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Cheng JT, Obaisi O, Yadav R, Gupta E, Fu JB, Bruera E, Collaco A, Szewczyk N, Popat UR, Ngo-Huang A. Role of Outpatient Physical Medicine and Rehabilitation in a Multidisciplinary Prehabilitation Program for Older Adults Before Allogeneic Hematopoietic Stem Cell Transplant. Am J Phys Med Rehabil 2024; 103:710-715. [PMID: 38207179 DOI: 10.1097/phm.0000000000002428] [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: 01/13/2024]
Abstract
INTRODUCTION Physical rehabilitation is increasingly incorporated throughout the allogeneic hematopoietic stem cell transplant journey for older adults. OBJECTIVE This study aimed to describe physical medicine and rehabilitation-related diagnoses, exercise barriers, and management recommendations for older adults before allogeneic hematopoietic stem cell transplant. DESIGN Fifty physical medicine and rehabilitation consults as part of the Enhanced Recovery-Stem Cell Transplant multidisciplinary prehabilitation program at a comprehensive cancer center were retrospectively reviewed. RESULTS Many physical medicine and rehabilitation-related diagnoses (173), exercise barriers (55), and management recommendations (112) were found. Common diagnoses were musculoskeletal dysfunction (more commonly back, shoulder, then knee) ( n = 39, 23%) and fatigue ( n = 36, 21%). Common exercise barriers were also musculoskeletal dysfunction (more commonly back, knee, then shoulder) (total n = 20, 36%) and fatigue ( n = 20, 36%). Most patients ( n = 32, 64%) had one or more exercise barriers. Common physical medicine and rehabilitation management recommendations were personalized exercise counseling ( n = 37, 33%), personalized nutrition management ( n = 19, 17%), body composition recommendations ( n = 17, 15%), medications ( n = 15, 13%), and orthotics and durable medical equipment ( n = 8, 7%). CONCLUSIONS Routine physical medicine and rehabilitation referral of older allogeneic hematopoietic stem cell transplant patients for prehabilitation resulted in the identification of many rehabilitative needs and substantial additional management recommendations. Increased early, collaborative prehabilitation efforts between physical medicine and rehabilitation and allogeneic hematopoietic stem cell transplant teams to optimize care for these patients is recommended.
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Affiliation(s)
- Jessica T Cheng
- From the Department of Supportive Care Medicine, City of Hope Orange County Lennar Foundation Cancer Center, Irvine, California (JTC); Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, Illinois (OO); Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson, Houston, Texas (RY, EG, JBF, EB, AC, AN-H); and Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas (NS, UP)
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Yang L, Courneya KS, Friedenreich CM. The Physical Activity and Cancer Control (PACC) framework: update on the evidence, guidelines, and future research priorities. Br J Cancer 2024:10.1038/s41416-024-02748-x. [PMID: 38926526 DOI: 10.1038/s41416-024-02748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/22/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND We proposed the Physical Activity and Cancer Control (PACC) framework in 2007 to help organise, focus, and stimulate research on physical activity in eight cancer control categories: prevention, detection, treatment preparation/coping, treatment coping/effectiveness, recovery/rehabilitation, disease prevention/health promotion, palliation, and survival. METHODS This perspective paper provides a high-level overview of the scientific advances in physical activity research across cancer control categories, summarises current guidelines, updates the PACC framework, identifies remaining and emerging knowledge gaps, and provides future research directions. RESULTS Many scientific advances have been made that are reflected in updated physical activity guidelines for six of the cancer control categories apart from detection and palliation. Nevertheless, the minimal and optimal type, dose, and timing of physical activity across cancer control categories remain unknown, especially for the understudied population subgroups defined by cancer type, age, race/ethnicity, and resource level of regions/countries. CONCLUSION To achieve the full benefit of physical activity in cancer control, future research should use innovative study designs that include diverse at-risk populations and understudied cancer sites. Additionally, effective behaviour change strategies are needed to increase physical activity levels across populations that use implementation science to accelerate the translation from evidence generation into practical, real-world interventions.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Guerra-Londono CE, Cata JP, Nowak K, Gottumukkala V. Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness. Curr Oncol 2024; 31:2185-2200. [PMID: 38668065 PMCID: PMC11049527 DOI: 10.3390/curroncol31040162] [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: 03/21/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Cancer surgery places a significant burden on a patients' functional status and quality of life. In addition, cancer surgery is fraught with postoperative complications, themselves influenced by a patient's functional status. Prehabilitation is a unimodal or multimodal strategy that aims to increase a patient's functional capacity to reduce postoperative complications and improve postoperative recovery and quality of life. In most cases, it involves exercise, nutrition, and anxiety-reducing interventions. The impact of prehabilitation has been explored in several types of cancer surgery, most commonly colorectal and thoracic. Overall, the existing evidence suggests prehabilitation improves physiological outcomes (e.g., lean body mass, maximal oxygen consumption) as well as clinical outcomes (e.g., postoperative complications, quality of life). Notably, the benefit of prehabilitation is additional to that of enhanced recovery after surgery (ERAS) programs. While safe, prehabilitation programs require multidisciplinary coordination preoperatively. Despite the existence of numerous systematic reviews and meta-analyses, the certainty of evidence demonstrating the efficacy and safety of prehabilitation is low to moderate, principally due to significant methodological heterogeneity and small sample sizes. There is a need for more large-scale multicenter randomized controlled trials to draw strong clinical recommendations.
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Affiliation(s)
- Carlos E. Guerra-Londono
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, MI 48202, USA; (C.E.G.-L.); (K.N.)
| | - Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Katherine Nowak
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, MI 48202, USA; (C.E.G.-L.); (K.N.)
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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Ploussard G, Kesch C, Calleris G, Buhas B, Salin A, Almeras C, Loison G, Lesourd M, Tollon C, Pradère B, Beauval JB. From an On-site Program to a Mobile App for Prehabilitation and Rehabilitation for Robotic Radical Prostatectomy: Lessons Learned from 5 Years of Experience, the COVID-19 Outbreak, and Comparison with Nationwide Data. Eur Urol Oncol 2024; 7:297-299. [PMID: 37865569 DOI: 10.1016/j.euo.2023.10.007] [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: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/23/2023]
Abstract
Prehabilitation programs play a key role in optimizing patient experiences and outcomes after surgery. However, there are few data on robot-assisted radical prostatectomy, and prehabilitation programs may be challenging to launch and maintain over time for every patient. Here we report our 5-yr experience of an on-site prehabilitation program and its impact on patient and hospital outcomes. During the study period, we observed continuous improvements in the same-day discharge rate (from 0% to 26.4%), hospital stay (from 3 to 0.9. d), costs (-63%), days out of hospital within 30 d after surgery in our center, and in comparison to contemporary nationwide data. However, despite these advantages, maintenance and diffusion of this program could be challenging owing to the absence of incentive support and lack of human resources. This led us to develop two free-access mobile apps, available on the app stores for both patients and surgeons, that include checklists, remote monitoring, and multiple educational materials aimed at simplifying the widespread use of optimized perioperative pathways. PATIENT SUMMARY: We found that a prehabilitation program before surgery can help in optimizing patient outcomes after robot-assisted removal of the prostate. We translated this program into a mobile app available for every patient.
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Affiliation(s)
| | - Claudia Kesch
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Giorgio Calleris
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Bogdan Buhas
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Marine Lesourd
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Benjamin Pradère
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
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Yang L, Alice A, Friedenreich CM. Physical activity for cancer prehabilitation: A scoping review. Crit Rev Oncol Hematol 2024; 196:104319. [PMID: 38460927 DOI: 10.1016/j.critrevonc.2024.104319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Abstract
This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for exercise interventions and observational studies that measured exercise or physical activity before cancer treatment from inception to January 20, 2023. Fifty-one articles from 44 unique studies were reviewed, including 32 intervention and 12 observational studies. Surgery is the only treatment modality that has been investigated. Included studies used heterogeneous exercise interventions and measures for physical activity. Colorectal and other gastrointestinal, lung, and urologic cancers are the most studied cancer types. Exercise intervention in cancer prehabilitation is highly feasible. The evidence for improved fitness, functional, psychosocial, and clinical outcomes is promising yet limited. Although research has increased recently, prehabilitation exercise remains a relatively under-investigated area in oncology. We have provided research directions towards an ideal cancer prehabilitation design in the real-world setting.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Azam Alice
- Adapted Physical Activity and Health, University Rennes 2, Rennes, France
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
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Grant SJ, Kay S, Lacey J, Kumar S, Kerin-Ayres K, Stehn J, Gonzalez M, Templeton S, Heller G, Cockburn J, Wahlroos S, Malalasekera A, Mak C, Graham S. Feasibility study of a multimodal prehabilitation programme in women receiving neoadjuvant therapy for breast cancer in a major cancer hospital: a protocol. BMJ Open 2024; 14:e080239. [PMID: 38508617 PMCID: PMC10961545 DOI: 10.1136/bmjopen-2023-080239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Neoadjuvant therapy has become a standard treatment for patients with stage II/III HER2 positive and triple negative breast cancer, and in well-selected patients with locally advanced and borderline resectable high risk, luminal B breast cancer. Side effects of neoadjuvant therapy, such as fatigue, cardiotoxicity, neurotoxicity, anxiety, insomnia, vasomotor symptoms, gastrointestinal disturbance as well as a raft of immune-related adverse events, may impact treatment tolerance, long-term outcomes, and quality of life. Providing early supportive care prior to surgery (typically termed 'prehabilitation') may mitigate these side effects and improve quality of life.During our codesign of the intervention, consumers and healthcare professionals expressed desire for a programme that 'packaged' care, was easy to access, and was embedded in their care pathway. We hypothesise that a multimodal supportive care programme including exercise and complementary therapies, underpinned by behavioural change theory will improve self-efficacy, quality of life, readiness for surgery and any additional treatment for women with breast cancer. We seek to explore cardiometabolic, residual cancer burden and surgical outcomes, along with chemotherapy completion (relative dose intensity). This article describes the protocol for a feasibility study of a multimodal prehabilitation programme. METHODS AND ANALYSIS This is a prospective, mixed-method, feasibility study of a multi-modal programme in a hospital setting for 20-30 women with breast cancer receiving neoadjuvant therapy. Primary outcomes are recruitment rate, retention rate, adherence and acceptability. Secondary outcomes include patient reported outcome measures (PROMs), surgical outcomes, length of stay, satisfaction with surgery, chemotherapy completion rates, changes in metabolic markers and adverse events. Interviews and focus groups to understand the experience with prehabilitation and different factors that may affect feasibility of the intervention . The output of this study will be a codesigned, evidence-informed intervention assessed for feasibility and acceptability by women with breast cancer and the healthcare professionals that care for them. ETHICS AND DISSEMINATION The study received ethics approval from the St Vincents Hospital HREC (HREC/2021/ETH12198). Trial results will be communicated to participants, healthcare professionals, and the public via publication and conferences. TRIAL REGISTRATION NUMBER ACTRN12622000584730.
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Affiliation(s)
- Suzanne J Grant
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Shelley Kay
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Judith Lacey
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Sanjeev Kumar
- Medical Oncology Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Kim Kerin-Ayres
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Justine Stehn
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Maria Gonzalez
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Sandra Templeton
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Cockburn
- Patient Advocate, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Sara Wahlroos
- Medical Oncology Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Ashanya Malalasekera
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- School of Medicine, University of Sydney SDN, Sydney, New South Wales, Australia
| | - Cindy Mak
- Surgical Oncology Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Susannah Graham
- Surgical Oncology Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
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7
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Abel R, Zoth N, Wilke C, Schmidt T. [Exercise-Based Prehabilitation In Orthopaedics, Cardiology And Oncology]. DIE REHABILITATION 2024; 63:51-64. [PMID: 38335973 DOI: 10.1055/a-2126-7431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Prehabilitation (prehab) aims to prepare patients for surgery, to reduce perioperative complications and to improve postoperative recovery. Pre-operative interventions depend on the indication and the specific patient characteristics and life circumstances. In orthopaedics, the focus is on preoperative improvement of physical performance, function and muscle strength through specific strength, mobility and sensomotoric training. In cardiology, endurance training and respiratory therapy are used in the preoperative phase, as well as coordination and strengthening exercises and occupational therapy to improve physical fitness and performance and reduce cardiovascular risk factors. In oncology, prehab is used preoperatively and also in addition to chemotherapy or radiotherapy to reduce medical side effects and to increase tolerance to cancer therapies (e. g. surgery, chemotherapy, radiotherapy). Exercise interventions in oncology differ according to the type of cancer (e. g. combined strength and endurance training, respiratory therapy, high-intensity interval training and walking). Study results often show positive effects on health resources using prehab. However, further high-quality clinical intervention studies are needed to confirm the clinical benefits of prehab for implementation in routine care.
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8
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Editor's Message: Increasing Our Effectiveness Detective-ness: Therapeutic Validity in Intervention Design and Study Quality Assessment. J Geriatr Phys Ther 2024; 47:1-2. [PMID: 38109149 DOI: 10.1519/jpt.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
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Hunter H, Bennington-McKay N, Sher J, Psutka SP, Lin C. Emerging Role of Mobile Applications and Wearable Devices for Prehabilitation in Urologic Oncology. Eur Urol Focus 2024; 10:20-22. [PMID: 37923631 DOI: 10.1016/j.euf.2023.10.010] [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: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
Treatment for urologic cancers often includes major oncologic procedures and surgeries with a risk of complications, especially in older and frail patients. The aim of prehabilitation programs is to optimize perioperative functional status in the hope of improving postoperative outcomes and preventing deconditioning. Mobile applications (mHealth) and wearable devices are being integrated into home-based prehabilitation programs. These not only encourage physical activity but also monitor health data in the perioperative period. This narrative review highlights current uses and the future role of mHealth and wearable devices for prehabilitation in patients with urologic cancers, particularly in the preoperative setting. PATIENT SUMMARY: Prehabilitation programs can help patients in preparing for surgery and improve their postoperative recovery. Mobile apps and wearable devices can play a role in home-based programs. We review the use of these tools for patients for whom surgery for a urological cancer is planned.
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Affiliation(s)
- Hanna Hunter
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | | | - Jessica Sher
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cindy Lin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; The Sports Institute at UW Medicine, Department of Neurological Surgery, Seattle, WA, USA
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Engle J. Pragmatic Approaches to Scalable Prehabilitation. Eur Urol Focus 2024; 10:26-28. [PMID: 38368173 DOI: 10.1016/j.euf.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/19/2024]
Abstract
Patients with cancer should ideally undergo proactive screening for muscle wasting, dietary deficiencies, functional changes, and/or psychological needs. Alternatively, a cross-referral strategy may be useful. A multimodal prehabilitation approach can address impairments and optimize function before treatment. Urological prehabilitation has led to improvements in lean body mass, bone density, erectile function, and urinary continence.
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Affiliation(s)
- Jessica Engle
- Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Psutka SP. Prehabilitation: A multidimensional adjunct to comprehensive personalized oncologic care. But, can we make it pragmatic? Eur Urol Focus 2024; 10:1-3. [PMID: 38365529 DOI: 10.1016/j.euf.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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12
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Sigg S, Zeidler K, Fankhauser CD. Is It Worth the Sweat? Prehabilitation in Uro-oncology: A Mini Review. Eur Urol Focus 2024; 10:29-31. [PMID: 37940390 DOI: 10.1016/j.euf.2023.10.022] [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: 10/19/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
In several surgical specialities, exercise as part of a prehabilitation program enhances recovery. However, for uro-oncological patients, evidence up to 2020 did not demonstrate significant benefits in terms of postoperative complications or hospital length of stay (LOS). We reviewed the literature from 2020 to 2023 and screened 205 reports, of which four full texts were included. Two retrospective cohort studies, despite having potential confounding risks, indicated that preoperative exercise might reduce LOS. One of these studies also suggested a lower likelihood of complications. Present evidence hints at the potential benefits of embedding exercise in prehabilitation for uro-oncological patients, particularly for short-term functional results. However, evidence on a direct effect on postoperative complications and LOS is still inconclusive. Future research should prioritise identification of specific exercises (eg, anaerobic vs aerobic, strength training, endurance, or respiratory exercises) that yield the most cost-effective benefits. PATIENT SUMMARY: Recent studies suggest that exercising before surgery might help people with urological cancers to improve their short-term fitness. More research is needed to see if exercise before surgery shortens hospital stays or reduces complications.
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Affiliation(s)
- Silvan Sigg
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland
| | - Kristin Zeidler
- Department of Oncology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland
| | - Christian Daniel Fankhauser
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland; University of Lucerne, Lucerne, Switzerland; University of Zurich, Zurich, Switzerland.
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Silver JK, Flores LE. Integrating Prehabilitation into the Cancer Survivorship Framework. Eur Urol Focus 2024; 10:23-25. [PMID: 37996272 DOI: 10.1016/j.euf.2023.11.006] [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: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances in urological prehabilitation and how it can be used together with enhanced recovery after surgery and conventional rehabilitation protocols. Urological prehabilitation has primarily focused on improving urinary continence, erectile function, bone density, and lean body mass, with some promising results for all of these outcomes. Although all cancer patients should be considered for prehabilitation, older or medically frail individuals may derive the greatest benefit. PATIENT SUMMARY: This mini-review discusses prehabilitation as part of the care for cancer patients. Although the research on prehabilitation is evolving, current studies generally demonstrate that it may help to enhance a patient's strength and endurance before upcoming surgery or other treatments.
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Affiliation(s)
- Julie K Silver
- Harvard Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
| | - Laura E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Thoft Jensen B, Bjerggaard Jensen J. One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy. Cancers (Basel) 2023; 15:5785. [PMID: 38136331 PMCID: PMC10741904 DOI: 10.3390/cancers15245785] [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: 10/26/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Multimodal prehabilitation is the process of enhancing physiological, nutritional, and psychological resilience to increase patients' functional capacity before major cancer surgery and aims to empower the patient to withstand the pending stress of major surgery and ultimately to improve long-term outcomes. The effect of physical prehabilitation to counteract the physical decline in surgical cancer patients has been documented; however, long-term results have not yet been published. This follow-up study aims to evaluate 1-year results on the efficacy of physical prehabilitation after bladder cancer surgery. The efficacy of prehabilitation was measured over the course of 1 year in 107 patients randomized to (1) pre- and rehabilitation or (2) standard care divided by n = 50 in the intervention (I) and n = 57 in the standard group (S). Physical function was measured by muscle leg power, and nutritional status was expressed with handgrip strength. Prehabilitation in major bladder cancer surgery can significantly improve physical function with 19.8 Watt/kg (p = 0.04), lean body mass (p = 0.047) and body cell mass (p = 0.03), and regained nutritional status one year after surgery. The results demonstrate that the restoration of physical function is vital to a full recovery.
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Affiliation(s)
- Bente Thoft Jensen
- Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Department of Public Health, Aarhus University, 8200 Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
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Mendes Wefelnberg M, Reimer N, Baumann FT. [Exercise therapy in prehabilitation : Current findings in urology]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1011-1016. [PMID: 37606656 DOI: 10.1007/s00120-023-02171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Prehabilitation refers to interventions that take place before starting medical treatment. Prehabilitation exercise therapy aims to increase functional physical capacities to improve recovery and reduce side effects. OBJECTIVES To present the evidence and potential of prehabilitation exercise therapy in urological oncology. METHODS Compilation and explanation of study results. RESULTS Studies are limited and primarily focused on prostate and bladder cancer. Current data show positive effects on physical functioning and cardiorespiratory capacity. The majority of prehabilitation studies in prostate cancer focus on specific goals of physical functioning, particularly maintenance and recovery of urinary continence with inconsistent results. CONCLUSIONS There is preliminary evidence to improve cardiorespiratory fitness and overall physical functioning in urinary bladder and prostate cancer. Further in-depth research is needed to map the potential spectrum of prehabilitation exercise therapy in uro-oncology.
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Affiliation(s)
- Michael Mendes Wefelnberg
- Centrum für Integrierte Onkologie (CIO), Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Nadine Reimer
- Centrum für Integrierte Onkologie (CIO), Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Freerk T Baumann
- Centrum für Integrierte Onkologie (CIO), Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Powell R, Davies A, Rowlinson-Groves K, French DP, Moore J, Merchant Z. Acceptability of prehabilitation for cancer surgery: a multi-perspective qualitative investigation of patient and 'clinician' experiences. BMC Cancer 2023; 23:744. [PMID: 37568097 PMCID: PMC10416438 DOI: 10.1186/s12885-023-10986-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND 'Prehabilitation' interventions aim to enhance individuals' physical fitness prior to cancer treatment, typically involve exercise training as a key component, and may continue to support physical activity, strength, and fitness during or after treatment. However, uptake of prehabilitation is variable. This study investigated how patients from diverse socio-economic status groups perceived an exemplar prehabilitation and recovery programme, aiming to understand factors impacting acceptability, engagement and referral. METHODS This research was conducted in the context of the Prehab4Cancer and Recovery Programme, a prehabilitation and recovery programme available across Greater Manchester, UK. Qualitative, semi-structured phone/video-call interviews were conducted with 18 adult patient participants referred to the programme (16 'engagers', 2 'non-engagers'; half the sample lived in localities with low socio-economic status scores). An online questionnaire with free-response and categorical-response questions was completed by 24 'clinician' participants involved in referral (nurses, doctors and other staff roles). An inductive, multi-perspective, thematic analysis was performed, structured using the Framework approach. RESULTS Discussing and referring patients to prehabilitation can be challenging due to large quantities of information for staff to cover, and for patients to absorb, around the time of diagnosis. The programme was highly valued by both participant groups; the belief that participation would improve recovery seemed a major motivator for engagement, and some 'clinicians' felt that prehabilitation should be treated as a routine part of treatment, or extended to support other patient groups. Engagers seemed to appreciate a supportive approach where they did not feel forced to do any activity and tailoring of the programme to meet individual needs and abilities was appreciated. Initial engagement could be daunting, but gaining experience with the programme seemed to increase confidence. CONCLUSIONS The prehabilitation programme was highly valued by engagers. Introducing prehabilitation at a challenging time means that personalised approaches might be needed to support engagement, or participation could be encouraged at a later time. Strategies to support individuals lacking in confidence, such as buddying, may be valuable. STUDY REGISTRATION The study protocol was uploaded onto the Open Science Framework 24 September 2020 ( https://osf.io/347qj/ ).
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Affiliation(s)
- Rachael Powell
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Amy Davies
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Moore
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Greater Manchester Cancer Alliance, The Christie NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Zoe Merchant
- Greater Manchester Cancer Alliance, The Christie NHS Foundation Trust, Manchester, UK
- North West Lung Centre, Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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Sliwinski S, Werneburg E, Faqar-Uz-Zaman SF, Detemble C, Dreilich J, Mohr L, Zmuc D, Beyer K, Bechstein WO, Herrle F, Malkomes P, Reissfelder C, Ritz JP, Vilz T, Fleckenstein J, Schnitzbauer AA. A toolbox for a structured risk-based prehabilitation program in major surgical oncology. Front Surg 2023; 10:1186971. [PMID: 37435472 PMCID: PMC10332323 DOI: 10.3389/fsurg.2023.1186971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/17/2023] [Indexed: 07/13/2023] Open
Abstract
Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients' resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3-6 weeks with 3-4 exercises per week that take 30-60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo-Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of $8 for treatment for $1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards.
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Affiliation(s)
- Svenja Sliwinski
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Elisabeth Werneburg
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Sara Fatima Faqar-Uz-Zaman
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Charlotte Detemble
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Julia Dreilich
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Lisa Mohr
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Dora Zmuc
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Katharina Beyer
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
| | - Wolf O. Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Florian Herrle
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Romed Klinik Prien am Chiemsee, Klinik für Allgemein- und Viszeralchirurgie, Prien am Chiemsee, Germany
| | - Patrizia Malkomes
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Christoph Reissfelder
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joerg P. Ritz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Helios Clinics Schwerin, Department for General and Visceral Surgery, Schwerin, Germany
| | - Tim Vilz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Johannes Fleckenstein
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Department of Pain Medicine, Hospital Landsberg am Lech, Landsberg am Lech, Germany
| | - Andreas A. Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
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19
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Storer TW, Pahor M, Woodhouse LJ, Lachman ME, Fielding RA. Exercise and Behavior: Adjuncts to Pro-Myogenic Compounds for Enhancing Mobility in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:61-66. [PMID: 37325956 PMCID: PMC10272978 DOI: 10.1093/gerona/glad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 06/17/2023] Open
Abstract
Physical activity and exercise training exert multiple and varied beneficial effects on a wide array of human tissues, making them therapeutic modalities that can prevent and treat age-related decline in physical function. The Molecular Transducers of Physical Activity Consortium is currently working to elucidate the molecular mechanisms underlying how physical activity improves and preserves health. Exercise training, especially when task specific, is an effective intervention for improving skeletal muscle performance and physical function in everyday activities. As seen elsewhere in this supplement, its adjunctive use with pro-myogenic pharmaceuticals may prove to be synergistic in effect. Behavioral strategies aiming to promote exercise participation and sustain adherence are being considered as additional adjuncts to further improve physical function in comprehensive, multicomponent interventions. One application of this combined strategy may be to target multimodal pro-myogenic therapies in prehabilitation to optimize physical preoperative health to enhance functional recovery postsurgery. We summarize here recent progress on biological mechanisms of exercise training, behavioral approaches to exercise participation, and the role task-specific exercise plays in synergy with pharmacologic therapies with a particular focus on older adults. Physical activity and exercise training in multiple settings should serve as the baseline standard of care around which other therapeutic interventions should be considered when the goal is restoring or increasing physical function.
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Affiliation(s)
- Thomas W Storer
- Research Program in Men’s Health, Aging, and Metabolism, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Marco Pahor
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Linda J Woodhouse
- Division of Physical Therapy, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Phoenix, Arizona, USA
| | - Margie E Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
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20
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Paulo CM, Ali AA, Schmeusser BN, Midenberg E, Helman TA, Diller ML, Pisters MF, Ogan K, Master VA. Barriers and facilitators to physical activity prehabilitation in patients with kidney cancer. Eur J Oncol Nurs 2023; 65:102333. [PMID: 37295278 DOI: 10.1016/j.ejon.2023.102333] [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: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Timely and effective physical activity (PA) prehabilitation is an evidence-based approach for improving a patient's health status preoperatively. Identifying barriers and facilitators to PA prehabilitation can help inform best practices for exercise prehabilitation program implementation. We explore the barriers and facilitators to PA prehabilitation in patients undergoing nephrectomy. METHODS A qualitative exploratory study was conducted by interviewing 20 patients scheduled for nephrectomy. Interviewees were selected via convenience sampling strategy. The interviews were semi-structured and discussed experienced and perceived barriers/facilitators to PA prehabilitation. Interview transcripts were imported to Nvivo 12 for coding and semantic content analysis. A codebook was independently created and collectively validated. Themes of barriers and facilitators were identified and summarized in descriptive findings based on frequency of themes. RESULTS Five relevant themes of barriers to PA prehabilitation emerged: 1) mental factors, 2) personal responsibilities, 3) physical capacity, 4) health conditions, and 5) lack of exercise facilities. Contrarily, facilitators potentially contributing to PA prehabilitation adherence in kidney cancer included 1) holistic health, 2) social and professional support, 3) acknowledgment of health benefits, 4) exercise type and guidance, and 5) Communication channels. CONCLUSION AND KEY FINDINGS Kidney cancer patient's adherence to physical activity prehabilitation is influenced by multiple biopsychosocial barriers and facilitators. Hence, adherence to physical activity prehabilitation requires timely adaptation of health beliefs and behavior embedded in the reported barriers and facilitators. For this reason, prehabilitation strategies should strive to be patient-centered and include health behavioral change theories as underlying frameworks for sustaining patient engagement and self-efficacy.
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Affiliation(s)
- Cristiany M Paulo
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Adil A Ali
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Benjamin N Schmeusser
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric Midenberg
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Talia A Helman
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Maggie L Diller
- Department of Surgery of Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA
| | - Martijn F Pisters
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Kenneth Ogan
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Viraj A Master
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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Graham LS, Lin JK, Lage DE, Kessler ER, Parikh RB, Morgans AK. Management of Prostate Cancer in Older Adults. Am Soc Clin Oncol Educ Book 2023; 43:e390396. [PMID: 37207299 DOI: 10.1200/edbk_390396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The majority of men with prostate cancer are diagnosed when they are older than 65 years; however, clinical trial participants are disproportionately younger and more fit than the real-world population treated in typical clinical practices. It is, therefore, unknown whether the optimal approach to prostate cancer treatment is the same for older men as it is for younger and/or more fit men. Short screening tools can be used to efficiently assess frailty, functional status, life expectancy, and treatment toxicity risk. These risk assessment tools allow for targeted interventions to increase a patient's reserve and improve treatment tolerance, potentially allowing more men to experience the benefit of the significant recent treatment advances in prostate cancer. Treatment plans should also take into consideration each patient's individual goals and values considered within their overall health and social context to reduce barriers to care. In this review, we will discuss evidence-based risk assessment and decision tools for older men with prostate cancer, highlight intervention strategies to improve treatment tolerance, and contextualize these tools within the current treatment landscape for prostate cancer.
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Affiliation(s)
- Laura S Graham
- Division of Medical Oncology, University of Colorado, Aurora, CO
| | - John K Lin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ravi B Parikh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Coporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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22
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Smelser WW, Tallman JE, Gupta VK, Al Hussein Al Awamlh B, Johnsen NV, Barocas DA, Kline-Quiroz C, Tomlinson CA, McEvoy MD, Hamilton-Reeves J, Chang SS. Implementation of a comprehensive prehabilitation program for patients undergoing radical cystectomy. Urol Oncol 2023; 41:108.e19-108.e27. [PMID: 36404231 DOI: 10.1016/j.urolonc.2022.10.017] [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: 05/04/2022] [Revised: 09/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coordinated preoperative optimization programs for radical cystectomy (RC) are limited and non-comprehensive. We evaluated the feasibility and acceptability of a coordinated, multi-faceted prehabilitation program for RC patients at a high-volume bladder cancer referral center. METHODS We performed a narrative literature review for prehabilitation in bladder cancer management as of December 1, 2020, with specific emphasis on examining higher-level evidence sources. We selected domains with the highest level of evidence and recruited a multidisciplinary team of experts to design our program. We implemented a comprehensive prehabilitation program with a pre-defined order set as standard of care for all patients undergoing RC beginning February 1, 2021. Demographic and clinicopathologic data were collected prospectively. Rates of adherence to the prehabilitation program services were analyzed using Stata version 13. RESULTS A total of 82 patients were enrolled between February - December 2021, of which 67 (81%) had undergone RC at data cutoff. Mean age was 68 years (SD 11) and 63 (76%) identified as male. Neoadjuvant chemotherapy (NAC) was utilized in 48 (59%) patients. The mean Charlson Comorbidity Index was 3.8 (SD 2.3). 100% of patients were screened for malnutrition, with 82% consuming nutritional supplements. Fifty-two percent of patients attended physical therapy pre-op. The 30-day and 30- to 90-day rates of complications were 56% and 40%, respectively. Resource length of stay (RLOS) declined after implementation of prehabilitation. CONCLUSIONS Implementation of a comprehensive prehabilitation program at a high-volume bladder cancer referral center is feasible and has a modest effect on resource consumption and complications in our early experience.
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Affiliation(s)
- Woodson W Smelser
- Division of Urology, Washington University in St. Louis, MISSOURI, Saint Louis, MO.
| | | | | | | | | | | | - Cristina Kline-Quiroz
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Carey A Tomlinson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University Medical Center
| | | | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center
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23
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Briggs LG, Sentana-Lledo D, Lage DE, Trinh QD, Morgans AK. Optimal assessment of quality of life for patients with prostate cancer. Ther Adv Med Oncol 2022; 14:17588359221141306. [PMID: 36531831 PMCID: PMC9747880 DOI: 10.1177/17588359221141306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/07/2022] [Indexed: 10/04/2023] Open
Abstract
The burden of cancer and oncologic treatment is reflected not only through morbidity and mortality, but also through impacts on patient quality of life (QoL). However, QoL has not been historically measured or addressed with the same rigorous methodology as traditional disease-related outcomes such as overall survival and progression, as these are driven by objective measurements and events. Prostate cancer (PCa) is one of the most prevalent non-cutaneous cancers in men around the world. Both the cancer and its treatment significantly impact patients' physical, emotional, sexual, social, and overall QoL. Ensuring assessment and integration of QoL in research and clinical care enables improvement in treatment outcomes that matter most to patients while also facilitating alignment of healthcare priorities with reimbursements. Great strides toward this end have been made over the last decade, but significant room for improvement remains. To ensure high quality, reliable data collection, QoL assessment tools must be psychometrically validated, standardized, widely implemented across trials, and regularly assessed to allow internal and external validity, longitudinal comparative effectiveness research, and quality control. Additional consideration should be taken for instruments used to measure the aspects of QoL specific to minority, caregiver, and elderly populations. Open clinical questions include how providers should weight changes in different QoL subscales and how clinically meaningful difference thresholds should be defined. Review of ongoing clinical trials encouragingly reveals an increased focus on measuring and improving QoL for men with PCa which will inform the way we utilize QoL assessments. However, additional efforts herein described are needed to fully optimize these processes. In summary, this review will explain the rationale for QoL assessments in PCa populations, discuss requirements for effective implementation, describe considerations for vulnerable and under-evaluated populations, and summarize ongoing clinical trials assessing patient QoL.
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Affiliation(s)
- Logan G Briggs
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Sentana-Lledo
- Department of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel E Lage
- Department of Hematology-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alicia K Morgans
- Faculty in Medicine, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Dana 09-930, Boston, MA 02215, USA
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Tay SS. Perspectives on the Direction of Cancer Prehabilitation in the Pandemic and Beyond. Arch Rehabil Res Clin Transl 2022; 4:100236. [PMID: 36277731 PMCID: PMC9574864 DOI: 10.1016/j.arrct.2022.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Growing attention has been placed on cancer prehabilitation in the recent years as the number of publications increase. The real-world application of prehabilitation remains heterogeneous and its implementation has been challenging during the COVID-19 pandemic. However, the pandemic has also provided impetus for change-leveraging technology and digitalization. This paper will discuss the pre-existing models of care, adaptations that had taken place in the pandemic, the model of care in the author's institution, and the future direction of cancer prehabilitation.
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Affiliation(s)
- San San Tay
- Corresponding author San San Tay, MBBS, MRCP (UK), MMED (Int Med), FAMS, Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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25
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Changes in skeletal muscle and adipose tissue during cytotoxic chemotherapy for testicular germ cell carcinoma and associations with adverse events. Urol Oncol 2022; 40:456.e19-456.e30. [DOI: 10.1016/j.urolonc.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
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Catto JWF, Khetrapal P, Ambler G, Williams NR, Brew-Graves C, Kelly JD. Reply to Bernardo Rocco and Maria Chiara Sighinolfi's Letter to the Editor re: James W.F. Catto, Pramit Khetrapal, Federico Ricciardi, et al. Effect of Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients with Bladder Cancer: A Randomized Clinical Trial. JAMA 2022;327:2092-103: Lacking the Evidence for Neobladder Use After Radical Cystectomy. Eur Urol 2022; 82:e167-e168. [PMID: 36114078 DOI: 10.1016/j.eururo.2022.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- James W F Catto
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Division of Surgery & Interventional Science, University College London, London, UK.
| | - Pramit Khetrapal
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Norman R Williams
- Surgical & Interventional Trials Unit, Division of Surgery & Interventional Science, University College London, London, UK
| | - Chris Brew-Graves
- National Cancer Imaging Translational Accelerator, Division of Medicine, University College London, London, UK
| | - John D Kelly
- Division of Surgery & Interventional Science, University College London, London, UK
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The Effects of Multimodal Prehabilitation Interventions in Men Affected by Prostate Cancer on Physical, Clinical and Patient Reported Outcome Measures: A Systematic Review. Semin Oncol Nurs 2022; 38:151333. [PMID: 35999090 DOI: 10.1016/j.soncn.2022.151333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To synthesize existing evidence on the effects of multimodal prehabilitation interventions in men affected by prostate cancer on physical, clinical, and patient-reported outcome measures. DATA SOURCES A systematic review was conducted according to the PRISMA 2020 Statement Guidelines. Electronic databases (ie, Medline, Embase, CINAHL and Cochrane CENTRAL, and clinicaltrials.gov) were searched using key search terms. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. The findings were integrated in a narrative synthesis. CONCLUSION Of the 5863 publications screened, 118 articles were assessed in full text and 17 studies met the prescreening eligibility criteria. There were a range of study designs that included randomized controlled clinical trials (n = 11), quasi experimental (n = 4), cohort (n = 1), and case series (n = 1), covering a total of 1739 participants. The prehabilitation interventions included physical activity, peer support, pelvic floor muscle training, diet, nurse-led prehabilitation, psychological, and prehabilitation administration of phosphodiesterase-5 inhibitors. IMPLICATIONS FOR NURSING PRACTICE Significant heterogeneity existed in the prehabilitation intervention programs for men affected by prostate cancer in terms of the composition, duration, method of administration, and the outcomes measured to quantify their impact. This systematic review has identified that multimodal prehabilitation interventions are an emerging area for practice and research among men affected by prostate cancer. Importantly, there has been a lack of focus on the inclusion of partners as critical companions during this distressing phase of the cancer care continuum. For the moment, all members of the multidisciplinary team caring for people affected by prostate cancer are encouraged to use the findings in this review to inform holistic models of care.
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Abstract
OBJECTIVE This article provides a map of key knowledge gaps regarding the evidence supporting prehabilitation and its integration with enhanced recovery after surgery (ERAS) programs. Filling this lack of knowledge with future research will further establish the effectiveness of prehabilitation. DATA SOURCES These are electronic databases including PubMed and CINAHL. CONCLUSION Future efforts must embrace the elderly frail or cognitively impaired patient with specific needs to further promote restoration of postoperative function throughout the surgical pathway. Prehabilitation should be coupled and integrated within the existent concept of the ERAS framework, to facilitate the continuous evolution of screening, assessment, and optimization of high-risk surgical patients who are at risk of not being restored to physical and psychological function after surgery, including independence. IMPLICATIONS FOR NURSING PRACTICE In the future, the ERAS nurse will be an essential figure of the prehabilitation program, proactively coordinating the assessment, optimization, and adjustment of perioperative comorbidity and guiding the rehabilitation process to improve patients' outcomes. These skills and characteristics will be required to provide optimal nursing care in the context of an integrated prehabilitation ERAS pathway.
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Re: Logan G. Briggs, Chanan Reitblat, Paul A. Bain, et al. Prehabilitation Exercise Before Urologic Cancer Surgery: A Systematic and Interdisciplinary Review. Eur Urol 2022;81:157-67: Recommendations for Experiments on Prehabilitation Exercise Programs for Health Optimization Before Cancer Surgeries. Eur Urol 2022; 82:e145. [PMID: 35961868 DOI: 10.1016/j.eururo.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022]
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Briggs LG, Labban M, Alkhatib K, Nguyen DD, Cole AP, Trinh QD. Digital technologies in cancer care: a review from the clinician's perspective. J Comp Eff Res 2022; 11:533-544. [PMID: 35416050 DOI: 10.2217/cer-2021-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Physicians are increasingly utilizing digital health technologies (DHT) such as smartphone applications, network-enabled wearable devices, web-based communication platforms, videoconferencing, chatbots, artificial intelligence and virtual reality to improve access to, and quality of, care. DHT aid in cancer screening, patient education, shared decision-making, promotion of positive health habits, symptom monitoring and intervention, patient-provider communication, provision of psychological support and delivery of effective survivorship care. This narrative review outlines how physicians may utilize digital health to improve or augment their delivery of cancer care. For the full potential of DHT to be realized, experts must develop appropriate solutions to issues surrounding the regulation, liability, quality, security, equity and reimbursement of DHT.
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Affiliation(s)
- Logan G Briggs
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Muhieddine Labban
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Khalid Alkhatib
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David-Dan Nguyen
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alexander P Cole
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Quoc-Dien Trinh
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Ushida K, Shimizu M, Momosaki R. Re: Logan G. Briggs, Chanan Reitblat, Paul A. Bain, et al. Prehabilitation Exercise Before Urologic Cancer Surgery: A Systematic and Interdisciplinary Review. Eur Urol. In press. https://doi.org/ 10.1016/j.eururo.2021.05.015: Strategies for Effective Prehabilitation in Urologic Cancer. Eur Urol 2021; 80:e139-e140. [PMID: 34565630 DOI: 10.1016/j.eururo.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Kenta Ushida
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Miho Shimizu
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan.
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Briggs LG, Parke S, Bain PA, Psutka SP. Reply to Kenta Ushida, Miho Shimizu, and Ryo Momosaki's Letter to the Editor re: Logan G. Briggs, Chanan Reitblat, Paul A. Bain, et al. Prehabilitation Exercise Before Urologic Cancer Surgery: A Systematic and Interdisciplinary Review. Eur Urol. In press. https://doi.org/ 10.1016/j.eururo.2021.05.015. Strategies for Effective Prehabilitation in Urologic Cancer. Eur Urol 2021; 80:e141-e142. [PMID: 34565629 DOI: 10.1016/j.eururo.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sara Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, AZ, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA.
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Labban M, Briggs L, Cole AP, Trinh QD. Measuring What Matters: Patient-Reported Outcome and Experience Measures for Men Undergoing Radical Prostatectomy. Eur Urol Focus 2021; 7:913-915. [PMID: 34556455 DOI: 10.1016/j.euf.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Patient-reported outcome and experience measures capture a reliable representation of a patient's functional outcomes and quality of life. However, they are only helpful if the data are easily comprehensible to patients and are accessible to providers, patients, and payers. If we want to ensure that these metrics are fair, accurate, and relevant, then physicians should be leaders in developing and adopting these tools.
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Affiliation(s)
- Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Logan Briggs
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Stangl-Kremser J, Ahmadi H, Derstine B, Wang SC, Englesbe MJ, Daignault-Newton S, Chernin AS, Montgomery JS, Palapattu GS, Lee CT. Psoas Muscle Mass can Predict Postsurgical Outcomes in Patients Who Undergo Radical Cystectomy and Urinary Diversion Reconstruction. Urology 2021; 158:142-149. [PMID: 34437899 DOI: 10.1016/j.urology.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To morphometrically measure to muscle mass which may reflect physical components of frailty. Hence, we evaluated the association between L4 total psoas area (TPA) and operative outcome after radical cystectomy (RC) for bladder cancer. METHODS In a retrospective single-center study, bladder cancer patients who underwent RC and urinary diversion between 2007 and 2012 were enrolled. TPA was evaluated in the cross-sectional imaging. The psoas muscles were normalized with the height. Male patients with a psoas mass index ≤7.4 cm2/m2 and female patients with a psoas mass index ≤5.2 cm2/m2 were classified as sarcopenic. Outcome measures were 30- and 90-day readmission and complications, and survival. Multivariable logistic and Cox proportional-hazards regression models were used to determine relevant predictors. RESULTS The median age of the 441 participants and follow up time was 68 years (IQR 59-75) and 1.2 years (IQR 0.5-1.9), respectively. One hundred forty-three patients (32.4%) were sarcopenic. The 30-day readmission and the complication rates were 13.8% and 44.7%, respectively. The 90-day readmission and complication rates were 23.9% and 53.1%, respectively. The 1-year mortality rate was 11.6% (95%CI 8.7-15.4). Multivariable logistic regression analysis revealed an association between increased TPA and lower odds of 30-day complications after RC (OR 0.95, 95%CI 0.92-0.99, P = .02); similarly, an increase in TPA was of prognostic value, although not statistically significant in the multivariable model (P = .05) once adjusting for other patient factors. CONCLUSION Sarcopenia predicted early complications and showed an informative trend for overall survival after RC, and thus may inform models predicting postsurgical outcomes.
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Affiliation(s)
- Judith Stangl-Kremser
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Hamed Ahmadi
- Department of Urology, University of Southern California, Los Angeles, CA
| | | | | | | | - Stephanie Daignault-Newton
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Department of Biostatistics, Michigan Medicine, Ann Arbor, MI
| | - Anna S Chernin
- Department of Biostatistics, Michigan Medicine, Ann Arbor, MI
| | | | - Ganesh S Palapattu
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Cheryl T Lee
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Department of Urology, The Ohio State University, Columbus, OH.
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