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Triguero-Cánovas D, López-Rodríguez-Arias F, Gómez-Martínez M, Sánchez-Guillén L, Peris-Castelló F, Alcaide-Quirós MJ, Morillas-Blasco P, Arroyo A, Ramírez JM. Home-based prehabilitation improves physical conditions measured by ergospirometry and 6MWT in colorectal cancer patients: a randomized controlled pilot study. Support Care Cancer 2023; 31:673. [PMID: 37930478 DOI: 10.1007/s00520-023-08140-4] [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: 07/08/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE/BACKGROUND Prehabilitation aims to improve physical condition in the preoperative period and, therefore, decrease the loss of cardiopulmonary capacity postoperatively, with the aim of reducing complications and promoting an early recovery. This study aims to evaluate the impact of home-based prehabilitation on the physical condition of patients treated surgically for colorectal cancer. METHODS A prospective and randomized clinical study was conducted on 60 patients during two periods from October 2018 to February 2019 and from September 2019 to September 2020, in a single university hospital. Patients were randomized into two study groups (30 per group): prehabilitation vs. standard care. Changes in physical condition, measured at diagnosis, the day before surgery, and at 6-8 weeks after surgery using the cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT) were evaluated. RESULTS Prehabilitation reduced postoperative complications (17.4% vs. 33.3%, p = 0.22) and hospital stay (5.74 vs. 6.67 days, p = 0.30). 6MWT showed a significant improvement in the prehabilitation group (+78.9 m). Six weeks after surgery, prehabilitation showed a significant improvement in the 6MWT (+68.9 m vs. -27.2 m, p = 0.01). Significant differences were also observed in the ergospirometry between the diagnosis and postoperative study (+0.79 METs vs. -0.84 METs, p = 0.001). A strong correlation was observed between CPET and 6MWT (0.767 (p < 0.001)). CONCLUSION Home prehabilitation achieved lower overall postoperative complications than standard care and reached significant improvements in 6MWT and CET. A strong correlation was observed between CET and 6MWT, which allows validation of 6MWT as a valid and reliable measure of functional exercise capacity in colorectal patients when other, more specific and expensive tests are not available. TRIAL REGISTRATION Registered in ClinicalTrials.gov in August 2018 with registration number https://clinicaltrials.gov/study/NCT03618329?cond=Prehabilitation%20cancer&term=arroyo&distance=50&rank=1 (NCT03618329). Initial results published in Supportive Care in Cancer: Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic. DOI: https://doi.org/10.1007/s00520-021-06343-1 .
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Affiliation(s)
- Daniel Triguero-Cánovas
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Francisco López-Rodríguez-Arias
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Manuel Gómez-Martínez
- Department of Cardiology, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Luis Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain.
| | - Franc Peris-Castelló
- Department of Cardiology, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - María José Alcaide-Quirós
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Pedro Morillas-Blasco
- Department of Cardiology, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Antonio Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Jose Manuel Ramírez
- Department of General Surgery, Colorectal Unit, University Hospital Lozano Blesa, University of Zaragoza, Zaragoza, Spain
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Matos LL, Sanabria A, Robbins KT, Halmos GB, Strojan P, Ng WT, Takes RP, Angelos P, Piazza C, de Bree R, Ronen O, Guntinas-Lichius O, Eisbruch A, Zafereo M, Mäkitie AA, Shaha AR, Coca-Pelaz A, Rinaldo A, Saba NF, Cohen O, Lopez F, Rodrigo JP, Silver CE, Strandberg TE, Kowalski LP, Ferlito A. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Adv Ther 2023; 40:1957-1974. [PMID: 36920746 DOI: 10.1007/s12325-023-02460-x] [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: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard of care, as nonstandard approaches may result in increased treatment failure rates and mortality. The treatment plan is best established by a multidisciplinary tumor board with shared decision-making with patients and family. Treatment modifications should be considered for those patients who have severe comorbidities, evidence of frailty (low performance status), or low performance status or those who refuse the recommendations of the tumor board.
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Affiliation(s)
- Leandro L Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, São Paulo, Brazil
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - K Thomas Robbins
- Division of Otolaryngology, Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gyorgy B Halmos
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Robert P Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Israel, Affiliated with Ben-Gurion University of the Negev, Sheva, Israel
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, 8th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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López-Rodríguez-Arias F, Sánchez-Guillén L, Aranaz-Ostáriz V, Triguero-Cánovas D, Lario-Pérez S, Barber-Valles X, Lacueva FJ, Ramirez JM, Arroyo A. Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic. Support Care Cancer 2021; 29:7785-7791. [PMID: 34169328 PMCID: PMC8225311 DOI: 10.1007/s00520-021-06343-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/06/2021] [Indexed: 12/19/2022]
Abstract
Background Surgery remains the first curative treatment for colorectal cancer. Prehabilitation seems to attenuate the loss of lean mass in the early postoperative period. However, its long-term role has not been studied. Lockdown due to the COVID-19 pandemic has forced to carry out the prehabilitation program at home. This study aimed to assess the effect of home prehabilitation on body composition, complications, and hospital stay in patients undergoing oncological colorectal surgery. Methods A prospective and randomized clinical study was conducted in 20 patients operated of colorectal cancer during COVID-19 lockdown (13 March to 21 June 2020) in a single university clinical hospital. Patients were randomized into two study groups (10 per group): prehabilitation vs standard care. Changes in lean mass and fat mass at 45 and 90 days after surgery were measured using multifrequency bioelectrical impedance analysis. Results Prehabilitation managed to reduce hospital stay (4.8 vs 7.2 days, p = 0.052) and postoperative complications (20% vs 50%, p = 0.16). Forty-five days after surgery, the loss of lean mass decreased (1.7% vs 7.1%, p = 0.17). These differences in lean mass were attenuated at 90 days; however, the standard care group increased considerably their fat mass compared to the prehabilitation group (+ 8.72% vs − 8.16%). Conclusions Home prehabilitation has proven its effectiveness, achieving an attenuation of lean mass loss in the early postoperative period and a lower gain in fat mass in the late postoperative period. In addition, it has managed to reduce hospital stays and postoperative complications. Registration number This article is part of an ongoing, randomized, and controlled clinical trial approved by the ethics committee of our hospital and registered in ClinicalTrials.gov in August 2018 with registration number NCT03618329.
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Affiliation(s)
- Francisco López-Rodríguez-Arias
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Luis Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Verónica Aranaz-Ostáriz
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Daniel Triguero-Cánovas
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Sandra Lario-Pérez
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Xavier Barber-Valles
- Center for Operations Research, Miguel Hernández University, Elche, Alicante Spain
| | - Francisco J. Lacueva
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - José M. Ramirez
- Department of General Surgery, Colorectal Unit, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | - Antonio Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
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