1
|
Loughney L, Murphy K, Tully R, Robb WB, McCaffrey N, Dowd K, Skelly F. The effect of a pre- and post-operative exercise program versus standard care on physical activity and sedentary behavior of patients with esophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (the PERIOP-OG Trial): a randomized controlled trial†. Dis Esophagus 2024; 37:doae044. [PMID: 38769843 PMCID: PMC11447153 DOI: 10.1093/dote/doae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024]
Abstract
Neoadjuvant cancer treatment (NCT) reduces both physical fitness and physical activity (PA) levels, which can increase the risk of adverse outcomes in cancer patients. This study aims to determine the effect of exercise prehabilitation on PA and sedentary behavior (SB) in patients undergoing NCT and surgery for esophagogastric malignancies. This study is a randomized pragmatic controlled multi-center trial conducted across three Irish hospitals. Participants were aged ≥18 years scheduled for esophagectomy or gastrectomy and were planned for NCT and surgery. Participants were randomized to an exercise prehabilitation group (EX) that commenced following cancer diagnosis, continued to the point of surgery, and resumed following recovery from surgery for 6 weeks or to usual care (UC) who received routine treatment. The primary outcome measures were PA and SB. Between March 2019 and December 2020, 71 participants were recruited: EX (n = 36) or UC (n = 35). No significant differences were found between the EX group and UC group on levels of PA or SBs across all measured timepoints. Significant decreases in moderate-vigorous physical activity levels (MVPAs) were found between baseline and post-surgery (P = 0.028), pre-surgery and post-surgery (P = 0.001) and pre-surgery and 6-week follow-up (P = 0.022) for all participants. Step count also significantly decreased between pre-surgery and post-surgery (P < 0.001). Baseline aerobic fitness was positively associated to PA levels and negatively associated with SB. Esophagogastric cancer patients have lower than recommended levels of PA at the time of diagnosis and this decreased further following completion of NCT. An optional home- or group-based exercise intervention was not effective in improving PA levels or behaviors across the cancer treatment journey.
Collapse
Affiliation(s)
- Lisa Loughney
- ExWell Medical, Dublin, Ireland
- School of Health & Human Performance, Dublin City University, Dublin, Ireland
- The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kate Murphy
- School of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Roisin Tully
- The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland
| | - William B Robb
- The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Upper GI Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Kieran Dowd
- SHE Research Group, Department of Sports & Health Science, Technological University of the Shannon, Athlone Westmeath, Ireland
| | - Fiona Skelly
- ExWell Medical, Dublin, Ireland
- SHE Research Group, Department of Sports & Health Science, Technological University of the Shannon, Athlone Westmeath, Ireland
| |
Collapse
|
2
|
Kang DW, Dawson JK, Barnes O, Wilson RL, Norris MK, Gonzalo-Encabo P, Christopher CN, Ficarra S, Dieli-Conwright CM. Resistance Exercise and Skeletal Muscle-Related Outcomes in Patients with Cancer: A Systematic Review. Med Sci Sports Exerc 2024; 56:1747-1758. [PMID: 38650124 DOI: 10.1249/mss.0000000000003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Skeletal muscle loss is prevalent throughout the cancer continuum and correlated with morbidity and mortality. Resistance exercise has been trialed to mitigate skeletal muscle loss. This systematic review summarizes and qualitatively synthesizes the effects of resistance exercise on muscle-related outcomes in adult cancer populations, including skeletal muscle mass, performance and muscle-related biomarkers. METHODS The systematic review protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). We searched electronic databases including AMED, CENTRAL, CINAHL, CIRRIE, EMBASE, MEDLINE, PEDro, REHABDATA, Scopus, and SPORTDiscus from inception to December 2021. We included randomized controlled trials that investigated the effects of resistance exercise on muscle-related outcomes in adult cancer populations. Interventions that involved any resistance exercise were included. Muscle-related outcomes were categorized as skeletal muscle mass (e.g., lean mass, appendicular muscle mass), muscle performance (e.g., muscle strength, physical function), and muscle-related biomarkers (e.g., muscle cells, metabolic/inflammatory markers). Risk of bias (RoB) was assessed using the Cochrane ROB tool. RESULTS A total of 102 studies from 101 randomized controlled trials were included. The majority of studies focused on breast cancer (46%) and those who completed treatment (43%). Resistance exercise interventions were largely 3-4 months long (48%), combined with aerobic exercise (56%), at a vigorous intensity (25%), and in-person/supervised settings (57%). Among the studies assessing muscle mass, performance, and biomarkers ( n = 42, 83, and 22, respectively), resistance exercise interventions improved upper/lower body or appendicular muscle mass (67%-100%), muscle strength (61%-68%), and physical function (74%-100%). Most biomarkers did not show significant changes (75%-100%) or showed inconsistent results. CONCLUSIONS Generally, resistance exercise had positive effects on skeletal muscle mass and performance with no negative effects compared to controls. Our findings demonstrated that resistance exercise may be an effective strategy to attenuate deterioration or exert improvements in muscle mass and performance outcomes.
Collapse
Affiliation(s)
| | - Jacqueline K Dawson
- Department of Physical Therapy, California State University, Long Beach, Long Beach, CA
| | - Oscar Barnes
- Green Templeton College, University of Oxford, UNITED KINGDOM
| | | | - Mary K Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Salvatore Ficarra
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, ITALY
| | | |
Collapse
|
3
|
Del Bianco N, Borsati A, Toniolo L, Ciurnielli C, Belluomini L, Insolda J, Sposito M, Milella M, Schena F, Pilotto S, Avancini A. What is the role of physical exercise in the era of cancer prehabilitation? A systematic review. Crit Rev Oncol Hematol 2024; 198:104350. [PMID: 38642726 DOI: 10.1016/j.critrevonc.2024.104350] [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: 09/11/2023] [Revised: 03/18/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE Exercise before surgery, as part of prehabilitation, aiming to enhance patients' functional and physiological capacity, has become widespread, necessitating an in-depth understanding. METHODS A systematic search was conducted on Pubmed, Cochrane, and Scopus to examine the effect of exercise as prehabilitation, alone or in combination with other interventions, in patients with cancer. Interventional studies applying a single-arm, randomized controlled, or nonrandomized design were included. RESULTS A total of 96 studies were included, and categorized according to cancer types, i.e., gynecological, breast, urological, gastrointestinal and lung cancer. For each cancer site, the effect of exercise, on physical fitness parameters and postoperative outcomes, including length of hospital stay and postoperative complications, was reported. CONCLUSION Exercise as prehabilitation may have an important role in improving physical fitness, postoperative outcomes, and accelerating recovery, especially in certain types of malignancies.
Collapse
Affiliation(s)
- Nicole Del Bianco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anita Borsati
- Department of Medicine, Verona University Hospital Trust, Verona, Italy
| | - Linda Toniolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Christian Ciurnielli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Belluomini
- Section of Oncology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Jessica Insolda
- Section of Oncology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Marco Sposito
- Section of Oncology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Oncology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy.
| | - Alice Avancini
- Section of Oncology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| |
Collapse
|
4
|
Nemkov T, Cendali F, Dzieciatkowska M, Stephenson D, Hansen KC, Jankowski CM, D’Alessandro A, Marker RJ. A Multiomics Assessment of Preoperative Exercise in Pancreatic Cancer Survivors Receiving Neoadjuvant Therapy: A Case Series. PATHOPHYSIOLOGY 2024; 31:166-182. [PMID: 38535623 PMCID: PMC10975467 DOI: 10.3390/pathophysiology31010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
To molecularly characterize the impact of exercise on mitigating neoadjuvant treatment (NAT)-induced physical decline in pancreatic ductal adenocarcinoma (PDAC) patients, a multi-omics approach was employed for the analysis of plasma samples before and after a personalized exercise intervention. Consisting of personalized aerobic and resistance exercises, this intervention was associated with significant molecular changes that correlated with improvements in lean mass, appendicular skeletal muscle index (ASMI), and performance in the 400-m walk test (MWT) and sit-to-stand test. These alterations indicated exercise-induced modulation of inflammation and mitochondrial function markers. This case study provides proof-of-principal application for multiomics-based assessments of supervised exercise, thereby supporting this intervention as a feasible and beneficial intervention for PDAC patients to potentially enhance treatment response and patient quality of life. The molecular changes observed here underscore the importance of physical activity in cancer treatment protocols, advocating for the development of accessible multiomics-guided exercise programs for cancer patients.
Collapse
Affiliation(s)
- Travis Nemkov
- Department of Biochemistry and Molecular Genetics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA; (F.C.); (M.D.); (D.S.); (A.D.)
| | - Francesca Cendali
- Department of Biochemistry and Molecular Genetics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA; (F.C.); (M.D.); (D.S.); (A.D.)
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA; (F.C.); (M.D.); (D.S.); (A.D.)
| | - Daniel Stephenson
- Department of Biochemistry and Molecular Genetics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA; (F.C.); (M.D.); (D.S.); (A.D.)
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA; (F.C.); (M.D.); (D.S.); (A.D.)
| | | | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA; (F.C.); (M.D.); (D.S.); (A.D.)
| | - Ryan J. Marker
- Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| |
Collapse
|
5
|
Malveiro C, Correia IR, Cargaleiro C, Magalhães JP, de Matos LV, Hilário S, Sardinha LB, Cardoso MJ. Effects of exercise training on cancer patients undergoing neoadjuvant treatment: A systematic review. J Sci Med Sport 2023; 26:586-592. [PMID: 37696693 DOI: 10.1016/j.jsams.2023.08.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES This systematic review aimed to analyze the effects of different exercise protocols on physical fitness (cardiorespiratory fitness, muscle strength, and body composition), quality of life, cancer-related fatigue, and sleep quality in patients with different types of cancer undergoing neoadjuvant treatment. DESIGN Systematic review. METHOD A comprehensive search of existing literature was carried out using four electronic databases: PubMed, Scopus, Web of Science, and Cochrane Library (published until October 19, 2022). All databases were searched for randomized controlled trials, quasi-experimental investigations, and pre-post investigations assessing the effects of exercise in cancer patients during neoadjuvant treatment. Excluded articles included multicomponent interventions, such as exercise plus diet or behavioral therapy, and investigations performed during adjuvant treatment or survivorship. The methodological quality of each study was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Twenty-seven trials involving 999 cancer patients were included in this review. The interventions were conducted in cancer patients undergoing neoadjuvant treatment for rectal (n = 11), breast (n = 5), pancreatic (n = 4), esophageal (n = 3), gastro-esophageal (n = 2), and prostate (n = 1) cancers, and leukemia (n = 1). Among the investigations included, 14 utilized combined exercise protocols, 11 utilized aerobic exercise, and two utilized both aerobic and resistance training separately. Exercise interventions appeared to improve cardiorespiratory fitness, muscle strength, body composition, and quality of life, although many investigations lacked a between-group analysis. CONCLUSION Despite limited evidence, exercise interventions applied during neoadjuvant treatment demonstrate promising potential in enhancing cardiorespiratory fitness, muscle strength, body composition, and overall quality of life. However, a scarcity of evidence remains on the effects of exercise on cancer-related fatigue and sleep quality. Further research with high-quality randomized controlled trials is warranted.
Collapse
Affiliation(s)
- Carla Malveiro
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal; Breast Unit, Champalimaud Foundation, Portugal.
| | - Inês R Correia
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | - Catarina Cargaleiro
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | - João P Magalhães
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | | | - Sofia Hilário
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | - Maria João Cardoso
- Breast Unit, Champalimaud Foundation, Portugal; Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Portugal
| |
Collapse
|
6
|
Kjeldsted E, Ammitzbøll G, Jørgensen LB, Lodin A, Bojesen RD, Ceballos SG, Rosthøj S, Lænkholm AV, Skou ST, Jack S, Gehl J, Dalton SO. Neo-train: study protocol and feasibility results for a two-arm randomized controlled trial investigating the effect of supervised exercise during neoadjuvant chemotherapy on tumour response in patients with breast cancer. BMC Cancer 2023; 23:777. [PMID: 37598196 PMCID: PMC10439618 DOI: 10.1186/s12885-023-11284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Prehabilitation with exercise interventions during neoadjuvant chemotherapy (NACT) is effective in reducing physical and psychosocial chemotherapy-related adverse events in patients with cancer. In preclinical studies, data also support a growth inhibitory effect of aerobic exercise on the tumour microenvironment with possible improved chemotherapy delivery but evidence in human patients is limited. The aim of the study here described is to investigate if supervised exercise with high-intensity aerobic and resistance training during NACT can improve tumour reduction in patients with breast cancer. METHODS This parallel two-armed randomized controlled trial is planned to include 120 women aged ≥ 18 years with newly diagnosed breast cancer starting standard NACT at a university hospital in Denmark (a total of 90 participants needed according to the power calculation and allowing 25% (n = 30) dropout). The participants will be randomized to usual care or supervised exercise consisting of high-intensity interval training on a stationary exercise bike and machine-based progressive resistance training offered three times a week for 24 weeks during NACT, and screening-based advice to seek counselling in case of moderate-severe psychological distress (Neo-Train program). The primary outcome is tumour size change (maximum diameter of the largest lesion in millimetre) measured by magnetic resonance imaging prior to surgery. Secondary outcomes include clinical/pathological, physical and patient-reported measures such as relative dose intensity of NACT, hospital admissions, body composition, physical fitness, muscle strength, health-related quality of life, general anxiety, depression, and biological measures such as intratumoural vascularity, tumour infiltrating lymphocytes, circulating tumour DNA and blood chemistry. Outcomes will be measured at baseline (one week before to 1-2 weeks after starting NACT), during NACT (approximately week 7, 13 and 19), pre-surgery (approximately week 21-29), at surgery (approximately week 21-30) and 3 months post-surgery (approximately 33-42 weeks from baseline). DISCUSSION This study will provide novel and important data on the potential benefits of supervised aerobic and resistance exercise concomitant to NACT on tumour response and the tumour microenvironment in patients with breast cancer, with potential importance for survival and risk of recurrence. If effective, our study may help increase focus of exercise as an active part of the neoadjuvant treatment strategy. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (NCT04623554) on November 10, 2020.
Collapse
Affiliation(s)
- Eva Kjeldsted
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark.
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark.
- Danish Research Centre for Equality in Cancer (COMPAS), Rådmannsengen 5, Naestved, 4700, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark.
| | - Gunn Ammitzbøll
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark
- Danish Research Centre for Equality in Cancer (COMPAS), Rådmannsengen 5, Naestved, 4700, Denmark
| | - Lars Bo Jørgensen
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Sygehusvej 10, Roskilde, 4000, Denmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved- Slagelse-Ringsted Hospitals, Faelledvej 2C, 1, Slagelse, 4200, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
| | - Alexey Lodin
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
| | - Rasmus Dahlin Bojesen
- Department of Surgery, Naestved-Slagelse-Ringsted Hospitals, Faelledvej 11, Slagelse, 4200, Denmark
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, Køge, 4600, Denmark
| | | | - Susanne Rosthøj
- Statistics & Data Analysis, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark
| | - Anne-Vibeke Lænkholm
- Department of Pathology, Zealand University Hospital, Sygehusvej 9, Roskilde, 4000, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved- Slagelse-Ringsted Hospitals, Faelledvej 2C, 1, Slagelse, 4200, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
| | - Sandy Jack
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, MP218, Tremona Road, Southampton, SO16 6YD, UK
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark
- Danish Research Centre for Equality in Cancer (COMPAS), Rådmannsengen 5, Naestved, 4700, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
| |
Collapse
|
7
|
Raskov H, Gaggar S, Tajik A, Orhan A, Gögenur I. Metabolic switch in cancer - Survival of the fittest. Eur J Cancer 2023; 180:30-51. [PMID: 36527974 DOI: 10.1016/j.ejca.2022.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Cell metabolism is characterised by the highly coordinated conversion of nutrients into energy and biomass. In solid cancers, hypoxia, nutrient deficiencies, and tumour vasculature are incompatible with accelerated anabolic growth and require a rewiring of cancer cell metabolism. Driver gene mutations direct malignant cells away from oxidation to maximise energy production and biosynthesis while tumour-secreted factors degrade peripheral tissues to fuel disease progression and initiate metastasis. As it is vital to understand cancer cell metabolism and survival mechanisms, this review discusses the metabolic switch and current drug targets and clinical trials. In the future, metabolic markers may be included when phenotyping individual tumours to improve the therapeutic opportunities for personalised therapy.
Collapse
Affiliation(s)
- Hans Raskov
- Center for Surgical Science, Zealand University Hospital, Køge, 4600, Denmark.
| | - Shruti Gaggar
- Center for Surgical Science, Zealand University Hospital, Køge, 4600, Denmark
| | - Asma Tajik
- Center for Surgical Science, Zealand University Hospital, Køge, 4600, Denmark
| | - Adile Orhan
- Center for Surgical Science, Zealand University Hospital, Køge, 4600, Denmark; Department of Clinical Oncology, Zealand University Hospital, Roskilde, 4000, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Køge, 4600, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark
| |
Collapse
|
8
|
Cuyàs E, Verdura S, Martin-Castillo B, Menendez JA. Circulating levels of MOTS-c in patients with breast cancer treated with metformin. Aging (Albany NY) 2022; 15:892-897. [PMID: 36490309 PMCID: PMC10008497 DOI: 10.18632/aging.204423] [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: 10/08/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
The mitokine MOTS-c is a mitochondrially-encoded "exercise-mimetic peptide" expressed in multiple tissues, particularly skeletal muscles, which can be detected as a circulating hormone in the blood. MOTS-c mechanisms of action (MoA) involve insulin sensitization, enhanced glucose utilization, suppression of mitochondrial respiration, and targeting of the folate-AICAR-AMPK pathway. Although MOTS-c MoA largely overlap those of the anti-diabetic biguanide metformin, the putative regulatory actions of metformin on MOTS-c have not yet been evaluated in detail. Here, we measured circulating MOTS-c in paired baseline and post-treatment sera obtained from HER2-positive breast cancer patients randomized to receive either metformin combined with neoadjuvant chemotherapy and trastuzumab or an equivalent regimen without metformin. We failed to find any significant alteration of circulating MOTS-c -as measured using the commercially available competitive ELISA CEX132Hu- in response to 24 weeks of a neoadjuvant chemotherapy/trastuzumab regimen with or without daily metformin. Changes in circulating MOTS-c levels failed to reach statistical significance when comparing patients achieving pathological complete response (pCR), irrespective of metformin treatment. The inability of metformin to target skeletal muscle, the major tissue for MOTS-c production and secretion, might limit its regulatory effects on circulating MOTS-c. Further studies are needed to definitely elucidate the nature of the interaction between metformin and MOTS-c in cancer and non-cancer patients.
Collapse
Affiliation(s)
- Elisabet Cuyàs
- Metabolism and Cancer Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology, Girona 17005, Spain.,Girona Biomedical Research Institute, Girona 17190, Spain
| | - Sara Verdura
- Metabolism and Cancer Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology, Girona 17005, Spain.,Girona Biomedical Research Institute, Girona 17190, Spain
| | - Begoña Martin-Castillo
- Girona Biomedical Research Institute, Girona 17190, Spain.,Clinical Research Unit, Catalan Institute of Oncology, Girona 17005, Spain
| | - Javier A Menendez
- Metabolism and Cancer Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology, Girona 17005, Spain.,Girona Biomedical Research Institute, Girona 17190, Spain
| | | |
Collapse
|
9
|
Dawson JK, Kang DW, Barnes O, Wilson RL, Norris MK, Dieli-Conwright CM. Efficacy of resistive exercise on skeletal muscle-related outcomes in cancer survivors: a systematic review protocol. Syst Rev 2022; 11:252. [PMID: 36419204 PMCID: PMC9686078 DOI: 10.1186/s13643-022-02130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Symptom burden and adverse treatment effects can negatively impact physical function, health-related outcomes, and quality of life in cancer survivors. Resistive exercise that improves skeletal muscle function can ameliorate these complications, but the central role of the skeletal muscle in mediating improvements in patient-related outcomes has not been explored. This protocol describes the rationale and methods for a systematic review that aims to determine the effects of resistive exercise on the skeletal muscle hypertrophy, muscle performance, and muscle-related biomarkers in cancer survivors. METHODS A systematic review will be conducted on peer-reviewed randomized controlled trials (RCTs) that employ resistive exercise interventions for cancer survivors. The following electronic databases will be searched: AMED, CENTRAL, CINAHL, CIRRIE, EMBASE, MEDLINE, PEDro, REHABDATA, Scopus, and SPORTDiscus. Studies will be considered for inclusion if they present quantitative data in adult cancer survivors on skeletal muscle characteristics (e.g., muscle mass), muscle performance (e.g., strength), or skeletal muscle-related biomarkers (e.g., myocellular satellite cells). Secondary outcomes will be physical function (e.g., stair climb) and patient-reported outcomes (e.g., fatigue). Data will be reported through a narrative that describes study design, participants, interventions, and outcome characteristics. DISCUSSION This systematic review will help clarify the influence of resistive exercise on factors relating to the skeletal muscle in adult cancer survivors. Findings may provide insight into optimal exercise selection for evidence-based practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO: #277791 [under review].
Collapse
Affiliation(s)
- Jacqueline K Dawson
- Department of Physical Therapy, California State University, Long Beach, Long Beach, CA, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Oscar Barnes
- Green Templeton College, University of Oxford, Oxford, UK
| | - Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mary K Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
10
|
Sivakumar J, Forshaw MJ, Lam S, Peters CJ, Allum WH, Whibley J, Sinclair RCF, Snowden CP, Hii MW, Sivakumar H, Read M. Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data. Dis Esophagus 2022; 35:6524743. [PMID: 35138383 DOI: 10.1093/dote/doac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/28/2021] [Indexed: 12/11/2022]
Abstract
Preoperative cardiopulmonary exercise testing (CPET) provides an objective assessment of aerobic fitness in patients undergoing surgery. While peak oxygen uptake during exercise (VO2peak) and anaerobic threshold have demonstrated a moderate correlation with the development of complications following esophagectomy, no clinically useful threshold values have been defined. By pooling patient level data from existing studies, we aimed to define optimal thresholds for preoperative CPET parameters to predict patients at high risk of postoperative complications. Studies reporting on the relationship between preoperative CPET variables and post-esophagectomy complications were determined from a comprehensive literature search. Patient-level data were obtained from six contributing centers for pooled-analyses. Outcomes of interest included cardiopulmonary and non-cardiopulmonary complications, unplanned intensive care unit readmission, and 90-day and 12-month all-cause mortality. Receiver operating characteristic curves and logistic regression models estimated the predictive value of CPET parameters for each individual outcome of interest. This analysis comprised of 621 patients who underwent CPET prior to esophagectomy during the period from January 2004 to March 2017. For both anaerobic threshold and VO2peak, none of the receiver operating characteristic curves achieved an area under the curve value > 0.66 for the outcomes of interest. The discriminatory ability of CPET for determining high-risk patients was found to be poor in patients undergoing an esophagectomy. CPET may only carry an adjunct role to clinical decision-making.
Collapse
Affiliation(s)
- Jonathan Sivakumar
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Matthew J Forshaw
- Department of Upper Gastrointestinal Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen Lam
- Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Christopher J Peters
- Department of Surgery and Cancer, Imperial College London of St Mary's Hospital, London, UK
| | | | - Jessica Whibley
- Department of Physiotherapy, Royal Marsden Hospital, London, UK
| | - Rhona C F Sinclair
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | | | - Michael W Hii
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Harry Sivakumar
- Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia
| | - Matthew Read
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| |
Collapse
|
11
|
Schmid S, Minnella EM, Pilon Y, Rokah M, Rayes R, Najmeh S, Cools-Lartigue J, Ferri L, Mulder D, Sirois C, Owen S, Shieh B, Ofiara L, Wong A, Sud S, Baldini G, Carli F, Spicer J. Neoadjuvant Prehabilitation Therapy for Locally Advanced Non-Small-Cell Lung Cancer: Optimizing Outcomes Throughout the Trajectory of Care. Clin Lung Cancer 2022; 23:593-599. [PMID: 35705449 DOI: 10.1016/j.cllc.2022.05.004] [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: 02/03/2022] [Revised: 04/20/2022] [Accepted: 05/08/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prehabilitation is well established for improving outcomes in cancer surgery. Combining prehabilitation with neoadjuvant treatments may provide an opportunity to rapidly initiate cancer-directed therapy while improving functional status in preparation for local consolidation. In this proof-of-concept study, we analyzed non-small-cell lung cancer patients who underwent simultaneous prehabilitation and neoadjuvant therapy. PATIENTS AND METHODS We retrospectively analyzed all patients who underwent neoadjuvant treatment for non-small-cell lung cancer followed by curative intent surgery between 2015 and 2021. Patients who were screened for the prehabilitation program were identified. The screening included assessment of physical performance, nutritional status, and signs of anxiety and depression. RESULTS We identified a total of 141 patients who underwent neoadjuvant therapy. Twenty patients were screened to undergo a prehabilitation program. Four patients did not complete the exercise program (1 surgical intervention too soon, 1 drop-out after the first session, and 2 patients were deemed fit without intervention). The postoperative median length of stay was 2 days (range 1-18). Patients improved their 6-minute-walk test despite undergoing neoadjuvant treatment by a mean of 33 meters (± 50, P = .1). Self-reported functional status (DASI) showed significant improvement by a mean of 10 points (± 11, P = .03), and HADS-anxiety-score was significantly reduced after the prehabilitation program by a mean of 1.5 points (± 1, P = .005). CONCLUSION Neoadjuvant prehabilitation therapy is feasible and associated with encouraging results. The performance of all measures remains a logistic challenge. With multimodal strategies for lung cancer treatment becoming key to optimal outcomes, neoadjuvant prehabilitation therapy is a concept worthy of prospective multi-center evaluation.
Collapse
Affiliation(s)
- Severin Schmid
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany
| | | | - Yohann Pilon
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Merav Rokah
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Roni Rayes
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Sara Najmeh
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Lorenzo Ferri
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - David Mulder
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christian Sirois
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Scott Owen
- Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Benjamin Shieh
- Division of Respiratory Medicine, McGill University, Montreal, QC, Canada
| | - Linda Ofiara
- Division of Respiratory Medicine, McGill University, Montreal, QC, Canada
| | - Annick Wong
- Department of Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Shelly Sud
- Department of Medical Oncology, Centre Intégré de Santé et des Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Gabriele Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Jonathan Spicer
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
| |
Collapse
|
12
|
de Boniface J, Altena R, Haddad Ringborg C, Bolam KA, Wengström Y. Physical exercise during neoadjuvant chemotherapy for breast cancer as a mean to increase pathological complete response rates: Trial protocol of the randomized Neo-ACT trial. PLoS One 2022; 17:e0274804. [PMID: 36227931 PMCID: PMC9562167 DOI: 10.1371/journal.pone.0274804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION In early breast cancer, neoadjuvant chemotherapy (NACT) is increasingly used. The proof of efficacy is pathologically complete response (pCR), i.e. the absence of invasive tumour in breast and lymph nodes at surgery. Today, pCR is a common endpoint in pharmaceutical trials since it is significantly associated with survival especially in triple-negative and HER2-positive subtypes. Apart from the mitigation of treatment-related toxicity and symptoms, physical exercise mediates anti-tumoral systemic effects associated with tumour regression in preclinical and clinical models. The aim of Neo-ACT is to test the hypothesis that physical exercise can improve pCR rates in breast cancer patients receiving NACT. METHOD The Neo-ACT trial is a prospective clinical trial, randomising T1-3N0-2 breast cancer patients planned for NACT to either a home-based physical exercise intervention supported by a mobile application or routine care. The primary endpoint is pCR; secondary endpoints are patient-reported quality of life, toxicity-related outcomes, and oncological outcomes such as Residual Cancer Burden, objective radiological tumour response, as well as overall, breast cancer-specific and disease-free survival at 2, 5 and 10 years. The intervention consists of a combination of high-intensity interval and resistance training of progressing intensity, and includes at least 150 min of moderate to vigorous physical activity per week, inclusive of two weekly 60-min exercise sessions. In order to show an improvement in pCR of 10%, a total of 712 participants need to be included in the analysis. The Neo-ACT has been registered at clinicaltrials.gov on January 11, 2022 (NCT05184582). EXPECTED RESULTS If Neo-ACT can prove the oncological efficacy of physical exercise, implementation of training programmes into NACT schedules will be pursued. The use of a digitally led exercise intervention aims to test the potential of such a strategy for use in rural areas and areas of limited resources.
Collapse
Affiliation(s)
- Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Capio St. Göran’s Hospital, Stockholm, Sweden
- * E-mail:
| | - Renske Altena
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Haddad Ringborg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Kate A. Bolam
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
13
|
Falz R, Bischoff C, Thieme R, Lässing J, Mehdorn M, Stelzner S, Busse M, Gockel I. Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2022; 148:2187-2213. [PMID: 35695931 PMCID: PMC9349170 DOI: 10.1007/s00432-022-04088-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects of exercise prehabilitation depending on the duration of interventions on functional and postoperative outcomes in colon and rectal cancer surgery. METHODS Three electronic databases (MEDLINE Pubmed, Web of Sciences, and Cochrane Registry) were systematically searched (January 2022) for controlled trials that investigated the effects of prehabilitation prior to colo-rectal cancer resection. RESULTS Twenty-three studies were included in this systematic review and 14 in our meta-analyses assessing these outcomes: the 6 min walk distance (6MWD), postoperative overall complications, and length of stay (LOS). We observed a significant improvement in preoperative functional capacity as measured with 6MWD (mean difference: 30.8 m; 95% CI 13.3, 48.3; p = 0.0005) due to prehabilitation. No reductions in LOS (mean difference: - 0.27 days; 95% CI - 0.93, 0.40; p = 0.5) or postoperative overall complications (Odds ratio: 0.84; 95% CI 0.53, 1.31; p = 0.44) were observed. Prehabilitation lasting more than 3 weeks tended to lower overall complications (Odds ratio: 0.66; 95% CI 0.4, 1.1; p = 0.11). However, the prehabilitation time periods differed between colon and rectal carcinoma resections. CONCLUSION Prehabilitation while the patient is preparing to undergo surgery for colorectal carcinoma improves functional capacity; and might reduce postoperative overall complications, but does not shorten the LOS. The studies we reviewed differ in target variables, design, and the intervention's time period. Multicenter studies with sufficient statistical power and differentiating between colon and rectal carcinoma are needed to develop implementation strategies in the health care system. REGISTRATION PROSPERO CRD42022310532.
Collapse
Affiliation(s)
- Roberto Falz
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany.
| | - Christian Bischoff
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Lässing
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Busse
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
14
|
Navigante A, Cresta Morgado P, Daud ML, Dos Santos Regis H, Kolberg M, Marazzi C, Lobbe V, González AA, De Simone G. Physical exercise and fatigue in advanced gastrointestinal cancer during chemotherapy. BMJ Support Palliat Care 2022; 13:218-227. [PMID: 35738869 DOI: 10.1136/bmjspcare-2021-003516] [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: 12/23/2021] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study was aimed to analyse the effect of a patient-oriented modality of physical exercise (programmed and directed physical exercise (PDPE)) on cancer-related fatigue (CRF) and quality of life (QoL). The secondary aim was to evaluate changes in body composition and skeletal muscle function during the study in patients with and without PDPE. METHODS A prospective randomised study was conducted to analyse the impact of PDPE on CRF and QoL. Patients were selected before the development of CRF to set the intervention before its appearance. A high probability CRF population was chosen: patients with advanced gastrointestinal cancer undergoing chemotherapy with weight loss (≥5%) over the last 6 months. PDPE consisted of a programme of exercise delivered weekly and adjusted to patients' medical conditions. Four visits were planned (weeks 0, 4, 8 and 12). QoL, CRF, body composition and skeletal muscle function were evaluated in each visit. RESULTS From 101 patients recruited, 64 were considered evaluable, with three or four visits completed (n=30 control, n=34 PDPE group). Satisfactory compliance of ≥50% to the PDPE programme was seen in 47%. A reduction in the severity of fatigue was detected in the PDPE group (p=0.019), being higher in the subgroup of satisfactory compliance (p<0.001). This latter group showed better results of QoL in comparison with the control group (p=0.0279). A significant increase in endurance was found in the PDPE group (p<0.001). CONCLUSION PDPE reduced the severity of fatigue and improved QoL. The difference in endurance would explain the results seen in the severity of fatigue.
Collapse
Affiliation(s)
- Alfredo Navigante
- Pallium Latinoamérica Association, Buenos Aires, Argentina .,Translational Research Unit, Institute of Oncology Angel H Roffo, Buenos Aires, Argentina
| | - Pablo Cresta Morgado
- Translational Research Unit, Institute of Oncology Angel H Roffo, Buenos Aires, Argentina
| | - María Laura Daud
- Pallium Latinoamérica Association Buenos Aires, AR, CABA, Argentina
| | - Helca Dos Santos Regis
- Section of Rehabilitation and Physiotherapist, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Martín Kolberg
- Pallium Latinoamérica Association Buenos Aires, AR, CABA, Argentina
| | - Carla Marazzi
- Section of Rehabilitation and Physiotherapist, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Velia Lobbe
- Nutrition Department, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Andrea Alejandra González
- Section of Palliative Care, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Gustavo De Simone
- Pallium Latinoamérica Association, Buenos Aires, Argentina.,Section of Palliative Care, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| |
Collapse
|
15
|
Alsiaf H, O'Neill TW, Callaghan MJ, Goodwin PC. Physical therapy of patients undergoing first-time lumbar discectomy: a survey of current UK practice. BMC Musculoskelet Disord 2022; 23:503. [PMID: 35624458 PMCID: PMC9137089 DOI: 10.1186/s12891-022-05346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The type, timing, and extent of provision of rehabilitation for lumbar discectomy patients in the UK are currently unknown. The aim of this study was to determine the provision and type of rehabilitation for patients undergoing lumbar discectomy in UK neurosurgical centers. METHOD Physical therapists involved in treating lumbar discectomy patients in UK neurosurgery centers were invited to complete an online survey that asked about the type, timing (preop, postop), and rehabilitation content for patients undergoing lumbar discectomy. RESULTS Seventeen UK neurosurgery centers completed the survey. Twelve (36%) responded from the 33 centers targeted as well as an additional five private centers. All participating centers provided a rehabilitation service for lumbar discectomy patients. Rehabilitation was provided preoperatively in n = 6 (35%) centers, postoperatively as an inpatient in all centers, and postoperatively as an outpatient in n = 14 (82%) centers. Factors that influenced the decision to provide rehabilitation included both external and internal or patient-related factors. Preoperative rehabilitation focused mainly on education, whilst postoperative outpatient rehabilitation focused more on exercises. Rehabilitation consistently included mobility, functional task training, and exercise prescription. CONCLUSIONS Whilst all neurosurgical centers in this survey provided some form of rehabilitation for patients undergoing LD surgery, the approach remains inconsistent. Rehabilitation was delivered most frequently postoperatively, with one in three centers providing it preoperatively. Rehabilitation content also varied depending on when it was provided. Further research is needed to determine the optimum timing, contents, and target of rehabilitation for patients undergoing LD surgery.
Collapse
Affiliation(s)
- Hanan Alsiaf
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Department of Physiotherapy, King Fahad Military Medical Complex - KFMMC, Dhahran, Kingdom of Saudi Arabia.
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal, NHS Foundation Trust, Salford, UK
| | - Michael J Callaghan
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Department of health Professions, Manchester Metropolitan University, Manchester, UK.,Medical, Manchester United Ltd, Manchester, UK
| | - Peter C Goodwin
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Department of health Professions, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
16
|
Rose GA, Davies RG, Appadurai IR, Williams IM, Bashir M, Berg RMG, Poole DC, Bailey DM. 'Fit for surgery': The relationship between cardiorespiratory fitness and postoperative outcomes. Exp Physiol 2022; 107:787-799. [PMID: 35579479 PMCID: PMC9545112 DOI: 10.1113/ep090156] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022]
Abstract
New Findings What is the topic of this review? The relationships and physiological mechanisms underlying the clinical benefits of cardiorespiratory fitness (CRF) in patients undergoing major intra‐abdominal surgery. What advances does it highlight? Elevated CRF reduces postoperative morbidity/mortality, thus highlighting the importance of CRF as an independent risk factor. The vascular protection afforded by exercise prehabilitation can further improve surgical risk stratification and postoperative outcomes.
Abstract Surgery accounts for 7.7% of all deaths globally and the number of procedures is increasing annually. A patient's ‘fitness for surgery’ describes the ability to tolerate a physiological insult, fundamental to risk assessment and care planning. We have evolved as obligate aerobes that rely on oxygen (O2). Systemic O2 consumption can be measured via cardiopulmonary exercise testing (CPET) providing objective metrics of cardiorespiratory fitness (CRF). Impaired CRF is an independent risk factor for mortality and morbidity. The perioperative period is associated with increased O2 demand, which if not met leads to O2 deficit, the magnitude and duration of which dictates organ failure and ultimately death. CRF is by far the greatest modifiable risk factor, and optimal exercise interventions are currently under investigation in patient prehabilitation programmes. However, current practice demonstrates potential for up to 60% of patients, who undergo preoperative CPET, to have their fitness incorrectly stratified. To optimise this work we must improve the detection of CRF and reduce potential for interpretive error that may misinform risk classification and subsequent patient care, better quantify risk by expressing the power of CRF to predict mortality and morbidity compared to traditional cardiovascular risk factors, and improve patient interventions with the capacity to further enhance vascular adaptation. Thus, a better understanding of CRF, used to determine fitness for surgery, will enable both clinicians and exercise physiologists to further refine patient care and management to improve survival.
Collapse
Affiliation(s)
- George A Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Richard G Davies
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - Ian R Appadurai
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - Ian M Williams
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Mohammad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Ronan M G Berg
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Physiology and Nuclear Medicine, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark.,Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - David C Poole
- Departments of Kinesiology, Anatomy and Physiology, Kansas State University, USA
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| |
Collapse
|
17
|
Sleight AG, Crowder SL, Skarbinski J, Coen P, Parker NH, Hoogland AI, Gonzalez BD, Playdon MC, Cole S, Ose J, Murayama Y, Siegel EM, Figueiredo JC, Jim HSL. A New Approach to Understanding Cancer-Related Fatigue: Leveraging the 3P Model to Facilitate Risk Prediction and Clinical Care. Cancers (Basel) 2022; 14:cancers14081982. [PMID: 35454890 PMCID: PMC9027717 DOI: 10.3390/cancers14081982] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 01/02/2023] Open
Abstract
Simple Summary For the growing number of cancer survivors worldwide, fatigue presents a major hurdle to function and quality of life. Treatment options for cancer-related fatigue are still emerging, and our current understanding of its etiology is limited. In this paper, we describe a new application of a comprehensive model for cancer-related fatigue: the predisposing, precipitating, and perpetuating (3P) factors model. We propose that the 3P model may be leveraged—particularly using metabolomics, the microbiome, and inflammation in conjunction with behavioral science—to better understand the pathophysiology of cancer-related fatigue. Abstract A major gap impeding development of new treatments for cancer-related fatigue is an inadequate understanding of the complex biological, clinical, demographic, and lifestyle mechanisms underlying fatigue. In this paper, we describe a new application of a comprehensive model for cancer-related fatigue: the predisposing, precipitating, and perpetuating (3P) factors model. This model framework outlined herein, which incorporates the emerging field of metabolomics, may help to frame a more in-depth analysis of the etiology of cancer-related fatigue as well as a broader and more personalized set of approaches to the clinical treatment of fatigue in oncology care. Included within this review paper is an in-depth description of the proposed biological mechanisms of cancer-related fatigue, as well as a presentation of the 3P model’s application to this phenomenon. We conclude that a clinical focus on organization risk stratification and treatment around the 3P model may be warranted, and future research may benefit from expanding the 3P model to understand fatigue not only in oncology, but also across a variety of chronic conditions.
Collapse
Affiliation(s)
- Alix G. Sleight
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sylvia L. Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94501, USA;
- Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA 94501, USA
- Physician Researcher Program, Kaiser Permanente Northern California, Oakland, CA 94501, USA
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA 94501, USA
| | - Paul Coen
- AdventHealth Orlando, Translational Research Institute, Orlando, FL 32804, USA;
| | - Nathan H. Parker
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Mary C. Playdon
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84044, USA;
- Department of Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84044, USA
| | - Steven Cole
- Department of Psychiatry & Biobehavioral Sciences and Medicine, University of California, Los Angeles, CA 90001, USA;
| | - Jennifer Ose
- Department of Population Sciences, University of Utah, Salt Lake City, UT 84044, USA;
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84044, USA
| | - Yuichi Murayama
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Y.M.); (J.C.F.)
| | - Erin M. Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33601, USA;
| | - Jane C. Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Y.M.); (J.C.F.)
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
- Correspondence:
| |
Collapse
|
18
|
Grimmett C, Heneka N, Chambers S. Psychological Interventions Prior to Cancer Surgery: a Review of Reviews. CURRENT ANESTHESIOLOGY REPORTS 2022; 12:78-87. [PMID: 35125973 PMCID: PMC8801554 DOI: 10.1007/s40140-021-00505-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 01/26/2023]
Abstract
Purpose of Review Patients with cancer who have high levels of psychological distress have poor treatment compliance and worse outcomes. This “review of reviews” provides a narrative synthesis of the impact of psychological prehabilitation interventions on individuals awaiting cancer surgery. Recent Findings Twenty reviews of prehabilitation with psychological interventions were identified. There is a trend towards improved psychological outcomes following intervention, particularly when psychologist-led. However, there was considerable heterogeneity within interventions, outcome measures, and timing of assessment precluding numeric synthesis. Methodological limitations including non-blinding, absence of stratification, and underpowered studies were also pervasive. Summary Providing psychological support early in the cancer pathway and prior to surgery has the potential to improve psychological health and outcomes. The application of existing knowledge in psycho-oncology, including distress screening, is needed in the prehabilitation setting. Consistent outcome assessments, accurate reporting of intervention components and delivery methods, and a consideration of effective systems and economical implementation strategies would facilitate advancements in this field. Supplementary Information The online version contains supplementary material available at 10.1007/s40140-021-00505-x.
Collapse
Affiliation(s)
- Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Nicole Heneka
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Suzanne Chambers
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| |
Collapse
|
19
|
Exercise. Cancer 2022. [DOI: 10.1016/b978-0-323-91904-3.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
20
|
Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth 2021; 128:244-257. [PMID: 34922735 DOI: 10.1016/j.bja.2021.11.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The certainty that prehabilitation improves postoperative outcomes is not clear. The objective of this umbrella review (i.e. systematic review of systematic reviews) was to synthesise and evaluate evidence for prehabilitation in improving health, experience, or cost outcomes. METHODS We performed an umbrella review of prehabilitation systematic reviews. MEDLINE, Embase, Cochrane, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Joanna Briggs Institute's database, and Web of Science were searched (inception to October 20, 2020). We included all systematic reviews of elective, adult patients undergoing surgery and exposed to a prehabilitation intervention, where health, experience, or cost outcomes were reported. Evidence certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation. Primary syntheses of any prehabilitation were stratified by surgery type. RESULTS From 1412 titles, 55 systematic reviews were included. For patients with cancer undergoing surgery who participate in any prehabilitation, moderate certainty evidence supports improvements in functional recovery. Low to very low certainty evidence supports reductions in complications (mixed, cardiovascular, and cancer surgery), non-home discharge (orthopaedic surgery), and length of stay (mixed, cardiovascular, and cancer surgery). There was low to very low certainty evidence that exercise prehabilitation reduces the risk of complications, non-home discharge, and length of stay. There was low to very low certainty evidence that nutritional prehabilitation reduces risk of complications, mortality, and length of stay. CONCLUSIONS Low certainty evidence suggests that prehabilitation may improve postoperative outcomes. Future low risk of bias, randomised trials, synthesised using recommended standards, are required to inform practice. Optimal patient selection, intervention design, and intervention duration must also be determined.
Collapse
|
21
|
Effect of two different pre-operative exercise training regimens before colorectal surgery on functional capacity: A randomised controlled trial. Eur J Anaesthesiol 2021; 37:969-978. [PMID: 32976204 DOI: 10.1097/eja.0000000000001215] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multimodal prehabilitation, including exercise training, nutritional therapy and anxiety reduction, has been shown to attenuate functional decline associated with surgery. Due to the growing interest in functional status as a targeted surgical outcome, a better understanding of the optimal prescription of exercise is critical. OBJECTIVE The objective is to compare peri-operative functional trajectory in response to two different exercise training protocols within a 4-week, supervised, multimodal prehabilitation programme. DESIGN This was a single blinded, single centre, randomised controlled study. Participants performed four assessments: at baseline, after prehabilitation (just before surgery), and at 1 and 2 months after surgery. PATIENTS Adult patients scheduled for elective resection of nonmetastatic colorectal cancer were included provided there were no absolute contraindications to exercise nor poor language comprehension. INTERVENTION Patients followed either high-intensity interval training (HIIT), or moderate intensity continuous training (MICT), as part of a 4-week multimodal prehabilitation programme. Both groups followed the same supervised resistance training, nutritional therapy and anxiety reduction interventions. All patients followed standardised peri-operative management. MAIN OUTCOME MEASURE Changes in oxygen consumption at anaerobic threshold, measured with sequential cardio-pulmonary exercise testing, were assessed and compared between groups. RESULTS Forty two patients were included in the primary analysis (HIIT n = 21 vs. MICT n = 21), with mean ± SD age 64.5 ± 11.2 years and 62% were men. At 2 months after surgery, 13/21 (62%) in HIIT and 11/21 (52%) in MICT attended the study visits. Both protocols significantly enhanced pre-operative functional capacity, with no difference between groups: mean (95% confidence interval) oxygen consumption at anaerobic threshold 1.97 (0.75 to 3.19) ml kg min in HIIT vs. 1.71 (0.56 to 2.85) in MICT, P = 0.753. At 2 months after surgery, the HIIT group showed a higher improvement in physical fitness: 2.36 (0.378 to 4.34) ml kg min, P = 0.021. No adverse events occurred during the intervention. CONCLUSION Both MICT and HIIT enhanced pre-operative functional capacity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03361150.
Collapse
|
22
|
Argudo N, Rodó-Pin A, Martínez-Llorens J, Marco E, Visa L, Messaggi-Sartor M, Balañá-Corberó A, Ramón JM, Rodríguez-Chiaradía DA, Grande L, Pera M. Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: an interventional pilot study. Dis Esophagus 2021; 34:5906903. [PMID: 32940327 DOI: 10.1093/dote/doaa086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
Abstract
Patients requiring surgery for locally advanced esophagogastric cancer often require neoadjuvant therapy (NAT), which may have a detrimental impact on cardiorespiratory reserve. The aims of this study were to investigate the feasibility and tolerability of a 5-week preoperative high-intensity interval training program after NAT, and to assess the potential effects of the training protocol on exercise capacity, muscle function, and health-related quality of life (HRQL). We prospectively studied consecutive patients with resectable locally advanced esophageal and gastric cancer in whom NAT was planned (chemo- or chemoradiotherapy). Feasibility was assessed with the TELOS (Technological, Economics, Legal, Operational, and Scheduling) components, and data on exercise tolerability (attendance and occurrence of adverse or unexpected events). Exercise capacity was assessed with peak oxygen uptake (VO2peak) in a cardiopulmonary exercise test at baseline, post-NAT, and following completion of a high-intensity interval exercise training (25 sessions). Changes in muscle strength and HRQL were also assessed. Of 33 recruited subjects (mean age 65 years), 17 received chemoradiotherapy and 16 chemotherapy. All the TELOS components were addressed before starting the intervention; from a total of 17 questions considered as relevant for a successful implementation, seven required specific actions to prevent potential concerns. Patients attended a mean of 19.4 (6.4) exercise sessions. The predefined level of attendance (≥15 sessions of scheduled sessions) was achieved in 27 out of 33 (81.8%) patients. Workload progression was adequate in 24 patients (72.7%). No major adverse events occurred. VO2peak decreased significantly between baseline and post-NAT (19.3 vs. 15.5 mL/Kg/min, P < 0.05). Exercise led to a significant improvement of VO2peak (15.5 vs. 19.6 mL/kg/min, P < 0.05). Exercise training was associated with clinically relevant improvements in some domains of HRQL, with the social and role function increasing by 10.5 and 11.6 points, respectively, and appetite loss and fatigue declining by 16 and 10.5, respectively. We conclude that a structured exercise training intervention is feasible and safe following NAT in patients with esophagogastric cancer, and it has positive effects to restore exercise capacity to baseline levels within 5 weeks with some improvements in HRQL.
Collapse
Affiliation(s)
- Núria Argudo
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rodó-Pin
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Juana Martínez-Llorens
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Ester Marco
- Department of Physical Medicine and Rehabilitation. Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology. Hospital del Mar, Barcelona, Spain
| | - Monique Messaggi-Sartor
- Department of Physical Medicine and Rehabilitation. Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Balañá-Corberó
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - José M Ramón
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Luis Grande
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
23
|
Santa Mina D, van Rooijen SJ, Minnella EM, Alibhai SMH, Brahmbhatt P, Dalton SO, Gillis C, Grocott MPW, Howell D, Randall IM, Sabiston CM, Silver JK, Slooter G, West M, Jack S, Carli F. Multiphasic Prehabilitation Across the Cancer Continuum: A Narrative Review and Conceptual Framework. Front Oncol 2021; 10:598425. [PMID: 33505914 PMCID: PMC7831271 DOI: 10.3389/fonc.2020.598425] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
The field of cancer survivorship has significantly advanced person-centered care throughout the cancer continuum. Within cancer survivorship, the last decade has seen remarkable growth in the investigation of prehabilitation comprising pre-treatment interventions to prevent or attenuate the burden of oncologic therapies. While the majority of evidence remains in the surgical setting, prehabilitation is being adapted to target modifiable risk factors that predict poor treatment outcomes in patients receiving other systemic and localized anti-tumor treatments. Here, we propose a multiphasic approach for prehabilitation across the cancer continuum, as a conceptual framework, to encompass the variability in cancer treatment experiences while adopting the most inclusive definition of the cancer survivor.
Collapse
Affiliation(s)
- Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Enrico M Minnella
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Priya Brahmbhatt
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Susanne O Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Chelsia Gillis
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael P W Grocott
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Acute Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, University of Southampton, Southampton, United Kingdom
| | - Doris Howell
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ian M Randall
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Gerrit Slooter
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, Netherlands
| | - Malcolm West
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Trusts, Southampton, United Kingdom
| | - Sandy Jack
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Trusts, Southampton, United Kingdom
| | - Franco Carli
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada
| |
Collapse
|
24
|
Neuzillet C, Anota A, Foucaut AM, Védie AL, Antoun S, Barnoud D, Bouleuc C, Chorin F, Cottet V, Fontaine E, Garabige V, Hébuterne X, Huguet F, Lièvre A, Marchal T, Mouillot T, Peschaud F, Quilliot D, Raynard B, Schneider S, Scotté F, Vansteene D, Mariani P, Bouché O, Joly F. Nutrition and physical activity: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS). BMJ Support Palliat Care 2020; 11:381-395. [PMID: 33177113 DOI: 10.1136/bmjspcare-2020-002751] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently, in addition to anticancer treatments, supportive care including nutritional support and PA plays a central role in the management of digestive cancers. It is crucial to detect malnutrition (diagnostic criteria updated in 2019) early, to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition and PA in digestive oncology for each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). Guidelines for nutrition and PA management aim at increasing awareness about malnutrition in oncology. They are continuously evolving and need to be regularly updated.
Collapse
Affiliation(s)
- Cindy Neuzillet
- Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University (UVSQ) - Paris Saclay University, Saint-Cloud, France
| | - Amélie Anota
- Methodology and Quality of Life Unit in Oncology, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Hospital of Besançon, University Bourgogne Franche-Comté, Inserm, EFS BFC, Besançon, France.,Biostatistics Unit, DRCI, Centre Léon Bérard, Lyon, France
| | - Aude-Marie Foucaut
- Laboratoire Educations et Pratiques de Santé UR 3412, Université Sorbonne Paris Nord, Bobigny, France
| | - Anne-Laure Védie
- Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris 7 Diderot University, Clichy La Garenne, France
| | - Sami Antoun
- Nutrition and Readaptation Unit, Gustave Roussy Institute - Cancer Campus, Villejuif and Chevilly-Larue, France
| | - Didier Barnoud
- Department of Intensive Clinical Nutrition, Hospices Civils de Lyon (CHU Lyon), Lyon, France
| | - Carole Bouleuc
- Department of Supportive Care, Curie Institute, Paris, France
| | - Frédéric Chorin
- Plateforme Fragilité, Université Côte d'Azur, CHU Nice, LAMHESS, Nice, France
| | - Vanessa Cottet
- INSERM UMR1231 CIC 1432, CHU Dijon, NACRe National Network, University of Burgundy Franche-Comté, Dijon, France
| | - Eric Fontaine
- University of Grenoble Alpes, INSERM, LBFA, Grenoble, France
| | | | - Xavier Hébuterne
- Gastroenterology and Clinical Nutrition, CHU of Nice and University Côte d'Azur, Nice, France
| | - Florence Huguet
- Service d'Oncologie Radiothérapie, CHU Tenon, IUC, AP-HP, Sorbonne Université, Paris, France
| | - Astrid Lièvre
- Department of Gastroenterology, INSERM U1242 "Chemistry Oncogenesis Stress Signaling", University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | | | - Thomas Mouillot
- Service d'Hépato-gastro-entérologie, CHU F. Mitterrand, Dijon, France
| | - Frédérique Peschaud
- Department of Surgical Oncology, CHU Ambroise Paré, APHP, UVSQ - Paris Saclay University, Boulogne-Billancourt, France
| | - Didier Quilliot
- Nutritional Assistance Department and Transversal Nutrition Unit, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Bruno Raynard
- Nutrition and Readaptation Unit, Gustave Roussy Institute - Cancer Campus, Villejuif and Chevilly-Larue, France
| | - Stéphane Schneider
- Plateforme Fragilité, Université Côte d'Azur, CHU Nice, LAMHESS, Nice, France
| | - Florian Scotté
- Department of Supportive Care (Département Interdisciplinaire d'Organisation des Parcours Patients - DIOPP), Gustave Roussy Institute - Cancer Campus, Villejuif, France
| | - Damien Vansteene
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Pascale Mariani
- Department of Digestive Surgery, Curie Institute, Paris, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - Francisca Joly
- Department of Gastroenterology, IBD and Nutrition Support, CHU Beaujon, AP-HP, Paris 7 Diderot University, Clichy La Garenne, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Baimas-George M, Watson M, Thompson K, Shastry V, Iannitti D, Martinie JB, Baker E, Parala-Metz A, Vrochides D. Prehabilitation for Hepatopancreatobiliary Surgical Patients: Interim Analysis Demonstrates a Protective Effect From Neoadjuvant Chemotherapy and Improvement in the Frailty Phenotype. Am Surg 2020; 87:714-724. [PMID: 33170023 DOI: 10.1177/0003134820952378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prehabilitation encompasses multidisciplinary interventions to improve health and lessen incidence of surgical deterioration by reducing physiologic stress and functional decline. This study presents an interim analysis to demonstrate prehabilitation for hepatopancreatobiliary (HPB) surgical patients. METHODS In 2018, a structured prehabilitation pilot program was implemented. Eligibility required HPB malignancy, neoadjuvant chemotherapy, and residence within hour drive. Patients were enrolled into the 4-month program. The fitness component was composed of timed up and go test and grip strength with exercise recommendations. Nutrition involved evaluation of sarcopenic obesity, glucose management, and smoking and alcohol counseling. Psychological services included psychosocial assessments and advanced care planning, with social work referrals. Component were evaluated monthly by a physician using laboratory results, nutritional data and questionnaires, psychological assessments, and validated fitness tests. Nurse navigators spoke with patients weekly to monitor compliance. RESULTS At 12 months, nineteen patients were enrolled. Ten completed prehabilitation, neoadjuvant chemotherapy and underwent their surgical procedure. There were no differences found after prehabilitation in functional status, physical performance, psychosocial assessments, or nutrition. Frailty, as assessed by Fried frailty criteria, improved significantly after prehabilitation (P < .0001). Symptom severity and laboratory values did not change. Length of stay was 6.5 days and all patients were discharged to home. There was 1 readmission for transient ischemic attack and 90-day mortality rate was 0%. DISCUSSION Prehabilitation to improve recovery is a promising concept encompassing a wide array of multidisciplinary assessments and interventions. It may demonstrate a protective effect on physiologic decline from chemotherapy and may reverse frailty phenotypes.
Collapse
Affiliation(s)
- Maria Baimas-George
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Michael Watson
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Kyle Thompson
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Vivek Shastry
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - David Iannitti
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - John B Martinie
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Erin Baker
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Armida Parala-Metz
- Department of Supportive Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| |
Collapse
|
26
|
Thorsen L, Haugnes HS, Fosså SD, Brydøy M, Tandstad T, Wisløff T, Gjerset GM, Edvardsen E, Larsen KO, Sandset PM, Henriksson CE, Raastad T, Negaard HFS. Thromboembolic events after high-intensity training during cisplatin-based chemotherapy for testicular cancer: Case reports and review of the literature. Int J Cancer 2020; 147:3189-3198. [PMID: 32525564 DOI: 10.1002/ijc.33151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/21/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
The randomized "Testicular cancer and Aerobic and Strength Training trial" (TAST-trial) aimed to evaluate the effect of high-intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin-based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high-intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST-trial.
Collapse
Affiliation(s)
- Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway.,Department of Clinical Service, Oslo University Hospital, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, University of Tromsø - The Arctic University, Tromsø, Norway
| | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Brydøy
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | - Torbjørn Wisløff
- Institute of Clinical Medicine, University of Tromsø - The Arctic University, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Gunhild M Gjerset
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Edvardsen
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway.,Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Karl-Otto Larsen
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| | - Per Morten Sandset
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Carola E Henriksson
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | | |
Collapse
|
27
|
Pollán M, Casla-Barrio S, Alfaro J, Esteban C, Segui-Palmer MA, Lucia A, Martín M. Exercise and cancer: a position statement from the Spanish Society of Medical Oncology. Clin Transl Oncol 2020; 22:1710-1729. [PMID: 32052383 PMCID: PMC7423809 DOI: 10.1007/s12094-020-02312-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
Due to improvements in the number of cancer survivors and survival time, there is a growing interest in healthy behaviors, such as physical activity (PA), and their potential impact on cancer- and non-cancer-related morbidity in individuals with cancer. Commissioned by the Spanish Society of Medical Oncology (SEOM), in this review, we sought to distill the most recent evidence on this topic, focusing on the mechanisms that underpin the effects of PA on cancer, the role of PA in cancer prevention and in the prognosis of cancer and practical recommendations for clinicians regarding PA counseling. Despite the available information, the introduction of exercise programs into the global management of cancer patients remains a challenge with several areas of uncertainty. Among others, the most effective behavioral interventions to achieve long-term changes in a patient’s lifestyle and the optimal intensity and duration of PA should be defined with more precision in future studies.
Collapse
Affiliation(s)
- M Pollán
- Cancer and Environmental Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - S Casla-Barrio
- Exercise-Oncology Unit, Spanish Cancer Association, Madrid, Spain.,GEICAM (Spanish Breast Cancer Group), Madrid, Spain
| | - J Alfaro
- Medical Oncology, Hospital de Terrassa, Barcelona, Spain
| | - C Esteban
- Medical Oncology, Hospital Virgen de la Salud, Toledo, Spain
| | - M A Segui-Palmer
- Medical Oncology, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - A Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain. .,Instituto de Investigación Hospital 12 de Octubre and CIBER de Envejecimiento Saludable y Fragilidad (CIBERFES), Madrid, Spain.
| | - M Martín
- GEICAM (Spanish Breast Cancer Group), Madrid, Spain. .,Instituto de Investigacion Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain. .,Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Calle Dr. Esquerdo 46, 28007, Madrid, Spain.
| |
Collapse
|
28
|
Parker NH, Lee RE, O'Connor DP, Ngo-Huang A, Petzel MQB, Schadler K, Wang X, Xiao L, Fogelman D, Simpson R, Fleming JB, Lee JE, Tzeng CWD, Sahai SK, Basen-Engquist K, Katz MHG. Supports and Barriers to Home-Based Physical Activity During Preoperative Treatment of Pancreatic Cancer: A Mixed-Methods Study. J Phys Act Health 2019; 16:1113-1122. [PMID: 31592772 PMCID: PMC8390122 DOI: 10.1123/jpah.2019-0027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/12/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical activity and exercise appear to benefit patients receiving preoperative treatment for cancer. Supports and barriers must be considered to increase compliance with home-based exercise prescriptions in this setting. Such influences have not been previously examined. METHODS The authors used quantitative and qualitative methods to examine potential physical activity influences among patients who were prescribed home-based aerobic and strengthening exercises concurrent with preoperative chemotherapy or chemoradiation for pancreatic cancer. Physical activity was measured using exercise logs and accelerometers. Social support for exercise and perceived neighborhood walkability were measured using validated surveys. Relationships between influences and physical activity were evaluated using linear regression analyses and qualitative interviews. RESULTS Fifty patients received treatment for a mean of 16 (9) weeks prior to planned surgical resection. Social support from friends and neighborhood esthetics were positively associated with physical activity (P < .05). In interviews, patients confirmed the importance of these influences and cited encouragement from health care providers and desire to complete and recover from treatment as additional motivators. CONCLUSIONS Interpersonal and environmental motivators of exercise and physical activity must be considered in the design of future home-based exercise interventions designed for patients receiving preoperative therapy for cancer.
Collapse
|
29
|
Abstract
Data from observational studies indicate that both physical activity as well as exercise (ie, structured physical activity) is associated with reductions in the risk of recurrence and cancer mortality after a diagnosis of certain forms of cancer. Emerging evidence from preclinical studies indicates that physical activity/exercise paradigms regulate intratumoral vascular maturity and perfusion, hypoxia, and metabolism and augments the antitumor immune response. Such responses may, in turn, enhance response to standard anticancer treatments. For instance, exercise improves efficacy of chemotherapeutic agents, and there is rationale to believe that it will also improve radiotherapy response. This review overviews the current preclinical as well as clinical evidence supporting exercise modulation of therapeutic response and postulated biological mechanisms underpinning such effects. We also examine the implications for tumor response to radiation, chemotherapy, and immunotherapy.
Collapse
Affiliation(s)
- Kathleen A Ashcraft
- Departments of Radiation Oncology, Duke University School of Medicine, Durham, NC
| | | | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Weill Cornell Medical College, New York, NY
| | - Mark W Dewhirst
- Departments of Radiation Oncology, Duke University School of Medicine, Durham, NC..
| |
Collapse
|
30
|
Exercise and Nutrition Prehabilitation for the Evaluation of Risk and Therapeutic Potential in Cancer Patients: A Review. Int Anesthesiol Clin 2018; 54:e47-61. [PMID: 27648892 DOI: 10.1097/aia.0000000000000122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
31
|
Parker NH, Ngo-Huang A, Lee RE, O'Connor DP, Basen-Engquist KM, Petzel MQB, Wang X, Xiao L, Fogelman DR, Schadler KL, Simpson RJ, Fleming JB, Lee JE, Varadhachary GR, Sahai SK, Katz MHG. Physical activity and exercise during preoperative pancreatic cancer treatment. Support Care Cancer 2018; 27:2275-2284. [PMID: 30334105 DOI: 10.1007/s00520-018-4493-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Guidelines recommend exercise to cancer survivors, but limited data exists regarding exercise among patients undergoing preoperative cancer treatment. We examined differences in weekly self-reported exercise and accelerometer-measured physical activity among participants in a home-based exercise program administered during preoperative treatment for pancreatic cancer. METHODS Participants were encouraged to perform at least 60 min/week of moderate-intensity aerobic exercise and at least 60 min/week of full-body strengthening exercises concurrent with chemotherapy, chemoradiation therapy or both sequentially and received resistance equipment, program instruction, and biweekly follow-up calls to encourage adherence. Self-reported aerobic and strengthening exercise minutes were measured using daily logs, and physical activity was measured objectively using accelerometers. RESULTS Fifty participants (48% female, mean age 66 ± 8 years) participated for an average of 16 ± 9 preoperative weeks. Participants reported overall means of 126 ± 83 weekly minutes of aerobic exercise and 39 ± 33 weekly minutes of strengthening exercise in daily logs. Participants performed 158.7 ± 146.7 weekly minutes of accelerometer-measured moderate-to-vigorous physical activity. There were no significant differences in exercise or physical activity between treatment phases. CONCLUSIONS These findings suggest that it is feasible to target the entire preoperative course for exercise prescription. Although participants exceeded aerobic exercise recommendations on average, we observed low strengthening exercise adherence and wide variability in self-reported exercise and accelerometer physical activity variables. These findings suggest that additional support, including program adaptations, may be necessary to overcome barriers to exercise or improve motivation when prescribing exercise in this clinical scenario.
Collapse
Affiliation(s)
- Nathan H Parker
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, CPB 3.3278, PO Box 301439, Houston, TX, 77030-1439, USA.
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca E Lee
- College of Nursing and Health Innovation, Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Karen M Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, CPB 3.3278, PO Box 301439, Houston, TX, 77030-1439, USA
| | - Maria Q B Petzel
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David R Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keri L Schadler
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard J Simpson
- Department of Nutritional Sciences, The University of Arizona Cancer Center, Phoenix, AZ, USA
| | - Jason B Fleming
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gauri R Varadhachary
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunil K Sahai
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
32
|
Fuller JT, Hartland MC, Maloney LT, Davison K. Therapeutic effects of aerobic and resistance exercises for cancer survivors: a systematic review of meta-analyses of clinical trials. Br J Sports Med 2018; 52:1311. [PMID: 29549149 DOI: 10.1136/bjsports-2017-098285] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To systematically appraise and summarise meta-analyses investigating the effect of exercise compared with a control condition on health outcomes in cancer survivors. DESIGN Umbrella review of intervention systematic reviews. DATA SOURCES Web of Science, Scopus, Cochrane Library, CINAHL and MEDLINE databases were searched using a predefined search strategy. ELIGIBILITY CRITERIA Eligible meta-analyses compared health outcomes between cancer survivors participating in an exercise intervention and a control condition. Health outcomes were cardiovascular fitness, muscle strength, health-related quality of life, cancer-related fatigue and depression. Pooled effect estimates from each meta-analysis were quantified using standardised mean differences and considered trivial (<0.20), small (0.20-0.49), moderate (0.50-0.79) and large (≥0.80). Findings were summarised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS There were 65 eligible articles that reported a total of 140 independent meta-analyses. 139/140 meta-analyses suggested a beneficial effect of exercise. The beneficial effect was statistically significant in 104 (75%) meta-analyses. Most effect sizes were moderate for cardiovascular fitness and muscle strength and small for cancer-related fatigue, health-related quality of life and depression. The quality of evidence was variable according to the GRADE scale, with most studies rated low or moderate quality. Median incidence of exercise-related adverse events was 3.5%. CONCLUSION Exercise likely has an important role in helping to manage physical function, mental health, general well-being and quality of life in people undergoing and recovering from cancer and side effects of treatment. PROSPERO REGISTRATION NUMBER CRD42015020194.
Collapse
Affiliation(s)
- Joel T Fuller
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Michael C Hartland
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Luke T Maloney
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
33
|
Effects of Preoperative Exercise on Physical Fitness and Body Composition in Pancreatic Cancer Survivors Receiving Neoadjuvant Therapy: A Case Series. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
34
|
Alvarez-Nebreda ML, Bentov N, Urman RD, Setia S, Huang JCS, Pfeifer K, Bennett K, Ong TD, Richman D, Gollapudi D, Alec Rooke G, Javedan H. Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth 2018; 47:33-42. [DOI: 10.1016/j.jclinane.2018.02.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/27/2018] [Indexed: 01/09/2023]
|
35
|
Eng L, Pringle D, Su J, Shen X, Mahler M, Niu C, Charow R, Tiessen K, Lam C, Halytskyy O, Naik H, Hon H, Irwin M, Pat V, Gonos C, Chan C, Villeneuve J, Harland L, Shani RM, Brown MC, Selby P, Howell D, Xu W, Liu G, Alibhai SMH, Jones JM. Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Support Care Cancer 2018; 26:3755-3763. [DOI: 10.1007/s00520-018-4239-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
|
36
|
Kudach C, Dunwoody C, Wesmiller S. The Relationship of Age and Postoperative Pain in Women after Surgery for Breast Cancer. Pain Manag Nurs 2018; 19:348-353. [PMID: 29503215 DOI: 10.1016/j.pmn.2017.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/19/2017] [Accepted: 12/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the past, elderly women with breast cancer were not offered surgery because of beliefs that they would experience serious complications from comorbidities and increased chronological age. Today the decision to offer surgery is based on a woman's fitness rather than her age. OBJECTIVE The purpose of this study is to compare the experience of postoperative nausea and vomiting (PONV), anxiety, and reported pain levels in women who represent four different age groups after breast cancer surgery. This study employed a prospective comparative design. A large women's hospital which houses a Comprehensive Breast Care Program. Women diagnosed with early stage breast cancer and scheduled for surgical resection. METHODS Postoperative pain was measured in the postanesthesia care unit using an 11-point verbal pain scale, PONV was measured categorically, and if present, severity of nausea was assessed. Anxiety was measured preoperatively by the short-form Profile of Mood States. FINDINGS A total of 97 women aged 37-78 participated in this study. Overall, 35% of all women experienced PONV; only two women (18%) in the highest age range (70-79) experienced PONV, yet they reported significantly more pain than women in the other age groups. Understanding the difference in postoperative symptoms experienced by older woman after surgery for breast cancer will support the development of age-specific strategies.
Collapse
Affiliation(s)
| | - Colleen Dunwoody
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Susan Wesmiller
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA.
| |
Collapse
|
37
|
Recommendations for preoperative management of frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI). ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.pcorm.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
38
|
Tew GA, Ayyash R, Durrand J, Danjoux GR. Clinical guideline and recommendations on pre-operative exercise training in patients awaiting major non-cardiac surgery. Anaesthesia 2018; 73:750-768. [PMID: 29330843 DOI: 10.1111/anae.14177] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2017] [Indexed: 01/17/2023]
Abstract
Despite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations.
Collapse
Affiliation(s)
- G A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - R Ayyash
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - J Durrand
- Northern School of Anaesthesia and Intensive Care Medicine, Newcastle University, Newcastle, UK
| | - G R Danjoux
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
| |
Collapse
|
39
|
Morielli AR, Usmani N, Boulé NG, Severin D, Tankel K, Nijjar T, Joseph K, Fairchild A, Courneya KS. Exercise during and after neoadjuvant rectal cancer treatment (the EXERT trial): study protocol for a randomized controlled trial. Trials 2018; 19:35. [PMID: 29329555 PMCID: PMC5767015 DOI: 10.1186/s13063-017-2398-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/07/2017] [Indexed: 12/15/2022] Open
Abstract
Background Standard treatment for locally advanced rectal cancer includes 5–6 weeks of neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision 6–8 weeks later. NACRT improves local disease control and surgical outcomes but also causes side effects including fatigue, diarrhea, hand-foot syndrome, and physical deconditioning that may impede quality of life (QoL), treatment completion, treatment response, and long-term prognosis. Interventions to improve treatment outcomes and manage side effects that are safe, tolerable and low-cost are highly desirable. Exercise has been shown to improve some of these outcomes in other cancer patient groups but no study to date has examined the potential benefits (and harms) of exercise training during and after NACRT for rectal cancer. Methods/design The Exercise During and After Neoadjuvant Rectal Cancer Treatment (EXERT) trial is a single-center, prospective, two-armed, phase II randomized controlled trial designed to test the preliminary efficacy of exercise training in this clinical setting and to further evaluate its feasibility and safety. Participants will be 60 rectal cancer patients scheduled to receive long-course NACRT followed by total mesorectal excision. Participants will be randomly assigned to exercise training or usual care. Participants in the exercise training group will be asked to complete three supervised, high-intensity interval training sessions/week during NACRT and ≥ 150 min/week of unsupervised, moderate-to-vigorous-intensity, continuous exercise training after NACRT prior to surgery. Participants in the usual care group will be asked not to increase their exercise from baseline. Assessments will be completed pre NACRT, post NACRT, and pre surgery. The primary endpoint will be cardiorespiratory fitness (VO2 peak) at the post-NACRT time point assessed by a graded exercise test. Secondary endpoints will include functional fitness assessed by the Senior’s Fitness Test, QoL assessed by the European Organisation of Research and Treatment of Cancer, and symptom management assessed by the M.D. Anderson Symptom Inventory. Exploratory clinical endpoints will include treatment toxicities, treatment completion, treatment response, and surgical complications. Discussion If the preliminary findings of EXERT are positive, additional research will be warranted to confirm whether exercise is an innovative treatment to maintain QoL, manage side effects, and/or improve treatment outcomes in rectal cancer patients. Trial registration ClinicalTrials.gov, ID: NCT03082495. Registered on 9 February, 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2398-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Andria R Morielli
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-113 University Hall, Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada
| | - Nawaid Usmani
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-113 University Hall, Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada
| | - Diane Severin
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Keith Tankel
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Tirath Nijjar
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Kurian Joseph
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Alysa Fairchild
- Department of Oncology, University of Alberta and Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-113 University Hall, Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada.
| |
Collapse
|
40
|
Marker RJ, Cox-Martin E, Jankowski CM, Purcell WT, Peters JC. Evaluation of the effects of a clinically implemented exercise program on physical fitness, fatigue, and depression in cancer survivors. Support Care Cancer 2017; 26:1861-1869. [PMID: 29270829 DOI: 10.1007/s00520-017-4019-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 12/10/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite national recommendations, exercise programs are still not clinically implemented as standard of care for cancer survivors. This investigation examined the effects of a clinically implemented and personalized exercise program on physical fitness, fatigue, and depression in a diverse population of cancer survivors. The association of various participant characteristics on program performance was also examined. METHODS Data were collected from 170 cancer survivors who had participated in a clinical exercise program. Any cancer type was included and survivors were either undergoing medical treatment or had completed treatment (< 6 months prior to program initiation). Baseline and post program measures of estimated VO2peak, grip strength, fatigue, and depression were compared in survivors who completed the program follow-up. Multiple regressions were performed to investigate the association of age, gender, body mass index (BMI), and medical treatment status on baseline and change scores in outcome measures, as well as program adherence. RESULTS All measures improved in participants who completed the program (p < 0.01). Age, gender, and BMI were associated with baseline measures of estimated VO2peak and grip strength (p < 0.01), and age was inversely associated with baseline fatigue (p = 0.02). Only BMI was inversely associated with change in estimated VO2peak (p < 0.01). No participant characteristics or baseline measures were predictive of program adherence (p > 0.05). CONCLUSION This investigation provides evidence that a personalized, clinical exercise program can be effective at improving physical fitness, fatigue, and depression in a diverse population of cancer survivors.
Collapse
Affiliation(s)
- Ryan J Marker
- Department of Physical Therapy, School of Health Sciences and Human Performance, Ithaca College, Ithaca, NY, USA.
| | - Emily Cox-Martin
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - W Thomas Purcell
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John C Peters
- Anschutz Health and Wellness Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
41
|
Rammant E, Decaestecker K, Bultijnck R, Sundahl N, Ost P, Pauwels NS, Deforche B, Pieters R, Fonteyne V. A systematic review of exercise and psychosocial rehabilitation interventions to improve health-related outcomes in patients with bladder cancer undergoing radical cystectomy. Clin Rehabil 2017; 32:594-606. [PMID: 29231044 DOI: 10.1177/0269215517746472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Summarizing the evidence on the effects of pre- and postoperative exercise and psychosocial rehabilitation interventions on patient-reported outcomes (PROs) and physical fitness in bladder cancer patients undergoing radical cystectomy. DATA SOURCES The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science and the Physiotherapy Evidence Database were searched independently by two authors from inception until 10 November 2017. Cited references of the studies and citing references retrieved via Web of Science were also checked. REVIEW METHODS Randomized controlled trials (RCTs) and non-randomized studies assessing effects of exercise and psychosocial interventions in bladder cancer patients undergoing radical cystectomy were eligible. Primary outcome measures were PROs and physical fitness. Risk of bias was assessed using the Cochrane Collaboration tool and the Newcastle-Ottawa Scale. RESULTS Five RCTs (three exercise and two psychosocial studies) and one non-randomized psychosocial study comprising 317 bladder cancer patients were included. Timing of the intervention was preoperative ( n = 2), postoperative ( n = 2) or both pre- and postoperative ( n = 2). Positive effects of exercise were found for physical fitness ( n = 3), some health-related quality-of-life (HRQoL) domains ( n = 2), personal activities in daily living ( n = 1) and muscle strength ( n = 1). Psychosocial interventions showed positive effects on anxiety ( n = 1), fatigue ( n = 1), depression ( n = 1), HRQoL ( n = 1) and posttraumatic growth ( n = 1). Quality assessment showed most shortcomings with sample sizes and strong heterogeneity was observed between studies. CONCLUSION The evidence relating to the effects of exercise in bladder cancer is very limited and is even less for psychosocial interventions.
Collapse
Affiliation(s)
- Elke Rammant
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Renée Bultijnck
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Nora Sundahl
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Nele S Pauwels
- 3 Knowledge Center Ghent, Ghent University Hospital, Ghent, Belgium
| | | | - Ronny Pieters
- 2 Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
42
|
Richardson K, Levett D, Jack S, Grocott M. Fit for surgery? Perspectives on preoperative exercise testing and training. Br J Anaesth 2017; 119:i34-i43. [DOI: 10.1093/bja/aex393] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
43
|
Ngo-Huang A, Parker NH, Wang X, Petzel MQB, Fogelman D, Schadler KL, Bruera E, Fleming JB, Lee JE, Katz MHG. Home-based exercise during preoperative therapy for pancreatic cancer. Langenbecks Arch Surg 2017; 402:1175-1185. [PMID: 28710540 PMCID: PMC8372869 DOI: 10.1007/s00423-017-1599-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/25/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Exercise concurrent with neoadjuvant chemotherapy and/or chemoradiation for pancreatic adenocarcinoma (PDAC) may mitigate the decline in function that may occur as a result of the disease or its treatment in the preoperative period. The primary objective of this single-arm prospective trial was to determine adherence to a home-based exercise program administered during preoperative therapy. METHODS Twenty patients from a quaternary cancer center with potentially resectable PDAC were enrolled. Patients were prescribed a minimum of 120 min of moderate-intensity exercise weekly: at least 60 min of aerobic exercise and 60 min of resistance exercise. Self-reported exercise was recorded in daily logs. Functional and survey measures were collected upon enrollment, following preoperative therapy, and 1 month after surgery. RESULTS Fifteen out of 20 patients participated in the program. They reported a mean (standard deviation (SD)) of 98.6 (69.8) min of aerobic exercise weekly and 57.4 (36.0) min of strengthening exercise weekly over a median of 17 weeks (range, 5-35 weeks) of preoperative therapy, for a mean (SD) of 156.0 (64.5) min of total exercise weekly. Eighty percent reported a mean of least 120 min of total exercise weekly during preoperative therapy. Patients with low baseline physical activity based on the International Physical Activity Questionnaire significantly increased their preoperative physical activity (p = .01). There were no adverse events associated with the exercise program. CONCLUSIONS Patients with PDAC will participate in a home-based exercise program of aerobic and strengthening exercise and will increase physical activity, concurrent with preoperative chemotherapy and/or chemoradiation.
Collapse
Affiliation(s)
- An Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX, 77030, USA.
| | - Nathan H Parker
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria Q B Petzel
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keri L Schadler
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX, 77030, USA
| | - Jason B Fleming
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
44
|
|
45
|
Chan CWH, Law BMH, So WKW, Chow KM, Waye MMY. Novel Strategies on Personalized Medicine for Breast Cancer Treatment: An Update. Int J Mol Sci 2017; 18:ijms18112423. [PMID: 29140300 PMCID: PMC5713391 DOI: 10.3390/ijms18112423] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
Breast cancer is the most common cancer type among women worldwide. With breast cancer patients and survivors being reported to experience a repertoire of symptoms that are detrimental to their quality of life, the development of breast cancer treatment strategies that are effective with minimal side effects is therefore required. Personalized medicine, the treatment process that is tailored to the individual needs of each patient, is recently gaining increasing attention for its prospect in the development of effective cancer treatment regimens. Indeed, recent studies have identified a number of genes and molecules that may be used as biomarkers for predicting drug response and severity of common cancer-associated symptoms. These would provide useful clues not only for the determination of the optimal drug choice/dosage to be used in personalized treatment, but also for the identification of gene or molecular targets for the development of novel symptom management strategies, which ultimately would lead to the development of more personalized therapies for effective cancer treatment. In this article, recent studies that would provide potential new options for personalized therapies for breast cancer patients and survivors are reviewed. We suggest novel strategies, including the optimization of drug choice/dosage and the identification of genetic changes that are associated with cancer symptom occurrence and severity, which may help in enhancing the effectiveness and acceptability of the currently available cancer therapies.
Collapse
Affiliation(s)
- Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Bernard M H Law
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| | - Mary M Y Waye
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, The New Territories, Hong Kong, China.
| |
Collapse
|
46
|
West MA, Wischmeyer PE, Grocott MPW. Prehabilitation and Nutritional Support to Improve Perioperative Outcomes. CURRENT ANESTHESIOLOGY REPORTS 2017; 7:340-349. [PMID: 29200973 PMCID: PMC5696441 DOI: 10.1007/s40140-017-0245-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW The purpose of this study is to evaluate the role of physical exercise and nutrition interventions in adult patients before elective major surgery. RECENT FINDINGS Exercise training before elective adult major surgery is feasible, safe, and efficacious, but the clinical effectiveness remains uncertain. Early data suggests a reduction in morbidity, length of stay, and quality of life, but the results of larger definitive studies are awaited. Nutritional interventions are less well evaluated and when they are, it is often in combination with exercise interventions as part of a prehabilitation package. SUMMARY Studies evaluating exercise and nutrition interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical evidence is currently very limited. Future research should focus on refining interventions, exploring mechanism, and evaluating the interactions between therapies and large-scale clinical effectiveness studies.
Collapse
Affiliation(s)
- Malcolm A. West
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton NIHR Biomedical Research Centre, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul E. Wischmeyer
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC USA
- Duke Clinical Research Institute, Durham, NC USA
| | - Michael P. W. Grocott
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton NIHR Biomedical Research Centre, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Anaesthesia and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
47
|
Al-Shammari L, Douglas D, Gunaratnam G, Jones C. Perioperative medicine: a new model of care? Br J Hosp Med (Lond) 2017; 78:628-632. [DOI: 10.12968/hmed.2017.78.11.628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lena Al-Shammari
- Perioperative Medicine Fellow, Department of Anaesthesia, UCLH, London NW1 2BU
| | - Deborah Douglas
- Perioperative Medicine Fellow, Department of Anaesthesia, UCLH, London
| | - Geetha Gunaratnam
- Perioperative Medicine Fellow, Department of Anaesthesia, UCLH, London
| | - Chris Jones
- Consultant Anaesthetist, Department of Anaesthesia, Royal Surrey County Hospital, Guildford
| |
Collapse
|
48
|
Frailty in major oncologic surgery of upper gastrointestinal tract: How to improve postoperative outcomes. Eur J Surg Oncol 2017; 43:1566-1571. [DOI: 10.1016/j.ejso.2017.06.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/25/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023] Open
|
49
|
Thorsen L, Kirkegaard C, Loge JH, Kiserud CE, Johansen ML, Gjerset GM, Edvardsen E, Hamre H, Ikdahl T, Fosså SD. Feasibility of a physical activity intervention during and shortly after chemotherapy for testicular cancer. BMC Res Notes 2017; 10:214. [PMID: 28619116 PMCID: PMC5472911 DOI: 10.1186/s13104-017-2531-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/05/2017] [Indexed: 12/19/2022] Open
Abstract
Background Given the risk of developing acute and long-term adverse effects in patients receiving cisplatin-based chemotherapy for testicular cancer (TC), risk-reducing interventions, such as physical activity (PA), may be relevant. Limited knowledge is available on the challenges met when conducting PA intervention trials in patients with TC during and shortly after chemotherapy. The aims of the present feasibility study are therefore to determine patient recruitment, compliance and adherence to a PA intervention. Results Patients with metastatic TC referred to cisplatin-based chemotherapy were eligible. They followed an individual low-threshold PA intervention, including counseling from a personal coach during and 3 months after chemotherapy. Outcomes were recruitment rate, compliance rate and adherence to the intervention including preferences for type of PA and barriers for PA. During 8 months 12 of 18 eligible patients were invited, all consented, but three dropped out. Walking and low intensity activities were preferred and nausea and feeling unwell were the most often reported barriers towards PA. Discussion In order to achieve adequate recruitment, compliance and complete data in future PA intervention trials, close cooperation with treating physicians, individual PA plans and availability of personalized coaching are required. Trial registration NCT01749774, November 2012, ClinicalTrials.gov Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2531-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lene Thorsen
- National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital, Box 4950, Nydalen, 0424 OSLO, Oslo, Norway.
| | | | - Jon Håvard Loge
- Department of Behavioral Sciences in Medicine, University of Oslo/Regional Advisory Unit in Palliative Care, Oslo University Hospital, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital, Box 4950, Nydalen, 0424 OSLO, Oslo, Norway
| | | | - Gunhild M Gjerset
- National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital, Box 4950, Nydalen, 0424 OSLO, Oslo, Norway
| | | | - Hanne Hamre
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - Tone Ikdahl
- Akershus University Hospital, Lorenskog, Norway
| | - Sophie D Fosså
- National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital, Box 4950, Nydalen, 0424 OSLO, Oslo, Norway
| |
Collapse
|
50
|
Systematic review: the impact of exercise on mesenteric blood flow and its implication for preoperative rehabilitation. Tech Coloproctol 2017; 21:185-201. [PMID: 28243813 PMCID: PMC5360832 DOI: 10.1007/s10151-017-1589-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/11/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Exercise in the preoperative period, or prehabilitation, continues to evolve as an important tool in optimising patients awaiting major intra-abdominal surgery. It has been shown to reduce rates of post-operative morbidity and length of hospital stay. The mechanism by which this is achieved remains poorly understood. Adaptations in mesenteric flow in response to exercise may play a role in improving post-operative recovery by reducing rates of ileus and anastomotic leak. AIMS To systematically review the existing literature to clarify the impact of exercise on mesenteric arterial blood flow using Doppler ultrasound. METHODS PubMed, EMBASE and the Cochrane library were systematically searched to identify clinical trials using Doppler ultrasound to investigate the effect of exercise on flow through the superior mesenteric artery (SMA). Data were extracted including participant characteristics, frequency, intensity, timing and type of exercise and the effect on SMA flow. The quality of each study was assessed using the Downs and Black checklist. RESULTS Sixteen studies, comprising 305 participants in total, were included. Methodological quality was generally poor. Healthy volunteers were used in twelve studies. SMA flow was found to be reduced in response to exercise in twelve studies, increased in one and unchanged in two studies. Clinical heterogeneity precluded a meta-analysis. CONCLUSION The weight of evidence suggests that superior mesenteric arterial flow is reduced immediately following exercise. Differences in frequency, intensity, timing and type of exercise make a consensus difficult. Further studies are warranted to provide a definitive understanding of the impact of exercise on mesenteric flow.
Collapse
|