1
|
McMullan JC, Graham MJ, Craig EF, McCluggage WG, Hunter DH, Feeney L. The malignant transformation of endometriosis: Is there a left lateral predisposition of ovarian clear cell and endometrioid carcinomas? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108247. [PMID: 38522332 DOI: 10.1016/j.ejso.2024.108247] [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: 01/16/2024] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Endometriosis affects 10% of women of reproductive age. There is evidence for a left lateral predisposition of endometriotic lesions and a 1.9-fold greater risk of ovarian cancer in endometriosis. The aim of this study is to determine whether a left lateral predisposition of ovarian clear-cell carcinoma (CCC) and endometrioid carcinoma (EC) exists. MATERIALS AND METHODS A retrospective cohort study of all EC and CCC patients in Northern Ireland between March-2011 and June-2018. ANOVA was used to analyse preoperative prediction of stage, chi-squared (χ2) was used to compare left- and right-sided masses. Survival was estimated using Kaplan-Meier and log-rank test. A p-value <0.05 was considered significant. RESULTS 158 patients were identified (95 EC, 55 CCC, 8 mixed). Mean age was 57.65 years with 69% presenting at stage 1. The mean CA125 was 559 U/mL (p = 0.850) and mean abdominal mass size was 14.12 cm (p = 0.732). The most common presenting symptom was an abdominal mass (37%). Despite 67% of patients having endometriosis on final pathology, only 8.9% had a known history pre-operatively. 51% of tumours were located on the left (p = 0.036). For unilateral tumours this was significant for EC (P = 0.002) but not for CCC (P = 0.555). The 1-, 3- and 5-year overall survival for all types/stages was 85%, 78% and 71% respectively. CONCLUSION While CCC and EC are associated with endometriosis, only EC exhibits a left lateral predisposition. There is no association between preoperative CA125 or abdominal mass size and stage of disease.
Collapse
Affiliation(s)
| | - Michael J Graham
- Department of Gynaecology, Belfast City Hospital, Belfast, NI, BT9 7AB, UK
| | - Elaine F Craig
- Department of Gynaecology, Belfast City Hospital, Belfast, NI, BT9 7AB, UK
| | - W Glenn McCluggage
- Department of Pathology, Belfast City Hospital, Belfast, NI, BT9 7AB, UK
| | - David H Hunter
- Department of Gynaecology, Belfast City Hospital, Belfast, NI, BT9 7AB, UK
| | - Laura Feeney
- Patrick G Johnson Centre for Cancer Research (PGJCCR), Queen's University Belfast, Belfast, NI, BY9 7AE, UK
| |
Collapse
|
2
|
Smyth E, Brennan L, Enright R, Sekhon M, Dickson J, Hussey J, Guinan E. The acceptability of exercise prehabilitation before cancer surgery among patients, family members and health professionals: a mixed methods evaluation. Support Care Cancer 2024; 32:399. [PMID: 38819477 PMCID: PMC11142941 DOI: 10.1007/s00520-024-08574-4] [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: 10/27/2023] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Exercise prehabilitation aims to increase preoperative fitness, reduce post-operative complications, and improve health-related quality of life. For prehabilitation to work, access to an effective programme which is acceptable to stakeholders is vital. The aim was to explore acceptability of exercise prehabilitation before cancer surgery among key stakeholders specifically patients, family members and healthcare providers. METHODS A mixed-methods approach (questionnaire and semi-structured interview) underpinned by the Theoretical Framework of Acceptability was utilised. Composite acceptability score, (summation of acceptability constructs and a single-item overall acceptability construct), and median of each construct was calculated. Correlation analysis between the single-item overall acceptability and each construct was completed. Qualitative data was analysed using deductive and inductive thematic analysis. RESULTS 244 participants completed the questionnaire and n=31 completed interviews. Composite acceptability was comparable between groups (p=0.466). Four constructs positively correlated with overall acceptability: affective attitude (r=0.453), self-efficacy (r=0.399), ethicality (r=0.298) and intervention coherence (r=0.281). Qualitative data confirmed positive feelings, citing psychological benefits including a sense of control. Participants felt flexible prehabilitation program would be suitable for everyone, identifying barriers and facilitators to reduce burden. CONCLUSION Exercise prehabilitation is highly acceptable to key stakeholders. Despite some burden, it is a worthwhile and effective intervention. Stakeholders understand its purpose, are confident in patients' ability to participate, and regard it is an important intervention contributing to patients' psychological and physical wellbeing. IMPLICATIONS •Introduction should be comprehensively designed and clearly presented, providing appropriate information and opportunity for questions. •Programmes should be patient-centred, designed to overcome barriers and address patients' specific needs and goals. •Service must be appropriately resourced with a clear referral-pathway.
Collapse
Affiliation(s)
- Emily Smyth
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Louise Brennan
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Rachel Enright
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Mandeep Sekhon
- St George's, University of London, Population Health Research Institute, London, United Kingdom
| | | | - Juliette Hussey
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland.
- The Beacon Hospital, Dublin, Ireland.
- Department of Surgery, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
3
|
Watts T, Courtier N, Fry S, Gale N, Gillen E, McCutchan G, Patil M, Rees T, Roche D, Wheelwright S, Hopkinson J. Access, acceptance and adherence to cancer prehabilitation: a mixed-methods systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01605-3. [PMID: 38709465 DOI: 10.1007/s11764-024-01605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The purpose of this systematic review is to better understand access to, acceptance of and adherence to cancer prehabilitation. METHODS MEDLINE, CINAHL, PsychINFO, Embase, Physiotherapy Evidence Database, ProQuest Medical Library, Cochrane Library, Web of Science and grey literature were systematically searched for quantitative, qualitative and mixed-methods studies published in English between January 2017 and June 2023. Screening, data extraction and critical appraisal were conducted by two reviewers independently using Covidence™ systematic review software. Data were analysed and synthesised thematically to address the question 'What do we know about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups?' The protocol is published on PROSPERO CRD42023403776 RESULTS: Searches identified 11,715 records, and 56 studies of variable methodological quality were included: 32 quantitative, 15 qualitative and nine mixed-methods. Analysis identified facilitators and barriers at individual and structural levels, and with interpersonal connections important for prehabilitation access, acceptance and adherence. No study reported analysis of facilitators and barriers to prehabilitation specific to people from ethnic minority communities. One study described health literacy as a barrier to access for people from socioeconomically deprived communities. CONCLUSIONS There is limited empirical research of barriers and facilitators to inform improvement in equity of access to cancer prehabilitation. IMPLICATIONS FOR CANCER SURVIVORS To enhance the inclusivity of cancer prehabilitation, adjustments may be needed to accommodate individual characteristics and attention given to structural factors, such as staff training. Interpersonal connections are proposed as a fundamental ingredient for successful prehabilitation.
Collapse
|
4
|
Shen C, Gu L, Li N, Wang R, Yang X, Chu Z. Attitudes and perceptions of cancer patients and healthcare providers towards prehabilitation: A thematic synthesis. Br J Health Psychol 2024; 29:395-429. [PMID: 37985361 DOI: 10.1111/bjhp.12705] [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: 03/22/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Prehabilitation, which is the process of enhancing functional capacity before undergoing surgery or other treatments, has been shown to improve cancer patients' outcomes. Patient and healthcare provider attitudes and perceptions are essential factors in the successful implementation of prehabilitation. The purpose of this systematic review is to synthesize qualitative evidence and explore the barriers and facilitators to prehabilitation implementation. METHODS From the earliest available date to October 2023, 7 databases (PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE) were searched for a systematic review. Data were extracted, thematically analysed, and mapped onto the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). The Critical Appraisal Skills Programme (CASP) tool was used to assess the quality of the studies. RESULTS A total of 26 studies were included, involving 377 patients, 51 caregivers, and 156 healthcare providers. 16 factors were identified and mapped onto the COM-B model: reflective/automatic motivation, physical/social opportunity, physical/ psychological capability. CONCLUSIONS Patients and healthcare provides identified a lack of reflective motivation and physical opportunities as the most significant barriers to engagement in prehabilitation. Personalized approaches, social support, and healthcare providers' engagement are key factors for prehabilitation. Future research should focus on developing effective interventions to enhance the uptake and sustainability of prehabilitation.
Collapse
Affiliation(s)
- Chen Shen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Lianqi Gu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Na Li
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rao Wang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Yang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiping Chu
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
5
|
Eser P, Klaus C, Vetsch T, Ernst R, Engel D. Qualitative assessment of expectations on the content, form and way of delivery of a prehabilitation programme in patients with lung resection surgery - A Swiss tertiary centre experience. SAGE Open Med 2024; 12:20503121241233427. [PMID: 38414831 PMCID: PMC10898307 DOI: 10.1177/20503121241233427] [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: 08/29/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Objective To assess the interest in a prehabilitation programme of patients awaiting lung resection and to identify expectations from such a programme. Introduction At present, in Switzerland, there are no multimodal clinical prehabilitation programmes for lung resection patients awaiting surgery. Methods Semi-structured face-to-face interviews were conducted with patients who have had or were awaiting lung resection at a Swiss tertiary centre. Thematic analysis was performed to identify common prespecified themes. Results Twenty-two patients (45.5% female, age 70.6 ± 16.6 years) were interviewed. Seventy-seven percent were interested in a prehabilitation programme. Sixty-two percent, 67% and 90% were interested in endurance, strength and respiratory training, respectively. Six patients (27%) were active smokers, of whom two (one-third) were interested in a smoking cessation programme. Seventy-six percent were interested in nutrition counselling and 90% in receiving education on risk factor management. Forty percent preferred centre-based training/counselling sessions, 20% preferred home-based training/counselling and 30% found both forms acceptable. Patients were willing to perform prehabilitation activities on 2.6 days/week for a total of 162 min/week. Participating in peer groups was desired by only 25%. Conclusions Patients with lung resection were highly interested in participating in prehabilitation, albeit only for a mean time cost of 2.7 h per week. Offering a prehabilitation programme with a combination of in-hospital group sessions and home-based training seems feasible.
Collapse
Affiliation(s)
- Prisca Eser
- Rehabilitation & Sports Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Colette Klaus
- Rehabilitation & Sports Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Thomas Vetsch
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Raphaela Ernst
- Rehabilitation & Sports Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
6
|
汪 夏, 朱 晓, 吴 茜. [Influencing Factors of Adherence to Exercise Prehabilitation in Older Patients With Colorectal Cancer: A Qualitative Study]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:811-815. [PMID: 37545079 PMCID: PMC10442619 DOI: 10.12182/20230760501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Indexed: 08/08/2023]
Abstract
Objective To investigate the influencing factors of adherence to exercise prehabilitation in older patients with colorectal cancer. Methods Based on the capacity, opportunity, and motivation of behavior change (COM-B) model, 12 older colorectal tumors patients undergoing elective surgeries at a tertiary-care hospital in Shanghai between August 2022 and December 2022 were enrolled for the study through purposive sampling. The respondents were involved in semi-structured interviews. Directed content analysis of their data was conducted to extract themes. Results A total of 3 themes and 8 sub-themes were deduced from the analysis, including capacity (physical ability to tolerate exercise intensity and psychological experience of worrying about exercise risks), opportunity (adequate information support and professional guidance and simple and feasible exercise prescriptions and prehabilitation conditions), motivation (the intrinsic drive to identify with the prehabilitation values, the positive drive of inherent exercise habits, the continuous drive of exercise benefits, and the dual inspiration of team spirit and family support). These themes and subthemes were identified as influencing factors of adherence to exercise prehabilitation in older patients with colorectal cancer. Conclusion Prehabilitation in older patients with colorectal cancer is influenced by multiple factors. Healthcare professionals should enhance education, develop individualized prehabilitation programs, and improve the diversified social support system to enhance patients' adherence to prehabilitation exercise and maximize the benefits of prehabilitation.
Collapse
Affiliation(s)
- 夏云 汪
- 同济大学医学院 (上海 200072)School of Medicine, Tongji University, Shanghai 200072, China
- 同济大学附属第十人民医院 护理部 (上海 200072)Department of Nursing, Tenth People's Hospital of Tongji University, Shanghai 200072, China
| | - 晓萍 朱
- 同济大学医学院 (上海 200072)School of Medicine, Tongji University, Shanghai 200072, China
| | - 茜 吴
- 同济大学医学院 (上海 200072)School of Medicine, Tongji University, Shanghai 200072, China
| |
Collapse
|
7
|
van der Velde M, van der Leeden M, Geleijn E, Veenhof C, Valkenet K. What moves patients to participate in prehabilitation before major surgery? A mixed methods systematic review. Int J Behav Nutr Phys Act 2023; 20:75. [PMID: 37344902 DOI: 10.1186/s12966-023-01474-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Prehabilitation offers patients the opportunity to actively participate in their perioperative care by preparing themselves for their upcoming surgery. Experiencing barriers may lead to non-participation, which can result in a reduced functional capacity, delayed post-operative recovery and higher healthcare costs. Insight in the barriers and facilitators to participation in prehabilitation can inform further development and implementation of prehabilitation. The aim of this review was to identify patient-experienced barriers and facilitators for participation in prehabilitation. METHODS For this mixed methods systematic review, articles were searched in PubMed, EMBASE and CINAHL. Articles were eligible for inclusion if they contained data on patient-reported barriers and facilitators to participation in prehabilitation in adults undergoing major surgery. Following database search, and title and abstract screening, full text articles were screened for eligibility and quality was assessed using the Mixed Method Appraisal Tool. Relevant data from the included studies were extracted, coded and categorized into themes, using an inductive approach. Based on these themes, the Capability, Opportunity, Motivation, Behaviour (COM-B) model was chosen to classify the identified themes. RESULTS Three quantitative, 14 qualitative and 6 mixed methods studies, published between 2007 and 2022, were included in this review. A multitude of factors were identified across the different COM-B components. Barriers included lack of knowledge of the benefits of prehabilitation and not prioritizing prehabilitation over other commitments (psychological capability), physical symptoms and comorbidities (physical capability), lack of time and limited financial capacity (physical opportunity), lack of social support (social opportunity), anxiety and stress (automatic motivation) and previous experiences and feeling too fit for prehabilitation (reflective motivation). Facilitators included knowledge of the benefits of prehabilitation (psychological capability), having access to resources (physical opportunity), social support and encouragement by a health care professional (social support), feeling a sense of control (automatic motivation) and beliefs in own abilities (reflective motivation). CONCLUSIONS A large number of barriers and facilitators, influencing participation in prehabilitation, were found across all six COM-B components. To reach all patients and to tailor prehabilitation to the patient's needs and preferences, it is important to take into account patients' capability, opportunity and motivation. TRIAL REGISTRATION Registered in PROSPERO (CRD42021250273) on May 18th, 2021.
Collapse
Affiliation(s)
- Miriam van der Velde
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, NL, Netherlands.
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, NL, Netherlands.
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, NL, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, NL, Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, NL, Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, NL, Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, NL, Netherlands
| | - Karin Valkenet
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, NL, Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, NL, Netherlands
| |
Collapse
|
8
|
Impact of surgery and chemotherapy timing on outcomes in older versus younger epithelial ovarian cancer patients: A nationwide Danish cohort study. J Geriatr Oncol 2023; 14:101359. [PMID: 35989185 DOI: 10.1016/j.jgo.2022.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To explore differences in surgical complexity, chemotherapy administration, and treatment delays between younger and older Danish patients with epithelial ovarian cancer (EOC). MATERIALS AND METHODS We included a nationwide cohort diagnosed with EOC from 2013 to 2018. We described surgical complexity and outcomes, the extent of chemotherapy and treatment delays stratified by age (<70 and ≥ 70 years), and surgical modality (primary, interval, or no debulking surgery). RESULTS In total, we included 2946 patients. For patients with advanced-stage disease, 52% of the older patients versus 25% of the younger patients did not undergo primary debulking surgery (PDS) or interval debulking surgery (IDS). For patients undergoing PDS or IDS, older patients underwent less extensive surgery and more often had residual disease after surgery >0 cm compared to younger patients. Furthermore, older patients were less often treated with chemotherapy. Older patients had PDS later than younger. We did not find any differences between age groups concerning treatment delays. Two-year cancer-specific survival differed significantly between age groups regardless of curatively intended treatment. DISCUSSION This study demonstrates that older patients are treated less actively concerning surgical and oncological treatment than younger patients, leading to worse cancer-specific survival. Older patients do not experience more treatment delays than younger ones.
Collapse
|
9
|
Franssen RFW, Bongers BC, Vogelaar FJ, Janssen-Heijnen MLG. Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study. Perioper Med (Lond) 2022; 11:28. [PMID: 35879732 PMCID: PMC9313601 DOI: 10.1186/s13741-022-00260-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Prehabilitation appears to be an effective strategy to reduce postoperative complications and enhance recovery after colorectal surgery. Although many patients prefer (unsupervised) home-based prehabilitation, adherence can be problematic. Combining home-based prehabilitation with tele-monitoring might demonstrate a higher adherence than unsupervised prehabilitation; however, evidence on its feasibility and effectiveness in patients with colorectal cancer scheduled for elective surgery who are at high risk for postoperative complications is lacking. The aim of this study was to assess the feasibility of a bimodal tele-prehabilitation program in patients with colorectal cancer at high risk for postoperative complications. Methods High-risk patients (oxygen uptake at the ventilatory anaerobic threshold ≤11 mL/kg/min or oxygen uptake at peak exercise ≤ 18 mL/kg/min) with colorectal cancer were included in a home-based bimodal tele-prehabilitation program. The program consisted of a personalized tele-monitored moderate to high-intensity interval training intervention and nutritional counseling. Feasibility was measured by participation rate, dropout rate, adherence to the physical exercise training session’s frequency, intensity, and time, and retention rate. Patient appreciation was measured by a patient appreciation questionnaire. Changes in preoperative physical fitness as secondary outcomes were quantified by time to exhaustion on a constant work rate (cycle) test, number of repetitions on the 30-s chair-stand test, and walking speed on the 4-m gait speed test. Results The participation rate was 81%, there were no adverse events, and all participants managed to complete the tele-prehabilitation program (retention rate of 100%). Adherence with regard to the exercise program’s frequency, intensity, and time was respectively 91%, 84%, and 100%. All participants appreciated the tele-prehabilitation program. Time to exhaustion on the constant work rate test improved (not statistically significant) from a pre-prehabilitation median score of 317 seconds to a post-prehabilitation median score of 412 seconds (p = 0.24). Median number of repetitions on the 30-s chair-stand test improved from 12 to 16 (p = 0.01). Conclusions Tele-prehabilitation seems feasible in high-risk patients with colorectal cancer, but efforts should be made to further improve adherence to physical exercise training intensity. More research is needed to establish the (cost-)effectiveness of tele-prehabilitation regarding preoperative improvements in preoperative aerobic fitness and postoperative reduction of complications. Trial registration ISRCTN, ISRCTN64482109. Registered 09 November 2021 - Retrospectively registered.
Collapse
Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210 5912BL, Venlo, the Netherlands. .,Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
| |
Collapse
|
10
|
Saggu RK, Barlow P, Butler J, Ghaem-Maghami S, Hughes C, Lagergren P, McGregor AH, Shaw C, Wells M. Considerations for multimodal prehabilitation in women with gynaecological cancers: a scoping review using realist principles. BMC Womens Health 2022; 22:300. [PMID: 35854346 PMCID: PMC9294794 DOI: 10.1186/s12905-022-01882-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is increasing recognition that prehabilitation is important as a means of preparing patients physically and psychologically for cancer treatment. However, little is understood about the role and optimal nature of prehabilitation for gynaecological cancer patients, who usually face extensive and life-changing surgery in addition to other treatments that impact significantly on physiological and psychosexual wellbeing. REVIEW QUESTION This scoping review was conducted to collate the research evidence on multimodal prehabilitation in gynaecological cancers and the related barriers and facilitators to engagement and delivery that should be considered when designing a prehabilitation intervention for this group of women. METHODS Seven medical databases and four grey literature repositories were searched from database inception to September 2021. All articles, reporting on multimodal prehabilitation in gynaecological cancers were included in the final review, whether qualitative, quantitative or mixed-methods. Qualitative studies on unimodal interventions were also included, as these were thought to be more likely to include information about barriers and facilitators which could also be relevant to multimodal interventions. A realist framework of context, mechanism and outcome was used to assist interpretation of findings. RESULTS In total, 24 studies were included in the final review. The studies included the following tumour groups: ovarian only (n = 12), endometrial only (n = 1), mixed ovarian, endometrial, vulvar (n = 5) and non-specific gynaecological tumours (n = 6). There was considerable variation across studies in terms of screening for prehabilitation, delivery of prehabilitation and outcome measures. Key mechanisms and contexts influencing engagement with prehabilitation can be summarised as: (1) The role of healthcare professionals and organisations (2) Patients' perceptions of acceptability (3) Factors influencing patient motivation (4) Prehabilitation as a priority (5) Access to prehabilitation. IMPLICATIONS FOR PRACTICE A standardised and well evidenced prehabilitation programme for women with gynaecological cancer does not yet exist. Healthcare organisations and researchers should take into account the enablers and barriers to effective engagement by healthcare professionals and by patients, when designing and evaluating prehabilitation for gynaecological cancer patients.
Collapse
Affiliation(s)
- Rhia Kaur Saggu
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, Charing Cross Hospital, 13th Floor Laboratory Block, Fulham Palace Road, London, W6 8RF, UK.
| | - Phillip Barlow
- Medical Library, Chelsea and Westminster Campus, Imperial College London, Fulham Road, London, UK
| | - John Butler
- Gynaecological Unit, The Royal Marsden Hospital, Fulham Road, London, UK
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
| | - Cathy Hughes
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, University of Surrey, Guildford, UK
| | - Pernilla Lagergren
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alison H McGregor
- Musculoskeletal Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Clare Shaw
- Royal Marsden and Institute of Cancer Research Biomedical Research Centre, London and Sutton, UK
| | - Mary Wells
- Department of Surgery and Oncology, Nursing Directorate, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, UK
| |
Collapse
|
11
|
Ekmann-Gade AW, Høgdall CK, Seibæk L, Noer MC, Fagö-Olsen CL, Schnack TH. Incidence, treatment, and survival trends in older versus younger women with epithelial ovarian cancer from 2005 to 2018: A nationwide Danish study. Gynecol Oncol 2022; 164:120-128. [PMID: 34716025 DOI: 10.1016/j.ygyno.2021.10.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine clinical trends in Denmark for younger and older epithelial ovarian cancer (EOC) patients, focusing on incidence, treatment, and survival changes. METHODS We included a nationwide cohort diagnosed with EOC from 2005 to 2018. We described age-standardized incidence, surgical patterns, residual disease trends, and cancer-specific survival stratified by age (<70 and ≥ 70 years), stage, and period (2005-09, 2010-13, 2014-18). RESULTS We included 7522 patients. The incidence decreased from 16.3 (2005) to 11.4 (2018) per 100,000 woman-years, driven by the younger cohort. While the proportion of patients with stage IIIC-IV disease undergoing primary debulking surgery (PDS) decreased, the proportion of patients having interval debulking surgery (IDS) and no debulking surgery increased significantly. In 2014-18, 36% and 24% had PDS for younger and older patients, respectively, compared to 72% and 62% in 2005-09. In both age cohorts, the proportion of patients debulked to no residual disease increased significantly among patients with stage IIIC-IV and in the total cohort. Two-year cancer-specific survival increased from 75% (2005-09) to 84% (2014-18) for younger patients and from 53% to 66% for older patients. After adjusting for potential confounders, age ≥ 70 was associated with a 1.4-fold increased risk of cancer-specific death (95% confidence interval: 1.2,1.5). CONCLUSIONS The proportion of patients with advanced EOC not undergoing PDS or IDS increased significantly. During the same period, patients debulked to no residual disease, and cancer-specific survival increased. However, a survival gap in favor of the younger patients remains after adjusting for potential confounders.
Collapse
Affiliation(s)
| | | | - Lene Seibæk
- Department of Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Calundann Noer
- Department of Gynecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Tine Henrichsen Schnack
- Department of Gynecology, Rigshospitalet, Copenhagen, Denmark; Department of Gynecology, Odense University Hospital, Odense, Denmark
| |
Collapse
|