healthcare professionals were used. RESULTS 16 patients and 20 healthcare professionals were interviewed. Three themes important for prehabilitation were found: (1) "Motivation," (2) "Practical issues and facilitators," and (3) "Patient-related factors." A short time interval between diagnosis and surgery was reported as a potential barrier for prehabilitation. Given components for a tailor-made prehabilitation program are: (1) The first contact with a nurse who screens the patients, gives tailor-made advice on prehabilitation and keeps patients motivated and supports them mentally; (2) If patients are referred to a more extensive/supervised program, this should preferably be arranged close to a patients' home. CONCLUSION Based on our findings, an outline of a patient-tailored prehabilitation program was developed. The main important themes for prehabilitation were "Motivation," "Practical issues and facilitators," and "Patient-related factors."IMPLICATIONS FOR REHABILITATIONPatients and healthcare professionals are positive about prehabilitation.Main themes for designing a prehabilitation program are "Motivation," "Practical issues and facilitators," and "Patient-related factors."Nursing staff can play a key role in prehabilitation.It is important to screen patients for specific impairments to obtain a tailor-made prehabilitation program.For some patients, general advice on prehabilitation might be sufficient, while others may need more supervision.The time interval between diagnosis and surgery is often short and is perceived as a potentially significant barrier for an effective prehabilitation program.
Collapse
Affiliation(s)
- Vera van der Zanden
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands.,Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hester J van der Zaag-Loonen
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K Marieke Paarlberg
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Wouter J Meijer
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Marian J E Mourits
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
Gillis C, Davies SJ, Carli F, Wischmeyer PE, Wootton SA, Jackson AA, Riedel B, Marino LV, Levett DZH, West MA. Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review. Front Nutr 2021; 8:644723. [PMID: 33898499 PMCID: PMC8062858 DOI: 10.3389/fnut.2021.644723] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Prehabilitation aims to improve functional capacity prior to cancer treatment to achieve better psychosocial and clinical outcomes. Prehabilitation interventions vary considerably in design and delivery. In order to identify gaps in knowledge and facilitate the design of future studies, we undertook a scoping review of prehabilitation studies to map the range of work on prehabilitation being carried out in any cancer type and with a particular focus on diet or nutrition interventions. Objectives: Firstly, to describe the type of prehabilitation programs currently being conducted. Secondly, to describe the extent to which prehabilitation studies involved aspects of nutrition, including assessment, interventions, implementation, and outcomes. Eligibility Criteria: Any study of quantitative or qualitative design that employed a formal prehabilitation program before cancer treatment ("prehabilitation" listed in keywords, title, or abstract). Sources of Evidence: Search was conducted in July 2020 using MEDLINE, PubMed, EMBASE, EMCARE, CINAHL, and AMED. Charting Methods: Quantitative data were reported as frequencies. Qualitative nutrition data were charted using a framework analysis that reflects the Nutrition Care Process Model: assessment, intervention, and monitoring/evaluation of the nutrition intervention. Results: Five hundred fifty unique articles were identified: 110 studies met inclusion criteria of a formal prehabilitation study in oncology. prehabilitation studies were mostly cohort studies (41%) or randomized-controlled trials (38%) of multimodal (49%), or exercise-only (44%) interventions that were applied before surgery (94%). Nutrition assessment was inconsistently applied across these studies, and often conducted without validated tools (46%). Of the 110 studies, 37 (34%) included a nutrition treatment component. Half of these studies provided the goal for the nutrition component of their prehabilitation program; of these goals, less than half referenced accepted nutrition guidelines in surgery or oncology. Nutrition interventions largely consisted of counseling with dietary supplementation. The nutrition intervention was indiscernible in 24% of studies. Two-thirds of studies did not monitor the nutrition intervention nor evaluate nutrition outcomes. Conclusion: Prehabilitation literature lacks standardized and validated nutritional assessment, is frequently conducted without evidence-based nutrition interventions, and is typically implemented without monitoring the nutrition intervention or evaluating the intervention's contribution to outcomes. We suggest that the development of a core outcome set could improve the quality of the studies, enable pooling of evidence, and address some of the research gaps identified.
Collapse
Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Sarah J. Davies
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Paul E. Wischmeyer
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Stephen A. Wootton
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
- National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
- National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, United Kingdom
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Anaethesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Integrated Critical Care Medicine and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Luise V. Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
- Nutrition and Dietetics, Faculty of Health and Well Being, University of Winchester, Winchester, United Kingdom
| | - Denny Z. H. Levett
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
- Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Malcolm A. West
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
- Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, University of Southampton, Southampton, United Kingdom
- Faculty of Medicine, School of Cancer Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
16
|
Tasbihgou SR, Dijkstra S, Atmosoerodjo SD, Tigchelaar I, Huet R, Mariani MA, Absalom AR. A prospective pilot study assessing levels of preoperative physical activity and postoperative neurocognitive disorder among patients undergoing elective coronary artery bypass graft surgery. PLoS One 2020; 15:e0240128. [PMID: 33048965 PMCID: PMC7553306 DOI: 10.1371/journal.pone.0240128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022] Open
Abstract
Physical inactivity and a sedentary lifestyle are associated with a chronic low-level inflammatory state which has been implicated in the pathogenesis of cardiovascular disease. There is growing interest in exercise programs as part of surgical ‘prehabilitation’. We therefore studied preoperative physical activity levels of patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery, and performed an exploratory analysis of the influence of physical activity on postoperative outcome. The Short Questionnaire to Assess Health (SQUASH) was used to assess physical activity among 100 patients, of mean (SD) age 65.4 (7.6) years. Additionally, handgrip strength was measured, and the get-up-and-go test was conducted. Anxiety, depression, and quality of life were assessed, and a computerised cognitive test battery was used to assess cognitive performance preoperatively, and three months after surgery. Preoperatively, 76% of patients met the recommended national guidelines for physical activity. The incidence of pre-existing medical conditions, and other pre-operative patient features were similar in active and inactive patients. Preoperative physical activity was significantly inversely related to the logistic EuroSCORE. The level of physical activity was also significantly inversely related with preoperative C-reactive protein (CRP) and peak postoperative CRP, but physical activity did not appear to be associated with any adverse postoperative outcomes or extended length of hospital stay. The incidence of postoperative neurocognitive disorder (PNCD) at 3 months postoperatively was 26%. Cognitive performance was not related with physical activity levels. In summary, this was the first study to assess activity levels of cardiac surgical patients with the SQUASH questionnaire. The majority of patients were physically active. Although physical activity was associated with lower levels of inflammation in this pilot study, it was not associated with an improved clinical or cognitive postoperative outcome.
Collapse
Affiliation(s)
- Setayesh R Tasbihgou
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra Dijkstra
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sawal D Atmosoerodjo
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris Tigchelaar
- Laboratory for Experimental Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rolf Huet
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
17
|
Damiani GR, Villa M, Di Naro E, Signorelli M, Corso S, Trojano G, Loverro M, Capursi T, Muzzupapa G, Pellegrino A. Outcomes of robotic surgery performed in patients with high BMI class: experience by a single surgeon. ACTA ACUST UNITED AC 2020; 71:412-418. [PMID: 32064825 DOI: 10.23736/s0026-4784.19.04440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Advanced laparoscopic procedures have been shown to be safe in patients with high Body Mass Index (BMI), but conversion rates remain high. This analysis aimed to evaluate the feasibility and clinical outcomes in terms of long- and short-term complications, pain relief of robotic surgery in morbidly obese patients. METHODS Patients with BMI class I-II-III with endometrial cancer or hyperplasia were treated with robotic hysterectomy (RH). Patients' characteristics, operating room time (OT), type of surgery, length of hospital stay, and incidence of complications were recorded. Records were reviewed for demographic data, medical/surgical history and comorbidities, perioperative findings and outcomes, as well as long-term complications and recurrences. Regarding stage, according to 2009 FIGO, 26 of cases were IA, while eight and five of cases were, respectively, IB, II stage. RESULTS A total of 87 consecutive RH were analyzed. The more frequent comorbidity was hypertension. Twenty percent of the patients had multiple comorbidities (>2). The mean age was 63±10 years, with a mean BMI of 36±8.2 kg/m2. The more frequent BMI group treated was II class. The median OT was 114 minutes (range: 49-270). According to the Dindo Classification, there were no differences in major or minor complications between the 3 BMI classes. This series had a median follow-up of 60 months (range: 8-96) with an overall survival rate of 100%. The RRH+PLH was feasible and pathology confirmed the adequacy of the surgical specimen, with a median count of 20 nodes. CONCLUSIONS Our data support the adoption of the surgical management of the morbidly obese patient. Although short term complication rates are higher with increasing obesity (II-III class), a majority of procedures can still be completed with minimally invasive approach.
Collapse
Affiliation(s)
- Gianluca R Damiani
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy -
| | - Mario Villa
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Mauro Signorelli
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Silvia Corso
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Matteo Loverro
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Teresa Capursi
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Giuseppe Muzzupapa
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| |
Collapse
|
18
|
Lee K, Zhou J, Norris MK, Chow C, Dieli-Conwright CM. Prehabilitative Exercise for the Enhancement of Physical, Psychosocial, and Biological Outcomes Among Patients Diagnosed with Cancer. Curr Oncol Rep 2020; 22:71. [PMID: 32537699 DOI: 10.1007/s11912-020-00932-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the effects of prehabilitative exercise interventions on the physical, psychosocial, and biological outcomes among patients with cancer. Current gaps and future directions in prehabilitative exercise research will be addressed. RECENT FINDINGS Prehabilitative exercise mitigates the detrimental impact of cancer surgery on physical fitness, noted by increases in maximal oxygen consumption and 6-min walk distance. Beneficial effects on psychosocial and biological outcomes remain inconclusive. Aerobic exercise interventions were often prescribed and included low-, moderate-, or high-intensity exercise. Resistance exercise interventions were often performed in conjunction with aerobic exercise. Prehabilitative exercise elicits robust improvements in physical fitness; however, effect on psychosocial and biological outcomes remains inconclusive. Exercise prescription parameters varied greatly by frequency, intensity, time, and type across multiple cancer diagnoses. Future investigations are needed to systematically dose exercise for a wider variety of outcome measures, with an overall goal to set forth pre-operative exercise guidelines.
Collapse
Affiliation(s)
- Kyuwan Lee
- Department of Population Sciences, City of Hope, Duarte, CA, 91010, USA
| | - Judy Zhou
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, CA, 90089, USA
| | - Mary K Norris
- Division of Populations Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Ave, Boston, MA, 02215, USA
| | - Christina Chow
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, CA, 90089, USA
| | - Christina M Dieli-Conwright
- Division of Populations Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Ave, Boston, MA, 02215, USA.
| |
Collapse
|
19
|
Sahara K, Paredes AZ, Merath K, Tsilimigras DI, Bagante F, Ratti F, Marques HP, Soubrane O, Beal EW, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Aklile W, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Pawlik TM. Evaluation of the ACS NSQIP Surgical Risk Calculator in Elderly Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. J Gastrointest Surg 2020; 24:551-559. [PMID: 30937717 DOI: 10.1007/s11605-019-04174-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/20/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator (SRC) aims to help predict patient-specific risk for morbidity and mortality. The performance of the SRC among an elderly population undergoing curative-intent hepatectomy for hepatocellular carcinoma (HCC) remains unknown. METHODS Patients > 70 years of age who underwent hepatectomy for HCC between 1998 and 2017 were identified using a multi-institutional international database. To estimate the performance of SRC, 12 observed postoperative outcomes were compared with median SRC-predicted risk, and C-statistics and Brier scores were calculated. RESULTS Among 500 patients, median age was 75 years (IQR 72-78). Most patients (n = 324, 64.8%) underwent a minor hepatectomy, while 35.2% underwent a major hepatectomy. The observed incidence of venous thromboembolism (VTE) (3.2%) and renal failure (RF) (4.4%) exceeded the median predicted risk (VTE, 1.8%; IQR 1.5-3.1 and RF, 1.0%; IQR 0.5-2.0). In contrast, the observed incidence of 30-day readmission (7.0%) and non-home discharge (2.5%) was lower than median-predicted risk (30-day readmission, 9.4%; IQR 7.4-12.8 and non-home discharge, 5.7%; IQR 3.3-11.7). Only 57.8% and 71.2% of patients who experienced readmission (C-statistic, 0.578; 95%CI 0.468-0.688) or mortality (C-statistic, 0.712; 95%CI 0.508-0.917) were correctly identified by the model. CONCLUSION Among elderly patients undergoing hepatectomy for HCC, the SRC underestimated the risk of complications such as VTE and RF, while being no better than chance in estimating the risk of readmission. The ACS SRC has limited clinical applicability in estimating perioperative risk among elderly patients being considered for hepatic resection of HCC.
Collapse
Affiliation(s)
- Kota Sahara
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Anghela Z Paredes
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Katiuscha Merath
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Fabio Bagante
- Department of Surgery, University of Verona, Verona, Italy
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Eliza W Beal
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | | | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Workneh Aklile
- Department of Surgery, University of Ottawa, Ottawa, Canada
| | | | - Tom Hugh
- Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
| |
Collapse
|
20
|
Fit4SurgeryTV At-home Prehabilitation for Frail Older Patients Planned for Colorectal Cancer Surgery: A Pilot Study. Am J Phys Med Rehabil 2020; 98:399-406. [PMID: 30550454 DOI: 10.1097/phm.0000000000001108] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The preoperative phase is a potential window of opportunity. Although frail elderly patients are known to be more prone to postoperative complications, they are often not considered capable of accomplishing a full prehabilitation program. The aim of this study was to assess the feasibility of Fit4SurgeryTV, an at-home prehabilitation program specifically designed for frail older patients with colorectal cancer. DESIGN The Fit4SurgeryTV program consisted of a daily elderly adapted computer-supported strength training workout and two protein-rich meals. Frail patients 70 yrs or older with colorectal cancer were included. The program was considered feasible if 80% of the patients would be able to complete 70% of the program. RESULTS Fourteen patients (median age, 79 yrs; 5 males) participated. At baseline, 86% patients were physically impaired and 64% were at risk for malnourishment. The median duration of the program was 26 days. The program was feasible as patients followed the exercises for 6 (86%) of 7 days and prepared the recipes 5 (71%) of 7 d/wk. Patients specifically appreciated at-home exercises. CONCLUSIONS This study showed that at-home prehabilitation in frail older patients with colorectal cancer is feasible. As a result, patients might be fitter for surgery and might recover faster. The perioperative period could serve as a pivotal time point in reverting complications of immobility.
Collapse
|
21
|
Abstract
OBJECTIVES To recognize cancer prehabilitation as a pretreatment regimen to increase functional status for patients requiring cancer treatment. This article presents current evidence addressing the efficacy and benefits of prehabilitation regimens in different cancer survivor populations. DATA SOURCES Studies and case reports in the PubMed database. CONCLUSION Cancer prehabilitation may improve outcomes. Prehabilitation may include targeted or whole-body exercise, nutrition, education, psychologic counseling, and smoking cessation. Opportunities exist to further improve access to and delivery of multimodal prehabilitation, and nurses play a critical role in connecting patients to these services. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses who are knowledgeable of cancer treatment-related effects are poised to assess survivors for existing impairments, advocate for prehabilitation for existing and potential morbidities, and monitor functional status over time. As patient educators, they are key to informing cancer survivors about the role of prehabilitation.
Collapse
|
22
|
Prehabilitation programs and ERAS protocols in gynecological oncology: a comprehensive review. Arch Gynecol Obstet 2019; 301:315-326. [DOI: 10.1007/s00404-019-05321-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/21/2019] [Indexed: 12/18/2022]
|
23
|
Miralpeix E, Mancebo G, Gayete S, Corcoy M, Solé-Sedeño JM. Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program. Int J Gynecol Cancer 2019; 29:1235-1243. [DOI: 10.1136/ijgc-2019-000597] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.
Collapse
|
24
|
Drudi LM, Tat J, Ades M, Mata J, Landry T, MacKenzie KS, Steinmetz OK, Gill HL. Preoperative Exercise Rehabilitation in Cardiac and Vascular Interventions. J Surg Res 2019; 237:3-11. [DOI: 10.1016/j.jss.2018.11.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
|
25
|
Polastri M. Fast-track post-operative rehabilitation to maximise outcomes of minimally invasive surgical procedures. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.5.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Massimiliano Polastri
- Physiotherapist, Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, University Hospital St Orsola-Malpighi, Bologna, Italy
| |
Collapse
|
26
|
Neuner B, Hadzidiakos D, Bettelli G. Pre- and postoperative management of risk factors for postoperative delirium: who is in charge and what is its essence? Aging Clin Exp Res 2018; 30:245-248. [DOI: 10.1007/s40520-017-0890-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/30/2017] [Indexed: 12/20/2022]
|
27
|
Prehabilitation in gynecological surgery? What do gynecologists know and need to know. Arch Gynecol Obstet 2017; 297:27-31. [DOI: 10.1007/s00404-017-4565-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/11/2017] [Indexed: 11/25/2022]
|
28
|
Eden MM, Tompkins J, Verheijde JL. Reliability and a correlational analysis of the 6MWT, ten-meter walk test, thirty second sit to stand, and the linear analog scale of function in patients with head and neck cancer. Physiother Theory Pract 2017; 34:202-211. [DOI: 10.1080/09593985.2017.1390803] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Melissa M. Eden
- Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, AZ, USA
| | - James Tompkins
- Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, AZ, USA
| | | |
Collapse
|
29
|
An international review and meta-analysis of prehabilitation compared to usual care for cancer patients. J Cancer Surviv 2017; 12:64-73. [DOI: 10.1007/s11764-017-0645-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
|
30
|
Baima J, Reynolds SG, Edmiston K, Larkin A, Ward BM, O'Connor A. Teaching of Independent Exercises for Prehabilitation in Breast Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:252-256. [PMID: 26541465 DOI: 10.1007/s13187-015-0940-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We attempted to determine the feasibility of studying prehabilitation exercises to improve shoulder pain and abduction range of motion (ROM) after breast cancer surgery. We evaluated methods of exercise teaching and assessed effect on postsurgical seroma formation. This was a feasibility study with two non-blinded groups of subjects randomized by timing of appointment. This single-site study was performed at an academic tertiary medical center. Sixty cancer patients were randomly assigned to either group 1, in-person teaching arm, n = 36, or group 2, video-only teaching arm, n = 24. Forty-five patients completed the study. Shoulder exercises were assigned to both groups 1 month prior to surgery during evaluation. Group 1 received in-person instruction on exercises, plus an information sheet with exercises and a link to an online video. Group 2 received only the information sheet with exercises and a link to the online video. The primary outcomes considered are as follows: exercise compliance, shoulder pain (via visual analog scale), shoulder abduction ROM (via goniometer), and presence or absence of seroma. Seventy-six percent of study patients chose to exercise. There was no difference in exercise compliance between in-person teaching versus video teaching (75 %, 24/32 vs. 77 %, 10/13, OR = 1.03). Sixty-six of patients (20/30) lost greater than 10° shoulder abduction ROM at 1 month post surgery. Twenty-nine of patients (9/31) had worse shoulder pain than baseline at 1 month post surgery (24 %, 6/25 exercisers, and 50 %, 3/6 non-exercisers). Fifteen percent of patients (4/27) had worse shoulder pain than baseline at 3 months post surgery (8 %, 2/23 exercisers, and 100 %, 2/2 non-exercisers). Prehabilitation exercise program inferred no additional risk of seroma formation (Exercisers 21 %, 7/33 vs. non-exercisers 22 %, 2/9, OR = 0.94). Our subjects were able to perform three exercises independently in the preoperative period. A high-quality randomized controlled trial is necessary to assess the appropriate timing and efficacy of this intervention.
Collapse
Affiliation(s)
- Jennifer Baima
- University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | - Anne Larkin
- University of Massachusetts Medical School, Worcester, MA, USA
| | - B Marie Ward
- University of Massachusetts Medical School, Worcester, MA, USA
| | | |
Collapse
|
31
|
The Utility of Preoperative Frailty Assessment. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0156-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
32
|
Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? J Geriatr Oncol 2016; 8:8-15. [PMID: 27318797 DOI: 10.1016/j.jgo.2016.06.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/21/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Traditionally used as a descriptive term, frailty is now a recognized medical syndrome identifying individuals with decreased physiologic reserve. Frailty is characterized by diminished strength, endurance, and reduced physiologic function. Several valid frailty screening tools exist in the literature, and these measures have been used to relate frailty to outcomes important to the older patient with cancer. Frail adults are at increased risk of adverse surgical outcomes and early findings suggest that frailty predicts poor chemotherapy tolerance. While much research is needed to explore the biologic relationships between frailty and cancer, there is an urgent need to implement frailty screening and management into the care of the older patient with cancer in order to improve outcomes in this vulnerable subset. The purpose of this paper is to provide an introduction of frailty to oncologists including a review of the definition, frailty screening tools, its clinical relevance to older patients with cancer, and a brief guide to frailty management.
Collapse
Affiliation(s)
| | - Jeremy Walston
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, USA
| |
Collapse
|
33
|
Weston M, Weston KL, Prentis JM, Snowden CP. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions. Perioper Med (Lond) 2016; 5:2. [PMID: 26770671 PMCID: PMC4712564 DOI: 10.1186/s13741-015-0026-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 12/15/2015] [Indexed: 12/12/2022] Open
Abstract
The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these interventions, the prescription of pre-operative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function. Any exercise programme incorporated into the pre-operative pathway of care needs to be effective and time efficient in that any fitness gains are achievable in the limited period between the decision for surgery and operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with the overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes. The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of more recent evidence demonstrating the effectiveness and time efficiency of high-intensity interval training—which involves brief bouts of intense exercise interspersed with longer recovery periods—the principles of exercise training programme design will be discussed mainly in the context of such high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of pre-operative exercise training programmes, such as individual exercise prescription, training session monitoring and potential barriers and risks to high-intensity exercise are also discussed. The evidence presented suggests that individually prescribed and supervised high-intensity interval training programmes, encompassing a variety of exercise modes represent an effective and safe means of exercise therapy prior to surgery.
Collapse
Affiliation(s)
- Matthew Weston
- Department of Sport & Exercise Sciences, School of Social Sciences, Business & Law, Teesside University, Middlesbrough, UK
| | - Kathryn L Weston
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - James M Prentis
- Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Chris P Snowden
- Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, UK ; Institute of Cellular Medicine, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| |
Collapse
|
34
|
Bouwman F, Smits A, Lopes A, Das N, Pollard A, Massuger L, Bekkers R, Galaal K. The impact of BMI on surgical complications and outcomes in endometrial cancer surgery--an institutional study and systematic review of the literature. Gynecol Oncol 2015; 139:369-76. [PMID: 26407479 DOI: 10.1016/j.ygyno.2015.09.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to evaluate the association between body mass index (BMI), perioperative complications and outcomes in endometrial cancer (EC) patients at our institution. In addition, we performed a systematic review to compare our results to the literature. METHODS This was a retrospective study of surgically managed EC patients between January 2006 and January 2015. Patient characteristics, surgical complications and intra- and postoperative outcomes were evaluated across BMI groups; BMI <30kg/m(2), BMI ≥30kg/m(2) and BMI ≥40kg/m(2). The systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS In total, we identified 627 women of which 514 were included; 249 women had a BMI of <30kg/m(2), 195 women had a BMI of 30-39.9kg/m(2), and 70 women were morbidly obese (BMI ≥40kg/m(2)). Obese women (BMI ≥30kg/m(2)) had significantly more postoperative surgical complications, including wound complications and antibiotics use, which was confirmed by the systematic review. The increase in complications mainly occurred in open surgery and morbidly obese patients were at highest risk. Obesity did not impact other outcomes including 30-day mortality. CONCLUSION Obesity is associated with an increased risk of surgical morbidity in EC patients, and is most profound in open surgery and among the morbidly obese. Laparoscopic surgery may well prevent the majority of postoperative complications in this group of patients, and should therefore be the favoured approach.
Collapse
Affiliation(s)
| | - Anke Smits
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom
| | - Alberto Lopes
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom
| | - Nagindra Das
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom
| | - Adam Pollard
- European Centre for the Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | | | | | - Khadra Galaal
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom.
| |
Collapse
|
35
|
Affiliation(s)
- Christos Iavazzo
- Post CCT Senior Clinical Fellow Gynaecological Oncology Department, Christie Hospital, Manchester
| | - Ioannis D. Gkegkes
- Resident trainee, First Department of Surgery, General Hospital of Attica KAT, Athens, Greece
| |
Collapse
|
36
|
Perioperative Implications of Neoadjuvant Therapies and Optimization Strategies for Cancer Surgery. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, Vohra R. Psychological Prehabilitation Before Cancer Surgery: A Systematic Review. Ann Surg Oncol 2015; 22:4117-23. [DOI: 10.1245/s10434-015-4550-z] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Indexed: 12/31/2022]
|
38
|
Otsuji H, Yokoyama Y, Ebata T, Igami T, Sugawara G, Mizuno T, Nagino M. Preoperative Sarcopenia Negatively Impacts Postoperative Outcomes Following Major Hepatectomy with Extrahepatic Bile Duct Resection. World J Surg 2015; 39:1494-500. [DOI: 10.1007/s00268-015-2988-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
39
|
Abstract
Patients who are elderly, malnourished, anxious, and have a low physical function before surgery are likely to have suboptimal recovery from cancer surgery. A multimodal prehabilitation program is proposed, consisting of exercise training and nutritional and psychological support, which increases physiologic reserve before the stress of surgery. This interventional approach seems to improve ability to undergo the stress of surgery and faster recovery. The integration of exercise, adequate nutrition, and psychosocial components, with medical and pharmacologic optimization in the presurgical period, deserves to receive more attention by clinicians to elucidate the most effective interventions.
Collapse
Affiliation(s)
- Francesco Carli
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
| | - Celena Scheede-Bergdahl
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada; Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
40
|
Silver JK. Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. Semin Oncol Nurs 2014; 31:13-30. [PMID: 25636392 DOI: 10.1016/j.soncn.2014.11.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the current state of cancer prehabilitation care and the impact that it may have on health-related and financial outcomes. DATA SOURCES Clinical trials, reviews and meta-analyses. CONCLUSION Research demonstrates that prehabilitation interventions may improve physical and/or psychological outcomes and help patients function at a higher level throughout their cancer treatment. Establishing a baseline status at diagnosis provides an opportunity to gain insight into the burden that cancer and its treatment can place on survivors with respect to physical and psychological impairments, function, and disability. Targeted interventions may reduce the incidence and/or severity of future impairments that often lead to reduced surgical complications, hospital lengths of stay, hospital readmissions, and overall health care costs. Thus, cancer prehabilitation is an opportunity to positively impact patient health-related and financial outcomes from diagnosis onward and, by decreasing the financial impact that cancer can have on individuals, may prove to be a sound investment for patients, hospitals, payers and society. IMPLICATIONS FOR NURSING PRACTICE Nurses, and particularly navigators, have an opportunity to significantly impact care through patient screening, prehabilitation assessments, documentation of baseline patient status and, in some cases, especially when impairments are not present at baseline, provide interventions designed to improve physical and psychological health before the start of upcoming oncology treatments and reduce the likelihood of patients developing future impairments.
Collapse
|
41
|
Santa Mina D, Matthew AG, Hilton WJ, Au D, Awasthi R, Alibhai SMH, Clarke H, Ritvo P, Trachtenberg J, Fleshner NE, Finelli A, Wijeysundera D, Aprikian A, Tanguay S, Carli F. Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial. BMC Surg 2014; 14:89. [PMID: 25394949 PMCID: PMC4246547 DOI: 10.1186/1471-2482-14-89] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 10/02/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An emerging field of research describes the role of preoperative health behaviours, known as prehabilitation. The preoperative period may be a more physically and emotionally salient time to introduce and foster chronic adherence to health behaviours, such as exercise, in patients compared to post-treatment during recovery. Moreover, physical and psychosocial improvements during the preoperative period may translate into an enhanced recovery trajectory with reduced operative complications and postoperative adverse effects. No studies have assessed prehabilitation for men with prostate cancer undergoing radical prostatectomy. METHODS/DESIGN This is a multi-centre, pilot randomized control trial conducted at two Canadian urban teaching hospitals. 100 men undergoing radical prostatectomy for prostate cancer with no contraindications to exercise will be recruited and randomized to the prehabiliation program or usual care. Prehabilitation participants will engage in a preoperative, individualized exercise program including pelvic floor muscle strengthening instructions and a healthy lifestyle guide for men with prostate cancer. These participants will be asked to engage in 60 minutes of home-based, unsupervised, moderate-intensity exercise on 3-4 days per week. Usual care participants will receive the same pelvic floor muscle strengthening instructions and healthy lifestyle guide only. We will assess the feasibility of conducting an adequately powered trial of the same design via recruitment rate, programmatic adherence/contamination, attrition, and safety. Estimates of intervention efficacy will be captured through measurements at baseline (4-8 weeks preoperatively), within 1 week prior to surgery, and postoperatively at 4, 12, and 26 weeks. Efficacy outcomes include: fatigue, quality of life, urinary incontinence, physical fitness, body composition, aerobic fitness, pain, and physical activity volume. DISCUSSION The primary outcome of this study is to determine the feasibility of conducting a full-scale, randomized controlled trial of prehabilitation versus usual care and to estimate effect sizes that will inform sample size determinations for subsequent trials in this field. To our knowledge, this is the first study to examine a structured presurgical exercise program for men undergoing radical prostatectomy for prostate cancer. This trial will advance our understanding of strategies to efficiently and effectively use the preoperative period to optimize postoperative recovery. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02036684.
Collapse
Affiliation(s)
- Daniel Santa Mina
- />Kinesiology Program, University of Guelph-Humber, Toronto, ON Canada
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | - Andrew G Matthew
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - William J Hilton
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | - Darren Au
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | | | - Shabbir MH Alibhai
- />University of Toronto, Toronto, ON Canada
- />University Health Network, Toronto, ON Canada
| | - Hance Clarke
- />University of Toronto, Toronto, ON Canada
- />University Health Network, Toronto, ON Canada
| | - Paul Ritvo
- />Kinesiology and Health Sciences Department, York University, Toronto, ON Canada
- />Cancer Care Ontario, Toronto, ON Canada
| | - John Trachtenberg
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Neil E Fleshner
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Antonio Finelli
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Duminda Wijeysundera
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | | | - Simon Tanguay
- />McGill University Health Centre, Montreal, QC Canada
| | - Franco Carli
- />McGill University Health Centre, Montreal, QC Canada
| |
Collapse
|
42
|
Carli F, Awasthi R, Gillis C, Kassouf W. Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program. Can Urol Assoc J 2014; 8:E884-7. [PMID: 25485023 PMCID: PMC4250260 DOI: 10.5489/cuaj.2025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this case report is to discuss the positive impact of a multimodal prehabilitation program on postoperative recovery of a frail patient undergoing radical cystectomy. An 85-year-old man with significant history for poorly controlled type II diabetes, anemia, chronic renal failure, and glaucoma was found to have muscle invasive urothelial carcinoma of the bladder with hydronephrosis. He was scheduled for elective radical cystoprostatectomy and ileal conduit diversion. He was enrolled in a multimodal prehabilitation program in view of his frailty (Fried score = 5), 15% body weight loss, weak grip strength, severe depression and moderate anxiety, poor nutritional status (patient-generated subjective global assessment [PG-SGA] = B), low functional walking capacity (6-minute walking test [6MWT] = 210 metres, predicted 621 metres). The 4-week program included moderate aerobic and resistant exercises, nutritional counselling with whey protein supplementation (20 g/day), and relaxation exercises. Surgery and the postoperative period were uneventful, although he required treatment of his hyperglycemia and hypomagnesemia. He left the hospital on postoperative day 7 and returned home where he continued the multimodal program for 8 weeks. Measurements of 6MWT, Health-Related Quality of Life (SF-36), physical activity, Hospital Anxiety and Depression Scale (HADS), were conducted at baseline, before surgery and at 4 and 8 weeks after surgery. These tests revealed a progressive remarkable improvement before surgery that continued after surgery.
Collapse
Affiliation(s)
- Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, QC
| | - Rashami Awasthi
- Department of Anesthesia, McGill University Health Centre, Montreal, QC
| | - Chelsia Gillis
- Department of Anesthesia, McGill University Health Centre, Montreal, QC
| | - Wassim Kassouf
- Department of Surgery, McGill University Health Centre, Montreal, QC
| |
Collapse
|
43
|
Abstract
Integrative oncology uses non-pharmacological adjuncts to mainstream care to manage physical, emotional, and psychological symptoms experienced by cancer survivors. Depression, anxiety, fatigue and pain are among the common, often burdensome symptoms that can occur in clusters, deplete patient morale, interfere with treatment plans, and hamper recovery. Patients already seek various modalities on their own to address a broad range of problems. Legitimate complementary therapies offered at major cancer institutions improve quality of life, speed recovery, and optimize patient support. They also augment the benefits of psychiatric interventions, due to their ability to increase self-awareness and improve physical and psychological conditioning. Further, these integrated therapies provide lifelong tools and develop skills that patients use well after treatment to develop self-care regimens. The active referral of patients to integrative therapies achieves three important objectives: complementary care is received from therapists experienced in working with cancer patients, visits become part of the medical record, allowing treatment teams to guide individuals in maximizing benefit, and patients are diverted from useless or harmful 'alternatives.' We review the reciprocal physical and psychiatric benefits of exercise, mind-body practices, massage, acupuncture, and music therapy for cancer survivors, and suggest how their use can augment mainstream psychiatric interventions.
Collapse
Affiliation(s)
- Barrie R Cassileth
- Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center , New York , USA
| |
Collapse
|
44
|
Sahai SK. Perioperative assessment of the cancer patient. Best Pract Res Clin Anaesthesiol 2013; 27:465-80. [PMID: 24267552 DOI: 10.1016/j.bpa.2013.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 11/26/2022]
Abstract
The perioperative evaluation of patients with cancer differs from that of other patients in that the former may have received prior chemotherapy or radiation therapy. These cancer treatments have a wide range of side effects and complications that may affect patients' perioperative risks. The perioperative specialist who evaluates the cancer patient prior to surgery must be familiar with the effects of these treatments and their consequences for the major organ systems. The perioperative specialist must also be familiar with the natural history of cancer and have a basic understanding of how cancer affects the body. In this article, we review the perioperative concerns that are specific to the patient with cancer.
Collapse
Affiliation(s)
- Sunil Kumar Sahai
- The Internal Medicine Perioperative Assessment Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
45
|
Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil 2013; 92:715-27. [PMID: 23756434 DOI: 10.1097/phm.0b013e31829b4afe] [Citation(s) in RCA: 347] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cancer prehabilitation, a process on the continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment, includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient's health to reduce the incidence and the severity of current and future impairments. There is a growing body of scientific evidence that supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments. This is the first review of cancer prehabilitation, and the purpose was to describe early studies in the noncancer population and then the historical focus in cancer patients on aerobic conditioning and building strength and stamina through an appropriate exercise regimen. More recent research shows that opportunities exist to use other unimodal or multimodal prehabilitation interventions to decrease morbidity, improve physical and psychological health outcomes, increase the number of potential treatment options, decrease hospital readmissions, and reduce both direct and indirect healthcare costs attributed to cancer. Future research may demonstrate increased compliance with acute cancer treatment protocols and, therefore, improved survival outcomes. New studies suggest that a multimodal approach that incorporates both physical and psychological prehabilitation interventions may be more effective than a unimodal approach that addresses just one or the other. In an impairment-driven cancer rehabilitation model, identifying current and anticipating future impairments are the critical first steps in improving healthcare outcomes and decreasing costs. More research is urgently needed to evaluate the most effective prehabilitation interventions, and combinations thereof, for survivors of all types of cancer.
Collapse
|
46
|
The next step: optimizing preoperative functional fitness and nutritional intervention. Can J Anaesth 2012; 60:208. [PMID: 23212698 DOI: 10.1007/s12630-012-9830-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022] Open
|
47
|
Fearon KC, Jenkins JT, Carli F, Lassen K. Patient optimization for gastrointestinal cancer surgery. Br J Surg 2012; 100:15-27. [PMID: 23165327 DOI: 10.1002/bjs.8988] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although surgical resection remains the central element in curative treatment of gastrointestinal cancer, increasing emphasis and resource has been focused on neoadjuvant or adjuvant therapy. Developments in these modalities have improved outcomes, but far less attention has been paid to improving oncological outcomes through optimization of perioperative care. METHODS A narrative review is presented based on available and updated literature in English and the authors' experience with enhanced recovery research. RESULTS A range of perioperative factors (such as lifestyle, co-morbidity, anaemia, sarcopenia, medications, regional analgesia and minimal access surgery) are modifiable, and can be optimized to reduce short- and long-term morbidity and mortality, improve functional capacity and quality of life, and possibly improve oncological outcome. The effect on cancer-free and overall survival may be of equal magnitude to that achieved by many adjuvant oncological regimens. Modulation of core factors, such as nutritional status, systemic inflammation, and surgical and disease-mediated stress, probably influences the host's immune surveillance and defence status both directly and through reduced postoperative morbidity. CONCLUSION A wider view on long-term effects of expanded or targeted enhanced recovery protocols is warranted.
Collapse
Affiliation(s)
- K C Fearon
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | | |
Collapse
|