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Porserud A, Karlsson P, Aly M, Rydwik E, Torikka S, Henningsohn L, Nygren-Bonnier M, Hagströmer M. Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer: a randomised controlled trial. BMC Cancer 2024; 24:891. [PMID: 39048933 PMCID: PMC11267740 DOI: 10.1186/s12885-024-12647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION After radical cystectomy physical activity is important to reduce risk of complications, but patients with urinary bladder cancer have difficulties in achieving general recommendations on physical activity and exercise. The aim of this randomised controlled trial was therefore to evaluate the effects of a physical exercise programme in primary care, following discharge from hospital after robot-assisted radical cystectomy for urinary bladder cancer. MATERIALS AND METHODS Patients with urinary bladder cancer scheduled for robot-assisted radical cystectomy at Karolinska University Hospital, Sweden between September 2019 and October 2022 were invited to join the study. At discharge, they were randomised to intervention or active control group. The intervention group was planned to start exercise with physiotherapist in primary care during the third week; the programme included aerobic and strengthening exercises, twice a week for 12 weeks, and daily walks. The control group received unsupervised home-based exercise with daily walks and a sit-to-stand exercise. Assessments were conducted before surgery, at discharge and after four months regarding the primary outcome physical function (Six-minute walk test), and secondary outcomes physical activity, pain, health-related quality of life, fatigue, and psychological wellbeing. RESULTS Ninety patients were included, mean (sd) age 71.5 (8.5) years. An intention-to-treat analysis showed no intervention effect on the primary outcome physical function, or on pain or psychological wellbeing, but effect on physical activity with a difference from discharge to four months with a median (IQR) of 4790 (3000) and 2670 (4340) daily steps in the intervention and control group, respectively (p = 0.046), and for fatigue, and health-related quality of life, in favour of the intervention group. CONCLUSION Both the intervention and control groups improved physical function, but the patients who exercised in primary care experienced additional positive effects on physical activity, fatigue, and health-related quality of life. Hence, exercise in primary care after discharge from hospital could be a promising method after radical cystectomy for urinary bladder cancer. TRIAL REGISTRATION The study was registered in Clinical Trials with registration number NCT03998579, 20,190,607.
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Affiliation(s)
- Andrea Porserud
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
| | - Patrik Karlsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Patient Area Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Rydwik
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Torikka
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Henningsohn
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Porserud A, Karlsson P, Nygren-Bonnier M, Aly M, Hagströmer M. The feasibility of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer, prior to the CanMoRe trial. Pilot Feasibility Stud 2024; 10:12. [PMID: 38254174 PMCID: PMC10802056 DOI: 10.1186/s40814-024-01443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Complications after radical cystectomy for urinary bladder cancer are common. Physical activity after surgery is thought to reduce complications. However, patients with urinary bladder cancer have low levels of physical activity, and interventions supporting physical exercise are needed. This study aimed to evaluate the feasibility of a physical exercise intervention in primary health care. One of the aims of the larger clinical trial will be to reduce complications. METHODS Patients with urinary bladder cancer and who were scheduled for a robotic-assisted radical cystectomy were recruited from Karolinska University Hospital, between February and May 2019. The patients had to be mobile, understand Swedish, and live in Stockholm. The exercise programme was conducted at one primary health care setting over 12 weeks. The exercise programme included supervised aerobic and strengthening exercises, which were performed twice a week, as well as daily walks. Feasibility was measured with process feasibility, including eligibility criteria, adherence, and acceptability, and scientific feasibility, including the ability of outcomes to indicate change, safety, and progression in the exercise programme. RESULTS Ten patients with a median age of 70 years (min 53-max 86) were included. Adherence to all parts of the intervention was not feasible because of patients' postoperative complications, resulting in dropouts. For the patients who took part in the exercise programme, adherence and acceptability for the exercise period were feasible, but the 6-min walk test was not feasible at discharge from the hospital. Physiotherapists in the primary health care setting perceived the process as feasible. Moreover, the ability of outcomes to indicate change and progression in the exercise programme was feasible, meanwhile no adverse events were registered. CONCLUSIONS The exercise intervention was feasible for the patients that took part in the exercise programme, with respect to safety and progression through the exercise programme. Furthermore, this study suggests that some improvements needed to be implemented in the process, prior to the upcoming randomised controlled trial.
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Affiliation(s)
- Andrea Porserud
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden.
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Patrik Karlsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden
- Patient Area Pelvic Cancer, Cancer Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Academic Primary Health Care Centre, 113 65, Stockholm, Region Stockholm, Sweden
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De Rose AF, Vecco F, Ambrosini F, Malinaric R, Mantica G, Terrone C. How long should we follow patients managed for muscle-invasive bladder cancer? Lesson learned from a recent clinical practice. Arch Ital Urol Androl 2022; 94:369-370. [DOI: 10.4081/aiua.2022.3.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
To the Editor,
The exact time to stop bladder cancer patient’s follow-up is not well known and there is not a clear recommendation on if and when stop to follow a patient managed for muscle invasive bladder cancer (MIBC). Major urological guidelines do not provide a precise indication on the timing of follow-up, and there is currently no real consensus on optimal time schedule [...].
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Ranasinghe R, Mathai ML, Zulli A. Cisplatin for cancer therapy and overcoming chemoresistance. Heliyon 2022; 8:e10608. [PMID: 36158077 PMCID: PMC9489975 DOI: 10.1016/j.heliyon.2022.e10608] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Cisplatin spearheads the anticancer chemotherapeutics in present-day use although acute toxicity is its primary impediment factor. Among a plethora of experimental medications, a drug as effective or surpassing the benefits of cisplatin has not been discovered yet. Although Oxaliplatin is considered more superior to cisplatin, the former has been better for colorectal cancer while cisplatin is widely used for treating gynaecological cancers. Carcinoma imposes a heavy toll on mortality rates worldwide despite the novel treatment strategies and detection methods that have been introduced; nanomedicine combined with precision medicine, immunotherapy, volume-regulated anion channels, and fluorodeoxyglucose-positron emission tomography. Millions of deaths occur annually from metastatic cancers which escape early detection and the concomitant diseases caused by highly toxic chemotherapy that causes organ damage. It continues due to insufficient knowledge of the debilitative mechanisms induced by cancer biology. To overcome chemoresistance and to attenuate the adverse effects of cisplatin therapy, both in vitro and in vivo models of cisplatin-treated cancers and a few multi-centred, multi-phasic, randomized clinical trials in pursuant with recent novel strategies have been tested. They include plant-based phytochemical compounds, de novo drug delivery systems, biochemical/immune pathways, 2D and 3D cell culture models using small molecule inhibitors and genetic/epigenetic mechanisms, that have contributed to further the understanding of cisplatin's role in modulating the tumour microenvironment. Cisplatin was beneficial in cancer therapy for modulating the putative cellular mechanisms; apoptosis, autophagy, cell cycle arrest and gene therapy of micro RNAs. Specific importance of drug influx, efflux, systemic circulatory toxicity, half-maximal inhibition, and the augmentation of host immunometabolism have been identified. This review offers a discourse on the recent anti-neoplastic treatment strategies to enhance cisplatin efficacy and to overcome chemoresistance, given its superiority among other tolerable chemotherapies.
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Affiliation(s)
- Ranmali Ranasinghe
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
| | - Michael L Mathai
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
| | - Anthony Zulli
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
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Bellos TC, Tzelves LI, Manolitsis IS, Katsimperis SN, Berdempes MV, Skolarikos A, Karakousis ND. Sarcopenia in Urinary Bladder Cancer: Definition, Prevalence and Prognostic Value in Survival. MAEDICA 2022; 17:427-435. [PMID: 36032591 PMCID: PMC9375863 DOI: 10.26574/maedica.2022.17.2.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sarcopenia, defined as the systemic loss of muscle function and mass, is commonly seen in advanced oncologic states, usually in conjunction with cancer cachexia. Bladder cancer represents one of the most common neoplasms worldwide and affects mainly the elderly who are already frail. The purpose of this study is to review the potential association between sarcopenia and bladder cancer in patients receiving different types of treatments. A thorough MEDLINE/PubMed non-systematic literature review was conducted from 1990 to January 2022, using the following search terms: "sarcopenia and bladder cancer" and "low muscle mass and bladder cancer". Sarcopenia probably poses a negative impact on the prognosis of patients at any stage of bladder cancer, as it is linked with overall worse survival, cancer specific survival and progression-free survival in those treated, with either radical cystectomy or chemotherapy. In addition, sarcopenia seems to be a strong predictor concerning complications and a negative prognostic factor following chemotherapy and surgery for bladder cancer. On the other hand, it seems that sarcopenic patients who receive radiotherapy or immunotherapy are not so severely affected.
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Affiliation(s)
| | - Lazaros I Tzelves
- 2nd Department of Urology, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Ioannis S Manolitsis
- 2nd Department of Urology, Sismanoglio General Hospital of Athens, Athens, Greece
| | | | - Marinos V Berdempes
- 2nd Department of Urology, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio General Hospital of Athens, Athens, Greece
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From Fast-track to Enhanced Recovery after Surgery (ERAS) in Radical Cystectomy Pathways –a Nursing Perspective. Asia Pac J Oncol Nurs 2022; 9:100048. [PMID: 35647225 PMCID: PMC9136268 DOI: 10.1016/j.apjon.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 01/02/2023] Open
Abstract
Objective The purpose of this narrative review is to summarize existing knowledge and evidence about the establishment of enhanced recovery after surgery (ERAS) pathways with emphasize on radical cystectomy (RC), and the emerging and prominent role of nursing within the ERAS pathway. The current status of implementation and adherence to ERAS protocol in RC is discussed and the impact on primary outcomes according to ERAS is summarized. Methods The review was conducted based on a focused search in PubMed and CINAHL. Results The goal of a modern RC enhanced recovery protocols (ERPs) anno 2022 is to have a positive impact on patient care from diagnosis throughout recovery with focus on the quality, rather than speed, of recovery. This may be more in alignment with the patient's needs and preferences. Conclusions Nursing has been in the forefront since the establishment of ERAS, and the nurse-coordinator must be skilled in evidence-based medicine and have excellent communicative competencies to support the patient journey. Implementation of ERAS have reduced hospitalization by improved minimal surgery, optimized anesthetic regimes without increasing readmission rates. It is not known which items can reduce post-operative complications. In the future, nurses should seek a more prominent and leading role during the implementation process and take responsibility for continued education of the staff. Likewise, future nursing interventions will focus on early identification of modifiable risk factors, and a deeper exploration of the patients personally needs and preferences to upcoming surgery could optimize adherence throughout the pathway, which may add to positive outcomes.
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Struck JP, Schnoor M, Schulze A, Hupe MC, Ozimek T, Oppolzer IA, Schnabel MJ, Burger M, Darr C, Gruenwald V, Hadaschik B, Weinke M, Kuebler H, Klockenbusch JC, Grabbert MT, Gratzke C, Kramer MW, Katalinic A, Merseburger AS. Impact of COVID-19 crisis on medical care of patients with metastasized uro-oncologic disease under systemic cancer therapy: a multicenter study in German university hospitals. World J Urol 2021; 40:409-418. [PMID: 34850270 PMCID: PMC8631559 DOI: 10.1007/s00345-021-03868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To date, over 4.2 million Germans and over 235 million people worldwide have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Uro-oncology (UO) patients are particularly vulnerable but in urgent need of life-saving systemic treatments. Our multicentric study examined the impact of the COVID-19 crisis on the medical care of UO patients in German university hospitals receiving ongoing systemic anti-cancer treatment and to detect the delay of medical care, defined as deferred medical treatment or deviation of the pre-defined follow-up assessment. Methods Data of 162 UO patients with metastatic disease undergoing systemic cancer treatment at five university hospitals in Germany were included in our analyses. The focus of interest was any delay or change in treatment between February 2020 and May 2020 (first wave of the COVID-19 crisis in Germany). Statistical analysis of contingency tables were performed using Pearson’s chi-squared and Fisher’s exact tests, respectively. Effect size was determined using Cramér’s V (V). Results Twenty-four of the 162 patients (14.8%) experienced a delay in systemic treatment of more than 2 weeks. Most of these received immuno-oncologic (IO) treatments (13/24, 54.2%, p = 0.746). Blood tests were delayed or canceled significantly more often in IO patients but with a small effect size (21.1%, p = 0.042, V = 0.230). Treatment of patients with renal cell carcinoma (12/73, 16.4%) and urothelial carcinoma (7/32, 21.9%) was affected the most. Conclusions Our data show that the COVID-19 pandemic impacted the medical care of UO patients, but deferment remained modest. There was a tendency towards delays in IO and ADT treatments in particular.
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Affiliation(s)
- Julian P. Struck
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Maike Schnoor
- Department of Social Medicine and Epidemiology and Department of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Andrea Schulze
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Marie C. Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Tomasz Ozimek
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Immanuel A. Oppolzer
- Department of Urology, University Hospital of Regensburg, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Marco J. Schnabel
- Department of Urology, University Hospital of Regensburg, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University Hospital of Regensburg, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Christopher Darr
- Department of Urology, Pediatric Urology and Uro-Oncology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Viktor Gruenwald
- Department of Urology, Pediatric Urology and Uro-Oncology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Boris Hadaschik
- Department of Urology, Pediatric Urology and Uro-Oncology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Maximilian Weinke
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany
| | - Hubert Kuebler
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany
| | - Jonas C. Klockenbusch
- Department of Urology, University Hospital of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Markus T. Grabbert
- Department of Urology, University Hospital of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Christian Gratzke
- Department of Urology, University Hospital of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Mario W. Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Alexander Katalinic
- Department of Social Medicine and Epidemiology and Department of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Axel S. Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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