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Toohey K, Mizrahi D, Hart NH, Singh B, Lopez P, Hunter M, Newton RU, Schmitz KH, Adams D, Edbrooke L, Hayes S. Exercise in cancer care for people with lung cancer: A narrative synthesis. J Sci Med Sport 2024:S1440-2440(24)00263-9. [PMID: 39155211 DOI: 10.1016/j.jsams.2024.08.002] [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: 01/13/2024] [Revised: 05/24/2024] [Accepted: 08/02/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES Lung cancer is the second most common cancer diagnosed worldwide, resulting in significant physical and psychological consequences. In this narrative review, we explore the role of exercise as an adjunct therapy to counteract health issues experienced by people before, during and after treatment for lung cancer, and offer recommendations for exercise prescription and future research. DESIGN Narrative cornerstone review. METHODS A narrative review was conducted to explore the role of exercise in cancer care for people diagnosed with lung cancer. RESULTS Improvements in fitness, strength and quality of life have been demonstrated in people with lung cancer following participation in exercise programmes before, during and post treatment. Whilst combined aerobic (50-100 % heart rate maximum) and resistance (50-85 % of 1 repetition maximum) training, 2-5 times per week across the cancer continuum is typically prescribed, few people with lung cancer currently access exercise services. 'Optimal' exercise prescription is unclear, although is likely individual-specific. The immediate priority is to identify a tolerable starting exercise dosage, with the side effects of lung cancer and its treatment on the respiratory system, particularly shortness of breath (dyspnoea), likely driving the initial maximum threshold for session mode, duration and intensity. To date, exercise safety for people with lung cancer has been poorly evaluated and reported - few trials report it, but those that do report small numbers of serious adverse events. CONCLUSIONS Recommendations for health professionals prescribing exercise therapy to people with lung cancer are provided, with consideration of the strengths and limitations of the current evidence base.
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Affiliation(s)
- Kellie Toohey
- Physical Activity, Sport, and Exercise Research Theme, Faculty of Health, Southern Cross University, Australia; Faculty of Health, University of Canberra, Australia.
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia; Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Australia; Institute for Health Research, The University of Notre Dame Australia, Australia
| | - Ben Singh
- Allied Health & Human Performance, University of South Australia, Australia
| | - Pedro Lopez
- Grupo de Pesquisa em Exercício para Populações Clínicas (GPCLIN), Universidade de Caxias do Sul, Brazil; Pleural Medicine Unit, Institute for Respiratory Health, Australia; Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Australia
| | | | - Robert U Newton
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
| | - Kathryn H Schmitz
- Division of Hematology and Oncology, Hillman Cancer Center, University of Pittsburgh, USA
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Australia; Viertel Cancer Research Centre, Cancer Council Queensland, Australia
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Wu W, Li H, Fan R. Summary of the best evidence for prehabilitation management of patients with non-small cell lung cancer. Asia Pac J Oncol Nurs 2024; 11:100516. [PMID: 39036283 PMCID: PMC11260363 DOI: 10.1016/j.apjon.2024.100516] [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] [Received: 03/10/2024] [Accepted: 05/12/2024] [Indexed: 07/23/2024] Open
Abstract
Objective This study adopts an evidence-based methodology to establish a comprehensive theory foundation for preoperative prehabilitation management in non-small cell lung cancer (NSCLC) patients. Methods A systematic literature review linked to prehabilitation management for NSCLC patients was conducted, utilizing reputable databases such as UpToDate, BMJ Best Practice, UK NICE, SIGN, GIN, Joanna Briggs Institute Library, Cochrane Library, Web of Science, Embase, OVID evidence-based database, PubMed, Chinese Wanfang database, CNKI, CBM, ATS, BTS, AACVPR, and EACTS. The search encompassed articles, including clinical decision-making, guidelines, evidence summaries, expert consensuses, and systematic reviews, from the inception of databases up to March 31st, 2023. Two researchers performed quality assessment of the literature and subsequent evidence extraction. Results Nineteen articles were included, comprising five guidelines, three expert consensuses, seven systematic reviews, and four randomized controlled trials. A total of 41 pieces of evidence were summarized, addressing key aspects such as the multidisciplinary team, appropriate patient population, prehabilitation modes, timing of prehabilitation, prehabilitation assessment, prehabilitation content, quality control, and effectiveness evaluation. Conclusions The synthesis of the best evidence for prehabilitation management in NSCLC patients provides a solid evidence-based foundation for its implementation. It is recommended that healthcare professionals conduct thorough patient evaluations, optimize and integrate medical resources, and collaboratively engage in interdisciplinarity efforts to develop and implement personalized and multimodal prehabilitation plans.
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Affiliation(s)
- Wenfang Wu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Huayan Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Rongrong Fan
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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Hentati A, Ayed AB, Jdidi J, Chaari Z, Halima GB, Frikha I. Enhanced recovery after thoracic surgery in low- and middle-income countries: Feasibility and outcomes. Asian Cardiovasc Thorac Ann 2024; 32:27-35. [PMID: 37993978 DOI: 10.1177/02184923231216131] [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] [Indexed: 11/24/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) applies multimodal, perioperative, and evidence-based practices to decrease postoperative morbi-mortality, the length of hospital stay, and hospitalization costs. Implementing enhanced recovery after thoracic surgery (ERATS) in low- and middle-income countries (LMIC) is problematic. This randomized controlled trial evaluated the feasibility and effectiveness of an ERATS protocol adapted to LMIC conditions in Tunisia. MATERIALS AND METHODS We conducted this randomized controlled trial between December 2015 and August 2017 in the Thoracic and Cardiovascular Surgery Department at Habib Bourguiba University Hospital of Sfax, Tunisia. RESULTS One hundred patients undergoing thoracic surgery were randomly allocated to the ERATS group or Control group. During the postoperative phase, 13 patients (13%) were excluded secondary. These complication rates were lower in the ERATS group: lack of reexpansion (14.63% vs 16.10%: p = 0.72), pleural effusion (0% vs 10.86%, p = 0.05), and prolonged air leak (17.07% vs 30.43%, p = 0.14). The pain level decreased significantly in the ERATS group from postoperative H3 (p = 0.006). This difference was significant at H6 (p = 0.001), H24 (p = 0.05), H48 (p = 0.01), discharge (p = 0.002), and after 15 days (p = 0.01), with a decreased analgesic consumption. The length of hospital stay was shorter in the ERAS group (median six days vs seven days, p = 0.17). CONCLUSION This study provides an adapted ERATS protocol, applicable regardless of the surgical approach or the type of resection and suitable for LMIC hospital's conditions. This protocol can improve the postoperative outcomes of thoracic surgery.
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Affiliation(s)
- Abdessalem Hentati
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ahmed Ben Ayed
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Surgery Department, Gabes University Hospital, Gabes, Tunisia
| | - Jihen Jdidi
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Community Medicine Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Zied Chaari
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ghassen Ben Halima
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imed Frikha
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
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Fraile Olivero CA, Jarabo Sarceda JR, Fernández Martín E, Santos Capa P, Arribas Manzanal PD, Gómez Martínez AM, Calatayud Gastardi J, Hernando Trancho F. Implementation of a perioperative care App in elective thoracic surgery. Cir Esp 2023; 101:265-273. [PMID: 36108953 DOI: 10.1016/j.cireng.2022.09.022] [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: 10/06/2021] [Accepted: 01/26/2022] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The design and implementation inconsistency of perioperative care programs limits their universalization, and it is where e-Health can standardize these processes. The objective of the study is to create a Smartphone App with a perioperative care program, implement it in a group of patients scheduled for a thoracic surgical procedure, and evaluates its use. METHODS A prospective and descriptive study. We created a Smartphone app (Fissios App) which contains 40 perioperative recommendations and 10 chest physical exercises. Patients were recommended to use it before and after surgery; to measure its use, we created and applied a questionnaire. A descriptive analysis of patient variables and questionnaire responses was performed and their association evaluated. RESULTS One hundred four patients were included, 60.3% were men with a median age of 62 years (51-71), and 26.72% had completed high school. The 89.3% of patients highlighted the ease of downloading and setting up the app. More than 90% of patients positively assessed clarity in explaining chest physical exercises and perioperative recommendations. One hundred four (79.4%) patients highlighted the contribution of the use of the app during the preoperative period to face the postoperative period. CONCLUSIONS We created a Smartphone app (Fissios App) with a perioperative care program and it was successfully implemented regardless of the age or educational level of patients. The tool clearly explains the information contained and the patients reported that its use before surgery helped them to face the postoperative period, with an appropriate level of physical demand and time of use.
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Affiliation(s)
| | | | | | - Passio Santos Capa
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico San Carlos, Madrid, Spain
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Batchelor TJP. Enhanced recovery after surgery and chest tube management. J Thorac Dis 2023; 15:901-908. [PMID: 36910059 PMCID: PMC9992626 DOI: 10.21037/jtd-22-1373] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/13/2023] [Indexed: 02/28/2023]
Abstract
This review documents the relationships between enhanced recovery after surgery (ERAS) pathways, chest tube management and patient outcomes following lung resection surgery. ERAS pathways have been introduced to mitigate the harmful stress response that occurs following all major surgery, including lung resection. Improvements to the entire patient pathway, from the preoperative admission clinic through to discharge and beyond, can have additive or synergistic effects and result in improved patient outcomes, reduced length of stay and lower costs. At the same time, there are some key care elements that appear to be more important than others. In the postoperative period, early removal of chest tubes, early mobilization, and limited use of opioids are all independently important factors. These elements of care are all intertwined. Therefore, a focus on proactive chest tube management with the abandonment of conservative chest tube strategies should be a focus of postoperative ERAS pathways. This can be achieved with single tubes, no routine suction, the use of digital drainage systems, and removal of tubes even in the presence of relatively high serous pleural fluid outputs. The goals of early mobilization and opioid-sparing analgesia are more readily achieved once a chest tube has been removed. The result is superior patient outcomes with significantly fewer complications.
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Edbrooke L, Bowman A, Granger CL, Burgess N, Abo S, Connolly B, Denehy L. Exercise across the Lung Cancer Care Continuum: An Overview of Systematic Reviews. J Clin Med 2023; 12:1871. [PMID: 36902659 PMCID: PMC10003899 DOI: 10.3390/jcm12051871] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Growing evidence supports exercise for people with lung cancer. This overview aimed to summarise exercise intervention efficacy and safety across the care continuum. METHODS Eight databases (including Cochrane and Medline) were searched (inception-February 2022) for systematic reviews of RCTs/quasi-RCTs. Eligibility: population-adults with lung cancer; intervention: exercise (e.g., aerobic, resistance) +/- non-exercise (e.g., nutrition); comparator: usual care/non-exercise; primary outcomes: exercise capacity, physical function, health-related quality of life (HRQoL) and post-operative complications. Duplicate, independent title/abstract and full-text screening, data extraction and quality ratings (AMSTAR-2) were completed. RESULTS Thirty systematic reviews involving between 157 and 2109 participants (n = 6440 total) were included. Most reviews (n = 28) involved surgical participants. Twenty-five reviews performed meta-analyses. The review quality was commonly rated critically low (n = 22) or low (n = 7). Reviews commonly included combinations of aerobic, resistance and/or respiratory exercise interventions. Pre-operative meta-analyses demonstrated that exercise reduces post-operative complications (n = 4/7) and improves exercise capacity (n = 6/6), whilst HRQoL findings were non-significant (n = 3/3). Post-operative meta-analyses reported significant improvements in exercise capacity (n = 2/3) and muscle strength (n = 1/1) and non-significant HRQoL changes (n = 8/10). Interventions delivered to mixed surgical and non-surgical populations improved exercise capacity (n = 3/4), muscle strength (n = 2/2) and HRQoL (n = 3). Meta-analyses of interventions in non-surgical populations demonstrated inconsistent findings. Adverse event rates were low, however, few reviews reported on safety. CONCLUSIONS A large body of evidence supports lung cancer exercise interventions to reduce complications and improve exercise capacity in pre- and post-operative populations. Additional higher-quality research is needed, particularly in the non-surgical population, including subgroup analyses of exercise type and setting.
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Affiliation(s)
- Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Amy Bowman
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Physiotherapy, The Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Catherine L. Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Nicola Burgess
- Department of Physiotherapy, Austin Health, Melbourne, VIC 3084, Australia
| | - Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Physiotherapy, The Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Jones T, Fayle R. Letter to the editor referencing Effect of inspiratory muscle training associated or not to physical rehabilitation in preoperative anatomic pulmonary resection: a systemic review and meta-analysis. Support Care Cancer 2022; 31:66. [PMID: 36538106 DOI: 10.1007/s00520-022-07466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
The recent systematic review and meta-analysis by de Oliveria Vacchi, Martha, and Macagnan (2022) on the effect of inspiratory muscle training (IMT) and its association with physical rehabilitation in preoperative anatomic pulmonary resection raises some interesting findings, and the authors should be congratulated for their work. However, additional factors should be considered in the context of this study. These include frailty, postoperative pulmonary complications, and the high correlation between lung cancer and chronic obstructive disease. This study is paramount considering the potential to improve patient suitability for curative surgery, the high risks associated with surgery and shifting demographics with an increased prevalence of comorbidities, alongside fiscal pressures. This study suggests the need for further high-quality research in this high-risk population, considering IMT alone or with physical rehabilitation, with methodologies that are reproducible.
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Affiliation(s)
- Tracy Jones
- Department of Physiotherapy, Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, South Wales, UK.
| | - Rebecca Fayle
- Department of Physiotherapy, Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, South Wales, UK
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McIsaac DI, Fergusson DA, Khadaroo R, Meliambro A, Muscedere J, Gillis C, Hladkowicz E, Taljaard M. PREPARE trial: a protocol for a multicentre randomised trial of frailty-focused preoperative exercise to decrease postoperative complication rates and disability scores. BMJ Open 2022; 12:e064165. [PMID: 35940835 PMCID: PMC9364396 DOI: 10.1136/bmjopen-2022-064165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Frailty is a strong predictor of adverse postoperative outcomes. Prehabilitation may improve outcomes after surgery for older people with frailty by addressing physical and physiologic deficits. The objective of this trial is to evaluate the efficacy of home-based multimodal prehabilitation in decreasing patient-reported disability and postoperative complications in older people with frailty having major surgery. METHODS AND ANALYSIS We will conduct a multicentre, randomised controlled trial of home-based prehabilitation versus standard care among consenting patients >60 years with frailty (Clinical Frailty Scale>4) having elective inpatient major non-cardiac, non-neurologic or non-orthopaedic surgery. Patients will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of >3 weeks of prehabilitation (exercise (strength, aerobic and stretching) and nutrition (advice and protein supplementation)). The study has two primary outcomes: in-hospital complications and patient-reported disability 30 days after surgery. Secondary outcomes include survival, lower limb function, quality of life and resource utilisation. A sample size of 750 participants (375 per arm) provides >90% power to detect a minimally important absolute difference of 8 on the 100-point patient-reported disability scale and a 25% relative risk reduction in complications, using a two-sided alpha value of 0.025 to account for the two primary outcomes. Analyses will follow intention to treat principles for all randomised participants. All participants will be followed to either death or up to 1 year. ETHICS AND DISSEMINATION Ethical approval has been granted by Clinical Trials Ontario (Project ID: 1785) and our ethics review board (Protocol Approval #20190409-01T). Results will be disseminated through presentation at scientific conferences, through peer-reviewed publication, stakeholder organisations and engagement of social and traditional media. TRIAL REGISTRATION NUMBER NCT04221295.
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Affiliation(s)
- Daniel I McIsaac
- Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rachel Khadaroo
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Meliambro
- Patient Engagement, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | | | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Emily Hladkowicz
- Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Zhou W, Webster KE, Smith EL, Chen W, Veliz PT, Reddy RM, Larson JL. Physical activity in surgical lung cancer patients: a systematic review. Support Care Cancer 2022; 30:6473-6482. [PMID: 35384612 DOI: 10.1007/s00520-022-07018-1] [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: 12/07/2021] [Accepted: 03/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Perioperative exercise could improve health outcomes of surgical lung cancer patients, but less is known about their natural physical activity (PA) behavior before exercise interventions. This review aimed to synthesize evidence on PA, regarding the following: (1) proportion of patients meeting PA guidelines, (2) amount of PA, (3) PA trajectory following surgery, and (4) correlates of PA before or after surgery. METHODS We conducted a systematic review using PubMed, CINHAL, Scopus, and SPORTDiscus (July 2021). Observational or experimental studies that measure PA of lung cancer patients before/after surgery were included. We assessed methodological quality using the NIH Quality Assessment Tools and extracted data using a standardized form. RESULTS Seventeen studies (25 articles, N = 1737 participants) published between 2009 and 2021 were included. Fourteen studies had sample sizes less than 100. Thirteen studies were of fair quality and four studies were of good quality. Only 23-28% of patients met PA guideline (150 min/week moderate-vigorous PA) at 6 months-6 years after surgery. Patients took an average of 3822-10,603 daily steps before surgery and 3934-8863 steps at 1-3 months after surgery. Physical activity was lower at 1 day-3 months after surgery, compared with preoperative levels. Perioperative PA was positively associated with exercise capacity, quality of life and reduced postoperative complications. CONCLUSION This review suggests that PA is low among surgical lung cancer patients, and it may not recover within 3 months following surgery. Physical activity has the potential to improve postoperative outcomes. However, the existing evidence is weak, and future larger longitudinal studies are needed.
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Affiliation(s)
- Weijiao Zhou
- School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | | | - Ellen Lavoie Smith
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Weiyun Chen
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Philip T Veliz
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rishindra M Reddy
- Department of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Janet L Larson
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:208-241. [PMID: 35585017 DOI: 10.1016/j.redare.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, Spain
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - G Sanchez-Pedrosa
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, Spain
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de la Ribera, Alzira, Valencia, Spain
| | - P Piñeiro
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Cruz
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F de la Gala
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, Spain
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario A Coruña, La Coruña, Spain
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, Spain
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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11
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Implementación de una app de cuidados perioperatorios en cirugía torácica electiva. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Varghese TK. General Thoracic Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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13
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Xu X, Cheung DST, Smith R, Lai AYK, Lin CC. The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay. Clin Rehabil 2021; 36:172-189. [PMID: 34496658 DOI: 10.1177/02692155211043267] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. REVIEW METHODS Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. RESULTS Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = -1.68 days, 95% CI = -2.23, -1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = -0.23 days, 95% CI = -1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = -0.17, 95% CI = -0.29, -0.05). CONCLUSION Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.
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Affiliation(s)
- Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Agnes Yuen Kwan Lai
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Alice Ho Miu Ling Nethersole Charity Foundation Professorship in Nursing, Hong Kong.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery. A Systematic Review and Meta-analysis with Trial Sequential Analysis. Ann Am Thorac Soc 2021; 18:678-688. [PMID: 33030962 DOI: 10.1513/annalsats.202002-183oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: Poor preoperative physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications (PPCs) that result in prolonged hospital length of stay and increased mortality.Objectives: To examine the effect of preoperative exercise training on the risk of PPCs across different surgical settings.Methods: We searched MEDLINE, Web of Science, Embase, the Physiotherapy Evidence Database, and the Cochrane Central Register, without language restrictions, for studies from inception to July 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. PPCs were the main outcome; secondary outcomes were preoperative functional changes and postoperative mortality, cardiovascular complications, and hospital length of stay. The study was registered with PROSPERO (International Prospective Register of Systematic Reviews).Results: From 29 studies, 2,070 patients were pooled for meta-analysis. Compared with the control condition, preoperative exercise training was associated with a lower incidence of PPCs (23 studies, 1,864 patients; relative risk, 0.52; 95% confidence interval [CI], 0.41 to 0.66; grading of evidence, moderate); Trial Sequential Analysis confirmed effectiveness, and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined), or preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference [WMD], +2 ml/kg/min; 99% CI, 0.3 to 3.7) and higher maximal inspiratory pressure (WMD, +12.2 cm H2O; 99% CI, 6.3 to 18.2). Hospital length of stay was shortened (WMD, -2.3 d; 99% CI, -3.82 to -0.75) in the intervention group, whereas no difference was found in postoperative mortality.Conclusions: Preoperative exercise training improves physical fitness and reduces the risk of developing PPCs while minimizing hospital resources use, regardless of the type of intervention and surgery performed.Systematic review registered with https://www.crd.york.ac.uk/prospero/ (CRD 42018096956).
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00102-X. [PMID: 34294445 DOI: 10.1016/j.redar.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, España
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - G Sanchez-Pedrosa
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, España
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de La Ribera, Alzira, Valencia, España
| | - P Piñeiro
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Cruz
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F de la Gala
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, España
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario de A Coruña, La Coruña, España
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, España
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Longitudinal Health-related Quality of Life among Individuals Considering Treatment for Stage I Non-Small-Cell Lung Cancer. Ann Am Thorac Soc 2021; 17:988-997. [PMID: 32433897 DOI: 10.1513/annalsats.202001-029oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rationale: Because of improvements in screening, there is an increasing number of patients with early-stage non-small-cell lung cancer (NSCLC) who are making treatment decisions.Objectives: Among patients with suspected stage I NSCLC, we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared with surgical resection.Methods: We conducted a multisite, prospective, observational cohort study at seven medical institutions. We evaluated minimum clinically important differences of PCOs at four time points (during treatment, 4-6 wk after treatment, 6 mo after treatment, and 12 mo after treatment) compared with pretreatment values using validated instruments. We used adjusted linear mixed models to examine whether the association between treatment and European Organization for Research and Treatment of Cancer global and physical quality-of-life (QOL) scales differed over time.Results: We included 127 individuals with stage I NSCLC (53 surgery, 74 SBRT). At 12 months, approximately 30% of patients remaining in each group demonstrated a clinical deterioration on global QOL from baseline. There was a significant difference in slopes between treatment groups on global QOL (-12.86; 95% confidence interval [CI], -13.34 to -12.37) and physical QOL (-28.71; 95% CI, -29.13 to -28.29) between baseline and during treatment, with the steeper decline observed among those who underwent surgery. Differences in slopes between treatment groups were not significant at all other time points.Conclusions: Approximately 30% of patients with stage I NSCLC have a clinically significant decrease in QOL 1 year after SBRT or surgical resection. Surgical resection was associated with steeper declines in QOL immediately after treatment compared with SBRT; however, these declines were not lasting and resolved within a year for most patients. Our results may facilitate treatment option discussions for patients receiving treatment for early-stage NSCLC.
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Tenconi S, Mainini C, Rapicetta C, Braglia L, Galeone C, Cavuto S, Merlo DF, Costi S, Paci M, Fugazzaro S. Rehabilitation for lung cancer patients undergoing surgery: results of the PUREAIR randomized trial. Eur J Phys Rehabil Med 2021; 57:1002-1011. [PMID: 34042410 DOI: 10.23736/s1973-9087.21.06789-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery for Non Small Cell Lung Cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients' overall fitness. AIM To establish whether intensive pulmonary rehabilitation, preoperative and postoperative, improves exercise capacity in patients undergoing lung resection. DESIGN Single centre, unblinded, designed for superiority, 1:1 randomised controlled trial with two parallel arms. SETTING S.Maria Nuova Hospital of Reggio Emilia (Italy). POPULATION Patients referred from local lung cancer multi-disciplinary team for lung resection. METHODS Patients were randomised to either standard of care (SC) or SC + intensive perioperative pulmonary rehabilitation (SC+PR). The primary aim was to investigate the effectiveness of pulmonary rehabilitation in improving exercise capacity six months after surgery. Additionally, we wanted to investigate the same effect shortly after surgery (at one month), as well as the overall impact of rehabilitation on lung function, postoperative complications and length of stay, Quality of Life, mood disturbances and pain. Sample was sized based on the primary outcome assuming a minimal clinically significant difference of 25 metres in exercise tolerance, measured with 6 minutes walking test. RESULTS The exercise tolerance at 6 months after surgery was significantly higher in patients undertaking PR compared to SC (+48.9 metres vs -7.5 metres respectively, difference: +56.4 metres, 95% CI: 29.6 - 83.0, p<0.001) and it showed significantly lower impairment at 1 month after surgery in the intervention group (-3.0 metres vs -30.1 metres difference: +27.1 metres, 95% CI: 3.4 - 50.8, p=0.025). No other significant differences between groups were found. CONCLUSIONS Comparison between groups showed that pulmonary rehabilitation, administered pre and postoperatively, significantly improved exercise capacity at 6 months in patients undergoing lung resection; it also significantly reduced the decrease in exercise tolerance observed 1 month after surgery. CLINICAL REHABILITATION IMPACT The PUREAIR trial highlights the importance of combined pre-operative and post-operative rehabilitation in reducing physical deconditioning in lung cancer patients undergoing surgery. Comprehensive pulmonary rehabilitation improves exercise capacity at 1 and 6 months after surgery. The PUREAIR trial results increase knowledge on comprehensive rehabilitation's outcomes in the first six months after surgery.
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Affiliation(s)
- Sara Tenconi
- Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy -
| | - Cristian Rapicetta
- Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Luca Braglia
- Research and Statistic Infrastructure, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Carla Galeone
- Pulmonology, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Statistic Infrastructure, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Domenico F Merlo
- Research and Statistic Infrastructure, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, Università di Modena e Reggio Emilia, Reggio Emilia, Italy.,Scientific Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimiliano Paci
- Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
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Zhou W, Woo S, Larson JL. Effects of perioperative exercise interventions on lung cancer patients: An overview of systematic reviews. J Clin Nurs 2020; 29:4482-4504. [DOI: 10.1111/jocn.15511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Weijiao Zhou
- School of Nursing University of Michigan Ann Arbor MI USA
| | - Seoyoon Woo
- School of Nursing University of Michigan Ann Arbor MI USA
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The Impact of Exercise and Nutrition as Part of a Person-Centered Approach to Prehabilitation in Patients with Bladder Cancer. Semin Oncol Nurs 2020; 36:151072. [DOI: 10.1016/j.soncn.2020.151072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Perrotta F, Cennamo A, Cerqua FS, Stefanelli F, Bianco A, Musella S, Rispoli M, Salvi R, Meoli I. Effects of a high-intensity pulmonary rehabilitation program on the minute ventilation/carbon dioxide output slope during exercise in a cohort of patients with COPD undergoing lung resection for non-small cell lung cancer. ACTA ACUST UNITED AC 2019; 45:e20180132. [PMID: 31618297 PMCID: PMC7447542 DOI: 10.1590/1806-3713/e20180132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. METHODS We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. RESULTS There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). CONCLUSIONS Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.
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Affiliation(s)
- Fabio Perrotta
- . Dipartimento di Medicina e Scienze della Salute V. Tiberio, Università degli Studi del Molise, Campobasso, Italia
| | - Antonio Cennamo
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | - Francesco Saverio Cerqua
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | | | - Andrea Bianco
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | | | - Marco Rispoli
- . Dipartimento di Anestesia and Unità di Terapia Intensiva. A.O. dei Colli, Ospedale Monaldi, Napoli, Italia
| | - Rosario Salvi
- . Dipartimento di Chirurgia Toracica. A.O. dei Colli, Ospedale Monaldi, Napoli, Italia
| | - Ilemando Meoli
- . Divisione di Pneumologia, Ospedale Monaldi, Napoli, Italia
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Zhang Z, Yan S, Cui H, Chen H, Liu J. Correlation Between RASSF1A Gene Promoter Hypermethylation in Serum or Sputum and Non-Small Cell Lung Cancer (NSCLC): A Meta-Analysis. Med Sci Monit 2019; 25:5518-5524. [PMID: 31342946 PMCID: PMC6676991 DOI: 10.12659/msm.917457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The aim of this study was to evaluate the efficacy of RASSF1A promoter hypermethylation of serum or sputum in diagnosis of non-small cell lung cancer (NSCLC) by pooling open published data. Material/Methods Open-published studies relevant to RASSF1A promoter hypermethylation and NSCLC diagnosis were screened through Medline, EMBASE, the Cochrane Library, Web of Science, Google Scholar, and CBM. Number of cases of true positive (tp), false positive (fp), false negative (fn), and true negative (tn) by RASSF1A gene promoter hypermethylation was extracted from each of the include original studies. The combined diagnostic sensitivity, specificity, and symmetric receiver operating characteristic curve (SROC) were calculated, as was the effect size. Results Twelve studies with 826 NSCLC and 598 controls were included in the present work. The combined sensitivity and specificity were 0.45 (95%CI: 0.41–0.48) (random effects) and 0.99(95%CI: 0.98–1.00) (fixed effects) respectively. The pooled positive likelihood ratio (+LR) and negative likelihood ratio (−LR) were 20.27 (9.64–42.61) and 0.53 (0.42–0.66), respectively, through the random effects model. The combined DOR was 46.63 (95%CI: 17.30–125.65) through the fixed effects model. The AUC of the SROC was 0.9989, calculated through Moses’s model for RASSF1A promoter hypermethylation as a biomarker in diagnosis of NSCLC. Conclusions The low diagnostic sensitivity for RASSF1A gene promoter hypermethylation indicated that it is not suitable for NSCLC screening. However, the high specificity made it effective for NSCLC confirmation diagnosis, which could be used instead of pathological diagnosis.
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Affiliation(s)
- Zhen Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (mainland).,Tianjin Lung Cancer Center, Tianjin, China (mainland).,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland).,National Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Shaohui Yan
- Department of Thoracic Oncology, Fourth Hospital of Qinhuangdao, Qinhuangdao, Hebei, China (mainland)
| | - Haijing Cui
- Department of Oncology, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Hui Chen
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (mainland).,Tianjin Lung Cancer Center, Tianjin, China (mainland).,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland).,National Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Jianmin Liu
- Department of Thoracic Surgery, Tangshan People's Hospital, Tangshan, Hebei, China (mainland)
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Abstract
PURPOSE OF REVIEW Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization. RECENT FINDINGS Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications. SUMMARY The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.
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Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD, Naidu B. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2018; 55:91-115. [DOI: 10.1093/ejcts/ezy301] [Citation(s) in RCA: 461] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Timothy J P Batchelor
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Neil J Rasburn
- Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - René H Petersen
- Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wanda M Popescu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Peter D Slinger
- Department of Anesthesia, University Health Network – Toronto General Hospital, Toronto, ON, Canada
| | - Babu Naidu
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK
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Watanabe T, Hosaka T, Ohmori‐Matsuda K, Suzuki Y, Suzuki H, Yabuki H, Matsuda Y, Noda M, Sakurada A, Okada Y, Sato Y. High preoperative plasma vasohibin-1 concentration predicts better prognosis in patients with non-small cell lung carcinoma. Health Sci Rep 2018; 1:e40. [PMID: 30623077 PMCID: PMC6266348 DOI: 10.1002/hsr2.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/12/2018] [Accepted: 02/21/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND AIM Vasohibin-1 (VASH1) is an angiogenesis inhibitor synthesized and secreted by endothelial cells, whose expression is induced by angiogenic stimuli such as vascular endothelial growth factor. We have previously demonstrated that VASH1 is immunohistochemically evident in endothelial cells in the tumor microenvironment of patients with non-small cell lung cancer (NSCLC) and is positively correlated with that of vascular endothelial growth factor in cancer cells. Here, we determined the preoperative plasma concentration of VASH1 in patients with NSCLC and evaluated the association between the preoperative VASH1 levels and certain outcomes. METHODS We analyzed presurgical plasma VASH1 concentrations in a total of 79 lung cancer patients (51 males and 28 females; 34-83 y of age; 46 adenocarcinomas, 27 squamous cell carcinomas, and 6 other types) who underwent lung resection. The impact of preoperative VASH1 level was analyzed using clinical characteristics and prognosis. RESULTS Plasma VASH1 concentration ranged from 34.1 to 1190.4 fmol/mL. We divided the patients into 3 groups according to plasma VASH1 level for this assessment: low VASH1 group (n = 26), medium VASH1 group (n = 27), and high VASH1 group (n = 26). The death and recurrence rates of the high, medium, and low VASH1 groups were 5.5, 16.2, and 12.7 per 100 person-years, respectively. Multivariate adjusted hazard ratio of death and recurrence of the high VASH1 group was lower than that of the low VASH1 group (hazard ratio 0.42; 95% CI 0.17-0.99). CONCLUSION The present analysis suggests that high preoperative plasma VASH1 concentration is associated with better prognosis in patients with NSCLC. We propose preoperative VASH1 level as a biomarker for the prognosis of patients with non-small cell lung carcinoma.
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Affiliation(s)
- Tatsuaki Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
- Department of Vascular Biology, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Tomoko Hosaka
- Department of Vascular Biology, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
- Department of Thoracic SurgeryJapan Organization of Occupational Health and Safety Tohoku Rosai HospitalSendaiJapan
| | - Kaori Ohmori‐Matsuda
- Division of Epidemiology, Department of Public Health and Forensic MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuhiro Suzuki
- Department of Vascular Biology, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Hirotoshi Suzuki
- Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Hiroshi Yabuki
- Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Yasushi Matsuda
- Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Akira Sakurada
- Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Yasufumi Sato
- Department of Vascular Biology, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
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Abstract
Enhancing the recovery of patients undergoing Thoracic Surgery is the raison d'être of a pulmonary rehabilitation (PR) process. Benefits of a PR program have been shown to include reduced postoperative complications, hospital length of stay (LOS) and improved exercise and lung function parameters. Identifying which groups of patients benefit most and the constituency of the perfect PR program is subject to ongoing research. Providing PR to patients in a manner acceptable to their lifestyle and disease timeline within economic limitations is the challenge.
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Affiliation(s)
- Kajan Mahendran
- Thoracic Surgery Department, Birmingham Heartlands Hospital, Birmingham, UK
| | - Babu Naidu
- Thoracic Surgery Department, Birmingham Heartlands Hospital, Birmingham, UK.,Birmingham Medical School, University of Birmingham, Birmingham, UK
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27
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Dinic VD, Stojanovic MD, Markovic D, Cvetanovic V, Vukovic AZ, Jankovic RJ. Enhanced Recovery in Thoracic Surgery: A Review. Front Med (Lausanne) 2018; 5:14. [PMID: 29459895 PMCID: PMC5807389 DOI: 10.3389/fmed.2018.00014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/17/2018] [Indexed: 12/28/2022] Open
Abstract
The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.
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Affiliation(s)
- Vesna D Dinic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | | | - Danica Markovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | - Vladan Cvetanovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | - Anita Zoran Vukovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | - Radmilo J Jankovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia.,School of Medicine, University of Niš, Niš, Serbia
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28
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Li TC, Yang MC, Tseng AH, Lee HHC. Prehabilitation and rehabilitation for surgically treated lung cancer patients. JOURNAL OF CANCER RESEARCH AND PRACTICE 2017. [DOI: 10.1016/j.jcrpr.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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29
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Fugazzaro S, Costi S, Mainini C, Kopliku B, Rapicetta C, Piro R, Bardelli R, Rebelo PFS, Galeone C, Sgarbi G, Lococo F, Paci M, Ricchetti T, Cavuto S, Merlo DF, Tenconi S. PUREAIR protocol: randomized controlled trial of intensive pulmonary rehabilitation versus standard care in patients undergoing surgical resection for lung cancer. BMC Cancer 2017; 17:508. [PMID: 28760151 PMCID: PMC5537935 DOI: 10.1186/s12885-017-3479-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023] Open
Abstract
Background Non-small cell lung cancer is the most common type of lung cancer. Surgery is proven to be the most effective treatment in early stages, despite its potential impact on quality of life. Pulmonary rehabilitation, either before or after surgery, is associated with reduced morbidity related symptoms and improved exercise capacity, lung function and quality of life. Methods We describe the study protocol for the open-label randomized controlled trial we are conducting on patients affected by primary lung cancer (stages I-II) eligible for surgical treatment. The control group receives standard care consisting in one educational session before surgery and early inpatient postoperative physiotherapy. The treatment group receives, in addition to standard care, intensive rehabilitation involving 14 preoperative sessions (6 outpatient and 8 home-based) and 39 postoperative sessions (15 outpatient and 24 home-based) with aerobic, resistance and respiratory training, as well as scar massage and group bodyweight exercise training. Assessments are performed at baseline, the day before surgery and one month and six months after surgery. The main outcome is the long-term exercise capacity measured with the Six-Minute Walk Test; short-term exercise capacity, lung function, postoperative morbidity, length of hospital stay, quality of life (Short Form 12), mood disturbances (Hospital Anxiety and Depression Scale) and pain (Numeric Rating Scale) are also recorded and analysed. Patient compliance and treatment-related side effects are also collected. Statistical analyses will be performed according to the intention-to-treat approach. T-test for independent samples will be used for continuous variables after assessment of normality of distribution. Chi-square test will be used for categorical variables. Expecting a 10% dropout rate, assuming α of 5% and power of 80%, we planned to enrol 140 patients to demonstrate a statistically significant difference of 25 m at Six-Minute Walk Test. Discussion Pulmonary Resection and Intensive Rehabilitation study (PuReAIR) will contribute significantly in investigating the effects of perioperative rehabilitation on exercise capacity, symptoms, lung function and long-term outcomes in surgically treated lung cancer patients. This study protocol will facilitate interpretation of future results and wide application of evidence-based practice. Trial registration ClinicalTrials.gov Registry n. NCT02405273 [31.03.2015].
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Affiliation(s)
- Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy. .,Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Via del Pozzo n°71, 41124, Modena, Italy. .,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, L.go P. Daneo n°3, 16132, Genoa, Italy.
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Besa Kopliku
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Cristian Rapicetta
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberto Piro
- Pulmonology Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberta Bardelli
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Patricia Filipa Sobral Rebelo
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Carla Galeone
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Giorgio Sgarbi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Filippo Lococo
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Massimiliano Paci
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Tommaso Ricchetti
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Domenico Franco Merlo
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Sara Tenconi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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30
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Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F. Response to: Is prehabilitation limited to preoperative exercise? Surgery 2017; 162:192-193. [DOI: 10.1016/j.surg.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 02/06/2023]
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