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Drewniok N, Kiselev J, Daum N, Mörgeli R, Spies C, Schaller SJ. Concepts for exercise therapy in prehabilitation for elderly people with frailty or pre-frailty prior to elective surgery. A scoping review. J Bodyw Mov Ther 2023; 36:74-82. [PMID: 37949603 DOI: 10.1016/j.jbmt.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/19/2023] [Accepted: 05/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Frailty is a state of reduced functional capacities in older people that can be reversed through multimodal therapy concepts. The effect of preoperative prehabilitation on frailty has been examined, but the heterogeneity of exercise regimens has prevented conclusive evidence. This scoping review analyses prehabilitation interventions, particularly exercise methods, published in trials for prefrail and frail elderly patients. METHOD We identified studies evaluating prehabilitation for frail elderly using the framework of Arksey and O'Malley. Five scientific databases were searched until March 2022. Articles were screened by two independent reviewers. Data extraction included, but was not limited to, study design, intervention protocol of the prehabilitation including exercise therapy and additional interventions, and safety of the reported exercise concepts. RESULTS Nineteen studies were included, offering an insight into the utilized prehabilitation concepts for exercise. All study interventions were based around exercise programs, potentially with complementary interventions. Twelve studies based their exercise programs on a combination of endurance and strength training. Breathing exercises were prescribed in five studies, flexibility routines in five, and one study included balance training. Further interventions included nutritional counselling/supplementation in nine studies, smoking/alcohol cessation in five, in addition to two physiological and three medical/pharmaceutical interventions. DISCUSSION Prehabilitation for the frail elderly is safe and feasible. The general concept of prehabiliation for frail patients is promising. An exercise program should focus on improving the patient's endurance and strength, considering the positive effects that can be provided by breathing exercises and other additional interventions, such as nutritional support or lifestyle counselling.
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Affiliation(s)
- Nils Drewniok
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Jörn Kiselev
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Nils Daum
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Rudolf Mörgeli
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Claudia Spies
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Stefan J Schaller
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany.
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Mariniello DF, Aronne L, Vitale M, Schiattarella A, Pagliaro R, Komici K. Current challenges and perspectives in lung cancer care during COVID-19 waves. Curr Opin Pulm Med 2023; 29:239-247. [PMID: 37132294 PMCID: PMC10241323 DOI: 10.1097/mcp.0000000000000967] [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: 05/04/2023]
Abstract
PURPOSE OF REVIEW In the era of the SARS-Cov2 pandemic, the multidisciplinary care of patients with lung cancer is the main challenge for clinicians. The depiction of complex networking between SARS-CoV2 and cancer cells is crucial to understanding the downstream signalling pathways leading to more severe clinical behaviour of COVID-19 among lung cancer patients. RECENT FINDINGS The immunosuppressive status caused by both blunted immune response and active anticancer treatments (e.g. radiotherapy, chemotherapy) affects also the response to vaccines. Furthermore, the COVID-19 pandemic has significantly influenced early detection, therapeutic management, and clinical research for patients with lung cancer. SUMMARY SARS-CoV-2 infection does undoubtedly represent a challenge for care of patients with lung cancer. Since symptoms of infection may overlap with underlying condition, diagnosis must be reached and treatment should start as soon as possible. Although any cancer treatment should be procrastinated as long as infection is not cured, every choice must be pondered on individual basis, according to clinical conditions. Underdiagnosis should be avoided, and both surgical and medical treatment must be tailored to each patient. Therapeutic scenario standardization represents a major challenge for clinicians and researchers.
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Affiliation(s)
| | - Luigi Aronne
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli
| | - Maria Vitale
- CEINGE, Biotecnologie Avanzate
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples
| | - Angela Schiattarella
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli
| | - Raffaella Pagliaro
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli
| | - Klara Komici
- Department of Medicine and Health Sciences University of Molise, Campobasso, Italy
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Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients. Lung Cancer 2022; 171:9-17. [PMID: 35863255 DOI: 10.1016/j.lungcan.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Mean age at diagnosis of lung cancer is increasing with increasing age in Western populations. The present study was designed to evaluate the effect of adherence to first-line treatment guidelines on overall survival (OS) in elderly patients with non-small-cell lung cancer (NSCLC) and reasons for non-adherence to treatment guidelines. MATERIALS AND METHODS All patients aged ≥ 65 years diagnosed with NSCLC in Ostrobothnia, Finland, during the years 2016 to 2020 were identified from hospital registries. Adherence of first-line treatment to contemporary treatment guidelines was analysed based on diagnosis, tumour stage and performance status (PS), as was the effect of adherence on OS. RESULTS A review of hospital registries identified 238 NSCLC patients aged ≥ 65 years. Guideline adherence by stage decreased significantly with age, with 66.4% of patients aged 65 to 74 years, but only 33.3% of those aged > 80 years treated according to guidelines (p < 0.001). Other factors associated with non-adherence to guidelines included poor PS, frailty, and limited lung function. Of the patients with PS 0-2, 26.9% were under-treated according to guidelines. Reasons for under-treatment included comorbidities, decreased lung function, physician decision to reduce treatment intensity or recommend best supportive care, patient choice and PS decline before treatment initiation. Guideline adherence increased overall OS of elderly NSCLC patients in all stages. Elderly PS 2 patients appear to benefit from guideline adherence and active treatment. In contrast, active treatment did not benefit patients with PS 3-4. CONCLUSIONS Guideline adherence was associated with increased OS in elderly NSCLC patients. Almost 10% of elderly and otherwise fit NSCLC patients were not treated according to guidelines and could have benefitted from more intensive treatment.
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PERROTTA F, D’AGNANO V, SCIALÒ F, KOMICI K, ALLOCCA V, NUCERA F, SALVI R, STELLA GM, BIANCO A. Evolving concepts in COPD and lung cancer: a narrative review. Minerva Med 2022; 113:436-448. [DOI: 10.23736/s0026-4806.22.07962-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Impact of Physical Activity on Disability Risk in Elderly Patients Hospitalized for Mild Acute Diverticulitis and Diverticular Bleeding Undergone Conservative Management. ACTA ACUST UNITED AC 2021; 57:medicina57040360. [PMID: 33917780 PMCID: PMC8068129 DOI: 10.3390/medicina57040360] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 01/23/2023]
Abstract
Background and Objectives: The role of physical activity (PA) in elderly patients admitted to surgical units for mild acute diverticulitis in the development of disability has not been clarified so far. Our aim is to demonstrate the relationship between physical activity and better post-discharge outcomes on disability in elderly population affected by diverticular disease. Materials and Methods: We retrospectively reviewed data of 56 patients (32 Males-24 females) collected from October 2018 and March 2020 at Cardarelli Hospital in Campobasso. We included patients older than 65 yrs admitted for acute bleeding and acute diverticulitis stage ≤II, characterized by a good independence status, without cognitive impairment and low risk of immobilization, as evaluated by activity of daily living (ADL) and the instrumental activity of daily living (IADL) and Exton-Smith Scale. “Physical Activity Scale for the Elderly” (PASE) Score evaluated PA prior to admission and at first check up visit. Results: 30.4% of patients presented a good PA, 46.4% showed moderate PA and 23.2% a low PA score. A progressive reduction in ADL and IADL score was associated with lower physical activity (p value = 0.0038 and 0.0017). We consider cognitive performance reduction with a cut off of loss of more than 5 points in Short Port of ADL and IADL and a loss of more than 15 points on Exton-Smith Scale, (p-value 0.017 and 0.010). In the logistic regression analysis, which evaluated the independent role of PASE in disability development, statistical significance was not reached, showing an Odds Ratio of 0.51 95% CI 0.25–1.03 p value 0.062. Discussion: Reduced physical activity in everyday life in elderly is associated with increased post-hospitalization disability regarding independence, cognitive performance and immobilization. Conclusions: Poor physical performance diagnosis may allow to perform a standardized multidimensional protocol to improve PA to reduce disability incidence.
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Food, Nutrition, Physical Activity and Microbiota: Which Impact on Lung Cancer? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052399. [PMID: 33804536 PMCID: PMC7967729 DOI: 10.3390/ijerph18052399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
Lung cancer still represents the leading cause of cancer-related death, globally. Likewise, malnutrition and inactivity represent a major risk for loss of functional pulmonary capacities influencing overall lung cancer severity. Therefore, the adhesion to an appropriate health lifestyle is crucial in the management of lung cancer patients despite the subtype of cancer. This review aims to summarize the available knowledge about dietary approaches as well as physical activity as the major factors that decrease the risk towards lung cancer, and improve the response to therapies. We discuss the most significant dietary schemes positively associated to body composition and prognosis of lung cancer and the main molecular processes regulated by specific diet schemes, functional foods and physical activity, i.e., inflammation and oxidative stress. Finally, we report evidence demonstrating that dysbiosis of lung and/or gut microbiome, as well as their interconnection (the gut–lung axis), are strictly related to dietary patterns and regular physical activity playing a key role in lung cancer formation and progression, opening to the avenue of modulating the microbiome as coadjuvant therapy. Altogether, the evidence reported in this review highlights the necessity to consider non-pharmacological interventions (nutrition and physical activity) as effective adjunctive strategies in the management of lung cancer.
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Mollica M, Aronne L, Paoli G, Flora M, Mazzeo G, Tartaglione S, Polito R, Tranfa C, Ceparano M, Komici K, Mazzarella G, Iadevaia C. Elderly with COPD: comoborbitidies and systemic consequences. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D'Agnano V, Komici K, Mazzarella G, Parrella R, Bianco A. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res 2020; 32:1599-1608. [PMID: 32557332 PMCID: PMC7298699 DOI: 10.1007/s40520-020-01631-y] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viral-induced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19.
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Affiliation(s)
- Fabio Perrotta
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Grazia Mazzeo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
| | - Matilde Boccia
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Luigi Aronne
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Vito D'Agnano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Gennaro Mazzarella
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Roberto Parrella
- COVID Unit D, Department of Infectious Diseases, Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
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Rispoli M, Salvi R, Cennamo A, Di Natale D, Natale G, Meoli I, Gioia MR, Esposito M, Nespoli MR, De Finis M, Buono S, Corcione A, Lavoretano S, Bianco A, Fiorelli A, Curcio C, Perrotta F. Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection. TUMORI JOURNAL 2020; 106:300891619900808. [PMID: 32090715 DOI: 10.1177/0300891619900808] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. METHODS This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). RESULTS All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis (n = 6), pneumonia (n = 1), respiratory failure (n = 1), and pulmonary embolism (n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor (p = 0.001). CONCLUSIONS Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.
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Affiliation(s)
- Marco Rispoli
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Rosario Salvi
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Antonio Cennamo
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Davide Di Natale
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Ilernando Meoli
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Maria Rosaria Gioia
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Marianna Esposito
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Moana Rossella Nespoli
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Mario De Finis
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Salvatore Buono
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Antonio Corcione
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Sabrina Lavoretano
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Andrea Bianco
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Alfonso Fiorelli
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
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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: 10] [Impact Index Per Article: 2.0] [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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Perrotta F, Rocco D, Vitiello F, De Palma R, Guerra G, De Luca A, Navani N, Bianco A. Immune Checkpoint Blockade for Advanced NSCLC: A New Landscape for Elderly Patients. Int J Mol Sci 2019; 20:E2258. [PMID: 31067796 PMCID: PMC6539213 DOI: 10.3390/ijms20092258] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/21/2022] Open
Abstract
The therapeutic scenario for elderly patients with advanced NSCLC has been limited to radiotherapy and chemotherapy. Recently, a novel therapeutic approach based on targeting the immune-checkpoints has showed noteworthy results in advanced NSCLC. PD1/PD-L1 pathway is co-opted by tumor cells through the expression of PD-L1 on the tumor cell surface and on cells within the microenvironment, leading to suppression of anti-tumor cytolytic T-cell activity by the tumor. The success of immune-checkpoints inhibitors in clinical trials led to rapid approval by the FDA and EMA. Currently, data regarding efficacy and safety of ICIs in older subjects is limited by the poor number of elderly recruited in clinical trials. Careful assessment and management of comorbidities is essential to achieve better outcomes and limit the immune related adverse events in elderly NSCLC patients.
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Affiliation(s)
- Fabio Perrotta
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy.
| | - Danilo Rocco
- Pneumo-Oncology Unit, A.O. dei Colli "Monaldi Hospital", 80131 Naples, Italy.
| | - Fabiana Vitiello
- Pneumo-Oncology Unit, A.O. dei Colli "Monaldi Hospital", 80131 Naples, Italy.
| | - Raffaele De Palma
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80131 Naples, Italy.
| | - Germano Guerra
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy.
| | - Antonio De Luca
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania "L. Vanvitelli", 80131 Naples, Italy.
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory and Department of Thoracic Medicine, University College London Hospital, London WC1E6JF, UK.
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", 80131 Naples, Italy.
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Milder DA, Pillinger NL, Kam PCA. The role of prehabilitation in frail surgical patients: A systematic review. Acta Anaesthesiol Scand 2018; 62:1356-1366. [PMID: 30094821 DOI: 10.1111/aas.13239] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Increasing emphasis is being placed on the detection of frailty in the pre-operative setting given its association with surgical morbidity and mortality. Prehabilitation seeks to increase the physiological reserve of frail patients, attenuating the risk of irreversible functional decline following surgery. AIM/HYPOTHESIS This systematic review appraises the evidence available for prehabilitation in frail surgical patients. We proposed that exercise prehabilitation would especially benefit frail patients, with improvements in pre-operative functional capacity, and reductions in complications and length of hospital stay. METHODS A literature search was conducted in MEDLINE, PubMed and CINAHL databases. Studies were included if they consisted of a prehabilitation intervention in frail patients undergoing surgery and specified a frailty model/index. Eight studies were included for analysis, 2 of which are ongoing studies. RESULTS In 3 studies, prehabilitation consisted of an exercise intervention alone. There was a high feasibility of prehabilitation and a trend to improved pre-operative function, however, no evidence of improved post-operative functional recovery was there. In 2 studies, prehabilitation consisted of both exercise and nutritional interventions. Reductions in mortality and duration of hospital stay were reported, but the quality of evidence was judged to be very low. There was a lack of evidence of improved outcomes following pre-operative inspiratory muscle training in frail patients. DISCUSSION This systematic review focuses on prehabilitation in frail surgical patients and reports that evidence supporting any outcome is limited, despite high feasibility and acceptability. There is a need for large randomised controlled trials to better establish the effects of prehabilitation in frail patients.
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Affiliation(s)
| | - Neil L. Pillinger
- Department of Anaesthetics Royal Prince Alfred Hospital University of Sydney Camperdown NSW Australia
- The University of Sydney Sydney Medical School NSW Australia
| | - Peter C. A. Kam
- Department of Anaesthetics Royal Prince Alfred Hospital University of Sydney Camperdown NSW Australia
- The University of Sydney Sydney Medical School NSW Australia
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Abstract
Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.
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Affiliation(s)
- Hui-Shan Lin
- Centre for Research in Geriatric Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia,
- PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia,
| | - Rebecca L McBride
- PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia,
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia,
- PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia,
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15
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McCracken DJ, Moore AJ. Lung Cancer in the Elderly—Important Considerations When Assessing Fitness for Treatment. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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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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