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Flemming S. [App-based prehabilitation: implementation and adherence]. CHIRURGIE (HEIDELBERG, GERMANY) 2025; 96:459-463. [PMID: 40314821 DOI: 10.1007/s00104-025-02296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/02/2025] [Indexed: 05/03/2025]
Abstract
In recent years prehabilitation before oncological visceral surgery has become increasingly more in the clinical focus. The aim of prehabilitation is to significantly increase patient's physical and mental performance status through multimodal treatment resulting in a decrease of postoperative complications and faster rehabilitation. As prehabilitation requires a high level of personnel and economic resources in the healthcare system, app-based prehabilitation might be a suitable alternative. The currently available evidence shows a high patient adherence to app-based prehabilitation with an improvement of functional performance status; however, further studies with more patients especially from Germany are necessary to confirm the preliminary data and to become established in the clinical routine.
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Affiliation(s)
- Sven Flemming
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
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Popescu GA, Minca DG, Jafal NM, Toma CV, Alexandrescu ST, Costea RV, Vasilescu C. Multimodal Prehabilitation in Major Abdominal Surgery-Rationale, Modalities, Results and Limitations. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:908. [PMID: 40428866 DOI: 10.3390/medicina61050908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2025] [Revised: 05/03/2025] [Accepted: 05/14/2025] [Indexed: 05/29/2025]
Abstract
Recent evidence revealed that an adequate preoperative physiological reserve is crucial to overcome surgical stress response. Consequently, a new concept, called prehabilitation, emerged, aiming to improve the preoperative functional reserve of patients who will undergo major abdominal surgery. During the interval between diagnosis and surgery, a multimodal approach consisting of physical exercise and nutritional and psychological support could be employed to enhance physiologic reserve. Physical activity interventions aim to improve aerobic capacity, muscle strength and endurance. Nutritional support addressing malnutrition and sarcopenia also contributes to the achievement of the above-mentioned goals, particularly in patients undergoing cancer-related procedures. Psychological interventions targeting anxiety, depression and self-efficacy, as well as risk behavior modification (e.g., smoking cessation) seem to enhance recovery. However, there is a lack of standardization regarding these interventions, and the evidence about the impact of this multidisciplinary approach on the postoperative outcomes is still contradictory. This narrative review focuses on the physiological basis of surgical stress response and on the efficacy of prehabilitation, reflected mainly in the length of hospitalization and rates of postoperative complications. Multidisciplinary collaboration between surgeons, nutritionists, psychologists and physiotherapists was identified as the key to the success of prehabilitation programs. Synergizing prehabilitation and ERAS protocols significantly improves short-term surgical outcomes. Recent well-designed, randomized clinical trials revealed that this approach not only enhanced functional reserve, but also decreased the rates of postoperative complications and enhanced patient's overall quality of life, emphasizing the importance of its implementation in routine, elective, surgical care.
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Affiliation(s)
- George Andrei Popescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474 Bucharest, Romania
- Department of Hepato-Bilio-Pancreatic Surgery, Emergency University Hospital Bucharest, Splaiul Independentei 169, Sector 5, 050098 Bucharest, Romania
| | - Dana Galieta Minca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474 Bucharest, Romania
- Department of Public Health and Management, Dr. Leonte Anastasievici Street 1-3, Sector 5, 050463 Bucharest, Romania
| | - Nader Mugurel Jafal
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474 Bucharest, Romania
- Department of Anaesthesiology and Intensive Care, Emergency University Hospital Bucharest, Splaiul Independentei 169, Sector 5, 050098 Bucharest, Romania
| | - Cristian Valentin Toma
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474 Bucharest, Romania
- Department of Urology, "Prof. Dr. Theodor Burghele" Clinical Hospital, Soseaua Panduri 20, Sector 5, 050659 Bucharest, Romania
| | - Sorin Tiberiu Alexandrescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474 Bucharest, Romania
- Department of Hepato-Bilio-Pancreatic Surgery, Emergency University Hospital Bucharest, Splaiul Independentei 169, Sector 5, 050098 Bucharest, Romania
| | - Radu Virgil Costea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474 Bucharest, Romania
- 2nd Department of Surgery, Emergency University Hospital Bucharest, Splaiul Independentei 169, Sector 5, 050098 Bucharest, Romania
| | - Catalin Vasilescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Sector 5, 050474 Bucharest, Romania
- Department of Surgery, Fundeni Clinical Institute, Soseaua Fundeni 258, Sector 2, 022328 Bucharest, Romania
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Gooch JC, McClelland QY, Paschalis K, Dobbins J, Magnuson A, Marin C, Anand M, Skinner K, Olzinski-Kunze A, Weiss A. Same Day Discharges Among Elderly Mastectomy Patients: A Single Institution Prospective Study. Ann Surg Oncol 2025:10.1245/s10434-025-17436-0. [PMID: 40369395 DOI: 10.1245/s10434-025-17436-0] [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: 02/11/2025] [Accepted: 04/21/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Same-day mastectomy is safe and high value. However, patients ≥ 65 years are less likely to be discharged compared with younger patients. Our aim was to implement a protocol to increase the rate of elderly same-day discharge. PATIENTS AND METHODS Patients were screened by 5-factor modified frailty index and notification of frailty status was sent to surgeons. Patients with moderate-to-high frailty were encouraged to have prehabilitation. Chart review collected demographic/clinicopathologic variables, length of stay, and complications. The primary endpoint was same-day discharge, and sample size determination was 50 patients. Our discharge rate was compared with our historic rate (18.8% March 2022 to February 2023) by Fisher's exact test. RESULTS From March 2023 to January 2024, 306 patients aged ≥ 65 years were screened. Overall, 55 patients underwent a total of 57 mastectomies (18.6%). Median age was 72 years (range: 65-99). Frailty scores ranged from 0 to 4. In total, 11 patients (19.3%) had a score of zero, 41 (71.9%) scored 1 or 2, and 5 patients (8.8%) scored 3 or 4. Seven patients were referred to geriatric oncology for prehabilitation: one non-frail, four with low frailty, and two with moderate frailty. The median length of stay (LOS) was 0 days (range: 0-21). Thirty-two mastectomies had same-day discharge (56.1%), significantly higher than historic data (P < 0.00001). CONCLUSIONS We increased same-day discharges for patients ≥ 65 years from 18.8% to 56.1%. This protocol included a simple frailty screening and a weekly email. Future directions include increasing the proportion of patients who receive geriatric oncology prehabilitation referrals and evaluating patient-reported outcomes.
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Affiliation(s)
- Jessica C Gooch
- Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Qi Ying McClelland
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Kathryn Paschalis
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Jenna Dobbins
- Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Division of Medical Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Chelsea Marin
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Maya Anand
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kristin Skinner
- Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Ann Olzinski-Kunze
- Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Anna Weiss
- Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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Alves I, Moreira AP, Sousa T, Teles P, Magalhães BM, Goncalves F, Fernandes CS. Impact of Exergames on the Rehabilitation of Cancer Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial. Cancer Nurs 2025; 48:239-244. [PMID: 38417129 DOI: 10.1097/ncc.0000000000001331] [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: 03/01/2024]
Abstract
BACKGROUND Exergames can be an appealing strategy that is integrated into post-abdominal surgery rehabilitation. OBJECTIVE The aim of this study was to assess the effectiveness of exergame rehabilitation in improving independence in activities of daily living (ADLs) and patient balance after abdominal cancer surgery. METHODS A randomized control-group study was carried out in an oncological hospital in Portugal. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcomes were the Barthel and Berg scales, and data collection occurred at 3 different time points: admission, 48 hours postoperatively, and on the seventh day after surgery. RESULTS At the third assessment, a statistically significant difference was observed between the 2 groups for both indicators, ADLs and balance. CONCLUSIONS There was an improvement in ADLs and balance in the exergames group. By the seventh day after surgery, the intervention group showed improvement in balance and ADLs compared with the control group. IMPLICATIONS FOR PRACTICE The use of exergames can be a solution to the challenges of traditional rehabilitation methods after abdominal surgery for cancer for postoperative patients. This is the first study carried out in this specific population.
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Affiliation(s)
- Isabel Alves
- Author Affiliations: Portuguese Institute of Oncology (Mss Alves, Moreira, and Sousa), Porto; School of Economics, University of Porto (Dr Teles); School of Health, University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal (Dr Magalhães); and Oncology Nursing Research Unit IPO Porto Research Center (CI-IPOP), and Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal (Dr Magalhães); Clinical Academic Centre of Trás-os-Montes and Alto Douro (CACTMAD), Vila Real, Portugal (Dr Magalhães); University of A Coruña Faculty of Health Sciences, A Coruña, Spain (Mr Goncalves); and APELA - Portuguese Amyotrophic Lateral Sclerosis Association (Mr Goncalves); CINTESIS@RISE (Dr Fernandes); Porto Higher School of Nursing (Dr Fernandes); and ADITGames Association (Dr Fernandes), Porto, Portugal
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Chen X, Li Z, Zhang J. A novel approach to cancer rehabilitation: assessing the influence of exercise intervention on postoperative recovery and survival rates. Int J Surg 2025; 111:3373-3385. [PMID: 40146261 DOI: 10.1097/js9.0000000000002323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 02/07/2025] [Indexed: 03/28/2025]
Abstract
Cancer rehabilitation is the crucial process by which cancer patients regain their physical abilities and enhance their quality of life through diverse methods following treatment. As the cure rate of cancer continues to rise, the need for postoperative rehabilitation is becoming increasingly evident. This is particularly crucial for enhancing patient survival rates and minimizing the chances of cancer recurrence. Exercise intervention has become increasingly popular and widely used as a proactive rehabilitation therapy in recent years. This article examines the influence of exercise intervention on the recovery and survival rates of cancer patients after surgery. It specifically investigates the effects and mechanisms of various exercise interventions, such as aerobic exercise, strength training, and flexibility training, on patients with lung cancer, gastric cancer, colorectal cancer, and other forms of cancer. Exercise therapies before and after surgery can greatly boost patients' physical abilities, decrease postoperative problems, minimize hospital stays, and improve overall quality of life. In addition, implementing exercise intervention can enhance the long-term survival rates of patients. Future studies should investigate the most effective exercise programs and their suitability for various types of cancer, with the goal of offering better evidence-based clinical advice.
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Affiliation(s)
- Xiaoyan Chen
- Medical College of Nanchang Institute of Technology, Nanchang, China
| | - Zhi Li
- Interventional Cancer Institute of Chinese Integrative Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junfeng Zhang
- Rehabilitation Center of Taihe Hospital, Hubei University of Medicine, Hubei, China
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van der Graaff S, Backhuijs TAM, de Kort FP, Lockhorst EW, Smedts HPM, Schreinemakers JMJ, Nieuwenhuyzen-de Boer GM, Hoogstad-van Evert JS. Feasibility and Effects of Implementing Multimodal Prehabilitation Before Cytoreductive Surgery in Patients with Ovarian Cancer: The Gynofit Multicenter Study. Cancers (Basel) 2025; 17:1393. [PMID: 40361319 PMCID: PMC12070995 DOI: 10.3390/cancers17091393] [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: 02/25/2025] [Revised: 04/17/2025] [Accepted: 04/19/2025] [Indexed: 05/15/2025] Open
Abstract
Background: Cytoreductive surgery (CRS), in combination with chemotherapy, is the main treatment for advanced-stage ovarian cancer. In vulnerable patients, this extensive surgery has a high complication risk and may lead to clinical decline. There is emerging evidence that prehabilitation could be valuable in optimizing the patient's condition prior to cytoreductive surgery, as is shown in colorectal surgery. However, there is limited evidence in gynecologic oncology. The objective of this study is to evaluate the feasibility and effects of implementing multimodal prehabilitation before cytoreductive surgery in patients with ovarian cancer. Methods: In two Dutch hospitals, 46 patients with ovarian cancer were included during the study period, of whom 32 participated in a multimodal prehabilitation program before CRS. The programs included at least physiotherapy, dietary advice and intoxication cessation. The timing, extent and content of the programs differed. Feasibility was assessed by eligibility and participation rates and adherence to the physiotherapy program. Effectiveness was measured by differences in functional capacity, postoperative outcomes and tolerance to adjuvant chemotherapy. Results: Eligibility rates in both hospitals were 83% and 89%, and participation rates were 68% and 72%. Adherence to the physiotherapy program was moderate and only satisfactory in 55% and 63% of the patients. All fitness endpoint measurements improved compared to the baseline. No significant differences in postoperative outcomes were found between prehabilitation and control patients. Prehabilitation patients appeared to have better tolerance to adjuvant chemotherapy, with fewer dose reductions (21% vs. 73%, p = 0.017) and dose deferrals (39% vs. 46%, not significant) compared to the control group. Conclusions: The implementation of multimodal prehabilitation before CRS is feasible and effective in patients with ovarian cancer with respectable eligibility and participation rates, along with improved functional capacity, even during neoadjuvant chemotherapy.
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Affiliation(s)
- Stella van der Graaff
- Department of Gynecology and Obstetrics, Amphia Hospital, 4818 CK Breda, The Netherlands; (S.v.d.G.); (H.P.M.S.)
| | | | - Frank P. de Kort
- Department of Physiotherapy, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands;
| | - Elize W. Lockhorst
- Department of Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands; (E.W.L.)
| | - Huberdina P. M. Smedts
- Department of Gynecology and Obstetrics, Amphia Hospital, 4818 CK Breda, The Netherlands; (S.v.d.G.); (H.P.M.S.)
| | | | - Gatske M. Nieuwenhuyzen-de Boer
- Department of Gynecology and Obstetrics, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
- Department of Gynecological Oncology, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
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Alves I, Moreira AP, Sousa T, Teles P, Goncalves F, Magalhães BM, Fernandes CS. Exergames rehabilitation program for postoperative cancer patients undergoing abdominal surgery: A quasi-experimental study. ENFERMERIA CLINICA (ENGLISH EDITION) 2025:502212. [PMID: 40204240 DOI: 10.1016/j.enfcle.2025.502212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 01/21/2025] [Accepted: 01/23/2025] [Indexed: 04/11/2025]
Abstract
OBJECTIVES This study aimed to describe and test a program implemented by a nurse for cancer patients in the postoperative period of abdominal surgery using Wii Fit games. It explored the relationship between the type of game, its duration, and the score obtained with variables such as quality of life, fatigue, balance, anxiety, and depression. METHODS A quasi-experimental project was conducted using a one-group pretest-posttest design to assess the effects of a rehabilitation program utilizing Nintendo Wii Fit. The games included were Wii Fit Aerobics - Basic Step, Wii Fit - Balance Games Penguin Slide, Wii Fit Training Plus - Birds Eye Bulls Eye, and Wii Fit - Hula Hoop. Data were collected 48h post-surgery and on the 7th day post-surgery. RESULTS Thirty-five patients participated in the study. The evaluation revealed that the scores and durations of the games had significantly related to the outcomes on the scales, with the "Wii Fit Aerobics - Basic Step" and "Wii Fit - Hula Hoop" games having the most significant impact across multiple aspects. CONCLUSIONS The study demonstrated that the rehabilitation program had a positive effect on the study population, administered by a rehabilitation nurse. The use of exergames may offer a viable solution to the challenges of traditional rehabilitation methods, particularly for cancer patients in the postoperative period.
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Affiliation(s)
- Isabel Alves
- Portuguese Institute of Oncology, Porto, Portugal
| | | | - Teresa Sousa
- Portuguese Institute of Oncology, Porto, Portugal
| | - Paulo Teles
- School of Economics, University of Porto, Portugal
| | - Filipe Goncalves
- University of A Coruña, Faculty of Health Sciences, Coruña, Spain; APELA - Portuguese Amyotrophic Lateral Sclerosis Association, Portugal
| | - Bruno Miguel Magalhães
- Porto Higher Health School of Health, University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal; Comprehensive Cancer Centre (Porto.CCC) RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Carla Sílvia Fernandes
- CINTESIS@RISE, Portugal; Porto Higher School of Nursing, Porto, Portugal; ADITGames Association, Portugal.
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Yu K, Yin B, Zhu Y, Meng H, Zhu W, Lu L, Wang J, Chen S, Ni J, Lin Y, Jia J. Efficacy of a Digital Postoperative Rehabilitation Intervention in Patients With Primary Liver Cancer: Randomized Controlled Trial. JMIR Mhealth Uhealth 2025; 13:e59228. [PMID: 40194311 PMCID: PMC11996149 DOI: 10.2196/59228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 10/27/2024] [Accepted: 02/26/2025] [Indexed: 04/09/2025] Open
Abstract
Background Rehabilitation is considered a fundamental component of cancer treatment, especially for patients undergoing cancer surgery. In contrast to conventional rehabilitation education, digital rehabilitation has the potential to improve patients' access to postoperative rehabilitation programs. While digital health has rapidly emerged to aid patients with various diseases, their clinical efficacy in the recovery of patients with primary liver cancer (PLC) undergoing hepatectomy remains inadequately investigated. Objective This study aims to evaluate whether a digital postoperative rehabilitation intervention is efficient in improving physical fitness, enhancing exercise adherence, and alleviating fatigue among patients with PLC after hepatectomy. Methods A randomized controlled trial was undertaken across 2 university-affiliated hospitals in Eastern China. A total of 100 participants were enrolled in this study and were allocated randomly to either the digital health (intervention group, n=50) or the rehabilitation manual-based group (control group, n=50) at a 1:1 ratio. Patients were unblinded and prospectively followed for the intervention of 3 weeks. Outcome measures included physical fitness, exercise adherence, and status of fatigue. Results Overall, 91 out of 100 patients completed the research and were evaluated after 3 weeks of intervention. The digital health group showed better cardiopulmonary endurance than the control group. The mean difference in the change of 6-minute walk test distance from baseline between the groups was 70.21 (95% CI 0.730-82.869) m (P=.05). No statistically significant effects were found for grip strength, 5-repetition-sit-to-stand test time, and fatigue. The exercise adherence in the digital health group was higher than that in the control group (χ22=15.871, P<.001). Conclusions The findings suggested that the implementation of digital health had a positive impact on recovery in exercise capacity after hepatectomy. In addition, rehabilitation exercise mode based on digital health has the potential to improve the exercise adherence of patients with PLC compared to conventional manual-based rehabilitation guidance.
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Affiliation(s)
- Kaitao Yu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China, 86 136 1172 2357
| | - Baobing Yin
- Department of General Surgery, Hepatobiliary Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hepatobiliary Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ying Zhu
- Department of General Surgery, Hepatobiliary Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongdao Meng
- College of Behavioral & Community Sciences, School of Aging Studies, University of South Florida, Florida, FL, United States
| | - Wenwei Zhu
- Department of General Surgery, Hepatobiliary Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lu Lu
- Department of General Surgery, Hepatobiliary Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Junqiao Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China, 86 136 1172 2357
| | - Jun Ni
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yifang Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China, 86 136 1172 2357
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China, 86 136 1172 2357
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Yoo M, Jang CW. Prehabilitation Research: A Bibliometric Analysis of Past Trends and Future Directions. Am J Phys Med Rehabil 2025; 104:357-363. [PMID: 39235947 DOI: 10.1097/phm.0000000000002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
OBJECTIVE This study investigates the global research landscape of prehabilitation, identifying current trends, dominant disciplines, collaborative networks, and prominent articles in the field. DESIGN For our analysis, we employed the published prehabilitation literature indexed in the Web of Science Core Collection database, spanning from 2002 to 2022. In addition, we utilized CiteSpace (version 6.2; Drexel University), a widely used information visualization software to perform bibliometric analysis. RESULTS Analyzing 553 research articles, we observe a consistent upward trend in prehabilitation publication and citation activity. Interdisciplinary co-occurrence analysis highlights strong connections with fields such as surgery, rehabilitation, oncology, sports sciences, orthopedics, gastroenterology, and hepatology. Initially centered around postoperative outcomes in major abdominal surgeries, particularly for colorectal, pancreatic, and prostate cancers, prehabilitation research expanded to include thoracic surgeries, focusing on conditions like lung cancer and aortic valve replacement. Preoperative exercise remains a core area, with increasing interest in multimodal prehabilitation and its effectiveness based on patient group characteristics. North America and Western Europe emerge as primary contributors to prehabilitation research. CONCLUSIONS Current research concentrates on tailoring prehabilitation programs for specific groups, and broadening their geographical scope would enhance the studies, contributing valuable insights for medical practitioners shaping future research efforts.
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Affiliation(s)
- Myungeun Yoo
- From the Department of Rehabilitation Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea (MY); Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea (CWJ); and Command Center, Doheon Institute for Digital Innovation in Medicine, Hallym University Medical Center, Anyang, Republic of Korea (CWJ)
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Gränicher P, Reicherzer L, Wanivenhaus F, Farshad M, Spörri J, Wirz M, Scherr J. Supervised prehabilitation in patients scheduled for spinal surgery - a scoping review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025; 34:1366-1385. [PMID: 39920321 DOI: 10.1007/s00586-025-08710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 01/06/2025] [Accepted: 01/30/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND CONTEXT Prehabilitation before spinal surgery may enhance patients' ability to withstand physical and mental stress during the perioperative period. It has the potential to reduce complications, accelerate recovery, and deliver sustainable, patient-relevant improvements. However, high-quality evidence remains limited, and it is unclear which prehabilitation concepts, training protocols, and outcomes are most effective for different patient groups. PURPOSE To evaluate the current state of research on preoperative interventions before spinal surgery, including the representation of subgroups, types of surgical procedures, and prehabilitation concepts. Additionally, it examines the outcomes analyzed and the methodologies employed in existing studies. STUDY DESIGN Scoping review based on a systematic literature search. METHODS A comprehensive database search in MEDLINE/PubMed, EMBASE (Ovid), CINAHL (EBSCO), Cochrane Library, Physiotherapy Evidence Database, Web of Science and Scopus was conducted. Exercise- and/or education-based prehabilitation concepts were identified, and findings were clustered and summarized according to PRISMA reporting standards. RESULTS Thirty-six reports from 23 studies (50% RCTs), evaluating prehabilitation programs in terms of feasibility, experiences, and effects on physical performance, self-reported function, pain, psychological outcomes and health-economic factors were included. These studies encompassed 2,964 participants scheduled for spinal surgery and reported a wide range of preoperative interventions, settings, and adherence rates. Prehabilitation focused primarily on education (87%) and exercise (35%), either independently or in combination. Most authors have concluded that preoperative interventions benefit patients awaiting spinal surgery, particularly by improving self-reported function, disability, and pain in both the short and long term. However, the findings also highlight the variability in outcomes, strengths, limitations, and recommendations across studies. Notably, 76% of the authors advocated for preoperative preparation, emphasizing the importance of structured, personalized programs and the need for further large-scale clinical trials. CONCLUSION Based on the current evidence, preparation for spinal surgery is recommended, provided that it is individualized, multimodal, and interdisciplinary, and addresses patients' specific impairments, resources, and expectations. Future research should focus on identifying subgroups defined by biopsychosocial risk factors that may influence short- and long-term perioperative outcomes.
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Affiliation(s)
- Pascale Gränicher
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Peter Debyeplein 1, Maastricht, 6229 HA, The Netherlands.
- University Center for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 319, Zurich, CH-8008, Switzerland.
| | - Leah Reicherzer
- Institute of Physiotherapy, Research and Development, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland
| | - Florian Wanivenhaus
- Department of Orthopedics, Balgrist University Hospital, University Spine Center Zurich, University of Zurich, Forchstrasse 340, Zurich, CH-8008, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University Spine Center Zurich, University of Zurich, Forchstrasse 340, Zurich, CH-8008, Switzerland
| | - Jörg Spörri
- University Center for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 319, Zurich, CH-8008, Switzerland
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Lengghalde 5, Zürich, CH-8008, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, Research and Development, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland
| | - Johannes Scherr
- University Center for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 319, Zurich, CH-8008, Switzerland
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11
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Villajos-Guijarro M, Ramírez-Martín R, Mauleón-Ladrero C, Déniz González V, Forero Torres A, Garcia-Moreno Nisa F, González-Montalvo JI. Impact of malnutrition on the clinical evolution in a cohort of older patients undergoing emergency surgery for abdominal pathology. Rev Esp Geriatr Gerontol 2025; 60:101609. [PMID: 39721565 DOI: 10.1016/j.regg.2024.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 11/11/2024] [Accepted: 11/13/2024] [Indexed: 12/28/2024]
Abstract
PURPOSE Analyse the influence of the nutritional status of older patients undergoing emergency abdominal surgery on postoperative complications, mortality and mean length of hospital stay. METHODS We performed a longitudinal observational study including patients older than 80 years who underwent emergency surgery by the general surgery service for abdominal pathology, who were followed by the geriatrics service between September 2018 and May 2021. Malnutrition was diagnosed using Global Leadership Initiative on Malnutrition (GLIM) criteria, classifying patients as malnourished and normonourished. A comprehensive geriatric assessment was performed on patients, and postoperative complications, mean length of hospital stay and mortality in-hospital were recorded. RESULTS 131 patients were included, 84 of them were malnourished and 47 normonourished. Mean age was 86±4.7 years. Malnourished patients had higher incidence of new-onset atrial fibrillation (odds ratio [OR]: 6.1, 95% confidence interval [CI]: 1.33-27.6, p<0.05), urinary tract infection (OR 4.72, 95% CI: 1.02-21.95, p<0.05) and bacteraemia (OR 3.51, 95% CI: 1.14-11.1, p<0.05), compared with normonourished patients. Surgical complications were more frequent in malnourished patients (OR 3.34, 95% CI: 1.5-7.44, p<0.05). Mean length of hospital stay in malnourished patients was longer (22.6 (±14.1)) compared with normonourished patients (15.3 (±11.9)) (p<0.005). CONCLUSION Malnutrition in older patients (mean age 86 years old) undergoing emergency abdominal surgery is associated with a poorer clinical course; thus, it must be considered in the evaluation and follow-up of these patients.
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Affiliation(s)
| | - Raquel Ramírez-Martín
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital - Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Victoria Déniz González
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital - Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Francisca Garcia-Moreno Nisa
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital - Universidad Autónoma de Madrid, Madrid, Spain; Department of General and Digestive Surgery, La Paz University Hospital, Madrid, Spain; GIBBYC-UAH Ciber-BBN, Spain
| | - Juan Ignacio González-Montalvo
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital - Universidad Autónoma de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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12
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Gan W, Ouyang J, She G, Xue Z, Zhu L, Lin A, Mou W, Jiang A, Qi C, Cheng Q, Luo P, Li H, Zheng X. ChatGPT's role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study. Int J Surg 2025; 111:2546-2557. [PMID: 39903546 DOI: 10.1097/js9.0000000000002223] [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: 07/10/2024] [Accepted: 12/01/2024] [Indexed: 02/06/2025]
Abstract
BACKGROUND Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored. METHODS In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires. RESULTS Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P <.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels. CONCLUSIONS ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.
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Affiliation(s)
- Wenyi Gan
- Department of Joint Surgery and Sports Medicine, Zhuhai People's Hospital (The Affiliated Hospital of Beijing Institute of Technology, Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianfeng Ouyang
- Department of Joint Surgery and Sports Medicine, Zhuhai People's Hospital (The Affiliated Hospital of Beijing Institute of Technology, Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
| | - Guorong She
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhaowen Xue
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lingxuan Zhu
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Anqi Lin
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Weiming Mou
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aimin Jiang
- Department of Urology, Changhai hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Chang Qi
- The University of Hong Kong, Hong Kong, China
| | - Quan Cheng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hua Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Ogomori K, Broering J, Rogine C, Kin C, Chang GJ, Finlayson E. Evaluating a digital prehabilitation tool in patients with colorectal surgery: protocol for a multisite randomised controlled trial. BMJ Open 2025; 15:e088001. [PMID: 39965940 PMCID: PMC11836842 DOI: 10.1136/bmjopen-2024-088001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 01/31/2025] [Indexed: 02/20/2025] Open
Abstract
INTRODUCTION Colorectal cancer is a leading cause of cancer mortality in the USA and occurs most frequently in older adults. These patients are at increased risk of adverse outcomes following major cancer surgery. While prehabilitation has been shown to mitigate this risk, multiple barriers to implementation remain. Our team created a digital tool co-designed with older adults that employs an algorithm to assess patient-specific geriatric vulnerabilities and generate personalised prehabilitation programmes before surgery. METHODS AND ANALYSIS We have designed a multisite, unblinded randomised trial to be completed at three high-volume academic cancer centres located in California or Texas. Our study population is individuals aged 65 and older with planned colorectal cancer resection who are proficient in English and have home internet access. We aim to enroll 132 patients who will be randomised in a 2:1 ratio to receive the intervention (assistance from a home health coach and access to the web application (web app)) or control (usual care with written prehabilitation materials). Our primary outcome is patient engagement with prehabilitation activities. ETHICS AND DISSEMINATION A properly executed, written, informed consent will be obtained from each subject prior to entering the subject into the trial. Information will be given in both oral and written form, and subjects may withdraw at any time from the study without effect on their medical care. The protocol and consent form have been approved by the Institutional Review Board (IRB) of each participating centre. We anticipate publication of results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05520866.
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Affiliation(s)
- Kelsey Ogomori
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jeanette Broering
- Surgery, University of California San Francisco, San Francisco, California, USA
| | - Camille Rogine
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Cindy Kin
- Stanford University, Stanford, California, USA
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily Finlayson
- Surgery, University of California San Francisco, San Francisco, California, USA
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14
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Kim J, Lee CH, Yim GW. Multimodal Prehabilitation for Gynecologic Cancer Surgery. Curr Oncol 2025; 32:109. [PMID: 39996909 PMCID: PMC11853901 DOI: 10.3390/curroncol32020109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Revised: 02/11/2025] [Accepted: 02/12/2025] [Indexed: 02/26/2025] Open
Abstract
Surgical treatment is commonly employed to treat patients with gynecologic cancer, although surgery itself may function as a stressor, reducing the patients' functional capacity and recovery. Prehabilitation programs attempt to improve patients' overall health and baseline function prior to surgery, thereby enhancing recovery and lowering morbidity. In recent years, prehabilitation has come to primarily refer to multimodal programs that combine physical activity, nutritional support, psychological well-being, and other medical interventions. However, the specific methods of implementing prehabilitation and measuring its effectiveness are heterogeneous. Moreover, high-level evidence regarding prehabilitation in gynecologic cancer surgery is limited. This review provides a summary of multimodal prehabilitation studies in gynecologic oncologic surgery. Enhanced postoperative recovery, lower postoperative complications, lower rate of blood transfusions, and faster gastrointestinal functional recovery have been reported after multimodal prehabilitation interventions. Patients and healthcare professionals should recognize the importance of prehabilitation in the field of gynecologic oncologic treatment, based on the emerging evidence. In addition, there is a need to establish an appropriate target group and construct a well-designed and tailored prehabilitation program.
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Affiliation(s)
| | | | - Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang 10326, Republic of Korea; (J.K.); (C.H.L.)
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15
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Carr ZJ, Siller S, McDowell BJ. Perioperative Pulmonary Complications in the Older Adults: The Forgotten System. Clin Geriatr Med 2025; 41:1-18. [PMID: 39551535 DOI: 10.1016/j.cger.2024.03.003] [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: 11/19/2024]
Abstract
With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.
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Affiliation(s)
- Zyad J Carr
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Saul Siller
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA
| | - Brittany J McDowell
- Department of Anesthesiology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT 84107, USA
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16
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Soh NH, Yau CRZ, Low XZ, Kadir HA, Fong WJ, Ramalingam MB, Tan PL, Ng KYY, Hsing YT, Cai M, Seo CJ, Ong JCA, Chia CS, Wong JSM. Prehabilitation Outcomes in Surgical Oncology Patients Undergoing Major Abdominal Surgery: A Meta-analysis of Randomized Control Trials. Ann Surg Oncol 2025; 32:1236-1247. [PMID: 39616295 DOI: 10.1245/s10434-024-16527-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/30/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Prehabilitation has been increasingly utilized to optimize perioperative outcomes. In this study, we aim to evaluate the impact of uni- and multimodal prehabilitation on functional capacity and postoperative outcomes among surgical oncology patients undergoing major abdominal surgery. PATIENTS AND METHODS Three electronic databases (PubMed, Embase, Cochrane) were systematically searched up until December 2023. We included randomized controlled trials comparing prehabilitation to standard of care in surgical oncology patients undergoing major abdominal surgery. Our primary outcome was functional capacity as measured by the 6-min walk distance (6MWD). Secondary outcomes include postoperative complications, emergency readmissions, and length of stay (LOS). We stratified our findings to determine the impact of uni- versus multimodal prehabilitation on outcomes. RESULTS We included 27 studies with 2532 surgical oncology patients. Overall, patients undergoing prehabilitation demonstrated a significant improvement in preoperative functional capacity compared to those without prehabilitation (mean difference in 6MWD 28.32 meters [m], 95% CI 15.26, 41.39, p < 0.01). Prehabilitation was also associated with significantly lower odds of postoperative complications (odds ratio [OR] 0.60, 95% CI 0.46, 0.78, p < 0.01). There was no difference in emergency readmission (OR 0.90, 95% CI 0.59, 1.38, p = 0.61) or LOS (mean difference -0.42 days, 95% CI -1.01, 0.16, p = 0.15). Comparing uni- versus multimodal prehabilitation, multimodal prehabilitation was associated with greater improvements in functional capacity (6MWD 37.35 m versus 13.38 m) and lower odds of postoperative complications (OR 0.61, 95% CI 0.45, 0.82, p < 0.01 versus OR 0.63, 95% CI 0.36, 1.11, p = 0.10) CONCLUSION: Prehabilitation improves functional capacity and reduces postoperative complications among surgical oncology patients undergoing major abdominal surgery.
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Affiliation(s)
- Natalie Hann Soh
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | | | - Xi Zhi Low
- Duke-NUS Medical School, Singapore, Singapore
| | - Hanis Abdul Kadir
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Wei Jing Fong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Mothi Babu Ramalingam
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pei Ling Tan
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Kennedy Yao Yi Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Division of Population Health and Integrated Care, Singapore General Hospital, Singapore, Singapore
| | - Ya Ting Hsing
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Mingzhe Cai
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Johnny Chin-Ann Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore
| | - Claramae S Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore.
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Legault EP, Ribeiro PAB, Moreau-Amaru D, Robert E, Forte S, Comtois AS, Samouëlian V, Tournoux F. The PREPARE Study: Acceptability and Feasibility of a Telehealth Trimodal Prehabilitation Program for Women with Endometrial Neoplasia. Curr Oncol 2025; 32:55. [PMID: 39851971 PMCID: PMC11763516 DOI: 10.3390/curroncol32010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/11/2025] [Accepted: 01/13/2025] [Indexed: 01/26/2025] Open
Abstract
Patients with endometrial neoplasia (EN) often have multiple comorbidities and a higher surgical risk. Prehabilitation programs (PPs) combine various interventions to improve preoperative conditions and reduce impairment due to surgical stress. We conducted a pragmatic pilot study to evaluate the acceptability and feasibility of a trimodal telehealth PP (exercise, nutrition, and psychological support) for EN patients. The participants could select their exercise group: (1) a supervised PP (SPP), group sessions 3×/week; (2) a semi-supervised PP (SSPP), group session 1×/week, training alone 2×/week; or (3) a physical activity counseling session (PACS). Out of the 150 EN patients awaiting surgery screened during the 18 months of the study recruitment, 66% (99/150) were eligible, and 40% consented to participate (SPP, n = 13; SSPP, n = 17; PACS, n = 9). The overall dropout was low (13%; 5/39), with no significant differences across groups. No serious adverse events occurred. We observed a positive impact on different outcomes across the different groups, such as in the Functional Assessment of Cancer Therapy quality of life score (SPP; delta = 6.1 [CI: 0.9; 12.6]) and functional capacity measured using the 30″ sit-to-stand test (PACS delta = 2.4 [CI: 1.2; 3.6]). The same-day hospital leave was high in the SSPP group (54.5%). Our pilot telehealth PP seems to be safe, feasible, and well accepted and may procure clinical and patient-centered gains that need to be confirmed in a larger trial.
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Affiliation(s)
- Elise P. Legault
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 1Y4, Canada;
| | - Paula A. B. Ribeiro
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
| | - Danielle Moreau-Amaru
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Emmanuelle Robert
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Sara Forte
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Alain S. Comtois
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 1Y4, Canada;
| | - Vanessa Samouëlian
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X 0A9, Canada
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - François Tournoux
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
- Service de Cardiologie du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada
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Guo Y, Pan M, Xiong M, Liu M, Zhu N, Dong H, Zhang C. Efficacy of preoperative pulmonary rehabilitation in lung cancer patients: a systematic review and meta-analysis of randomized controlled trials. Discov Oncol 2025; 16:56. [PMID: 39820966 PMCID: PMC11748636 DOI: 10.1007/s12672-025-01774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 01/03/2025] [Indexed: 01/19/2025] Open
Abstract
Although previous studies have shown that preoperative pulmonary rehabilitation training may improve postoperative prognosis in patients with lung cancer, the literature included in the existing meta-analysis is highly heterogeneous and lacks effective subgroup analysis. Therefore, an updated meta-analysis is needed to integrate the latest published randomized controlled clinical trials (RCT). This updated analysis was performed to identify the clinical effects of preoperative pulmonary rehabilitation on physical rehabilitation (lung function, activity endurance, and dyspnea), psychological rehabilitation, quality of life, length of hospital stay, and postoperative pulmonary complications in patients with lung cancer. The PubMed, Embase, Cochrane Library, and Web of Science database were searched since inception up to March 2024. A random-effects model was used to pool data, and sensitivity and subgroup analyses were performed to explore the stability of outcomes and potential sources of heterogeneity. All analyses were conducted via Review Manager 5.4.1 and STATA 15.0. The final analysis included 11 RCTs with 1250 patients. The results of meta-analysis suggest that preoperative pulmonary rehabilitation can significantly improve the quality of life of patients with lung cancer after surgery (SMD: 0.16; 95% CI: 0.01, 0.32; P = 0.04) and significantly reduce the risk of postoperative pulmonary complications (PPCs) (RR: 0.39; 95% CI: 0.25, 0.60; P < 0.0001). The results of subgroup analysis suggested that the effect of combined preoperative and postoperative rehabilitation was significantly better than that of preoperative rehabilitation alone, and the effect of short-term preoperative pulmonary rehabilitation (≤ 3 weeks) was significantly better than that of long-term rehabilitation. Preoperative pulmonary rehabilitation for patients with lung cancer can significantly improve their postoperative quality of life and reduce postoperative complications, but factors such as intervention time and intervention method may affect the rehabilitation effect.
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Affiliation(s)
- Yalun Guo
- Department of Nursing, Zhongnan Hospital of Wuhan University, No.169. East-Lake Road, Hubei, 430071, Wuhan, China
- Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Hubei, 430030, Wuhan, China
| | - Mengdie Pan
- Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Hubei, 430030, Wuhan, China
| | - Meidi Xiong
- Department of Nursing, Zhongnan Hospital of Wuhan University, No.169. East-Lake Road, Hubei, 430071, Wuhan, China
- Yangtze University, Hubei, 434023, Wuhan, China
| | - Miao Liu
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Hubei, 430071, Wuhan, China
| | - Na Zhu
- Department of Nursing, Zhongnan Hospital of Wuhan University, No.169. East-Lake Road, Hubei, 430071, Wuhan, China
- Department of Phase I Clinical Research, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300000, China
| | - Haoxu Dong
- Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Hubei, 430030, Wuhan, China
| | - Chunhua Zhang
- Department of Nursing, Zhongnan Hospital of Wuhan University, No.169. East-Lake Road, Hubei, 430071, Wuhan, China.
- Yangtze University, Hubei, 434023, Wuhan, China.
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19
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Alsayari R, McKechnie T, Kazi T, Heimann L, Sachdeva A, Lee Y, Huo B, Sne N, Hong D, Eskicioglu C. Modified Frailty Index for Patients Undergoing Surgery for Colorectal Cancer: Analysis of the National Inpatient Sample From 2015 to 2019. Am Surg 2025; 91:76-85. [PMID: 39663192 DOI: 10.1177/00031348241269398] [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: 12/13/2024]
Abstract
BACKGROUND Frailty is increasingly recognized as a perioperative risk for numerous surgical diseases. We applied the modified frailty index (mFI-11) to the National Inpatient Sample (NIS) for patients undergoing surgery for colorectal cancer (CRC). METHODS We performed a retrospective analysis of the NIS (2015-2019) including CRC patients undergoing surgery. We classified patients into frail (ie, mFI ≥0.27) and robust (ie, mFI <0.27) categories. Primary outcomes were in-hospital postoperative morbidity and mortality. The secondary outcomes included system-specific postoperative morbidity and length of stay (LOS). Multivariable regression models were fit. RESULTS Within the 53,652 identified patients undergoing surgery for CRC, 19.1% were frail. Frail patients were at higher risk of postoperative mortality (3.1% vs 1.0%, odds ratio [OR] 1.96, 95% confidence intervals [CIs] 1.68-2.30, P < 0.001), morbidity (41.3 % vs 23.1%, OR 1.75, 95% CI 1.66-1.83, P < 0.001), and LOS (mean difference [MD] 1.46, 95% CI 0.29-1.62, P < 0.001). Significant differences existed between groups in system-specific postoperative morbidity, with the largest effect estimates seen in cardiovascular morbidities (OR 4.07, 95% CI 3.36-4.93, P = 0.001), followed by respiratory (OR 1.75, 95% CI 1.66-1.83, P = 0.001). CONCLUSION Frail patients undergoing CRC surgery are at risk of increased postoperative complications. Preoperative frailty screening may allow for individualized preoperative counseling.
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Affiliation(s)
- Rehab Alsayari
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tania Kazi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Luke Heimann
- Liberty University, Lynchburg, Virginia, United States of America
| | - Anjali Sachdeva
- University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Bright Huo
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Niv Sne
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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Atreya CE, Leach H, Asiimwe E, Bahri N, Le BK, Macaire G, Wood KC, Van Blarigan EL, Lee RT. Integrative Oncology: Incorporating Evidence-Based Approaches for Patients With GI Cancers. Am Soc Clin Oncol Educ Book 2025; 45:e471734. [PMID: 39841946 DOI: 10.1200/edbk-25-471734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2025]
Abstract
Data have matured to support incorporation of integrative oncology modalities into comprehensive cancer care. Clinical practice guidelines have recently been published by ASCO for diet and exercise (2022) and use of cannabinoids and cannabis (2024) and jointly by ASCO and the Society for Integrative Oncology (SIO) for application of integrative approaches in the management of pain (2022), anxiety and depression (2023), and fatigue (2024) among adults with cancer. Following the ASCO-SIO guidelines, clinicians should recommend mindfulness-based interventions (MBIs) to patients with symptoms of anxiety or depression and MBIs and exercise for management of fatigue during or after completion of cancer treatment. We will review the basis of these recommendations and evidence to support use of other mind-body approaches, exercise, nutrition, acupuncture/acupressure, and natural products in the specific contexts of GI cancers. For example, optimizing physical activity and diet is associated with improved survival after a colorectal cancer (CRC) diagnosis, in addition to conferring symptom management benefits. We will also highlight gaps in research, including that most studies enrolling patients with GI malignancies have focused on CRC. A limitation of nonpharmacologic evidence-based guidelines is that they list broad categories (eg, yoga or acupuncture) and lack implementation details. How to safely and equitably incorporate integrative approaches into conventional cancer care will be addressed. This ASCO Educational Book article aims to be both evidence-informed and practical, with attention to unique considerations for people with GI cancers.
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Affiliation(s)
- Chloe E Atreya
- Department of Medicine, University of California, San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
- Osher Center for Integrative Health, San Francisco, CA
| | - Heather Leach
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO
| | - Edgar Asiimwe
- Department of Medicine, University of California, San Francisco, CA
- National Clinician Scholars Program, University of California, San Francisco, CA
| | | | - Bryan Khuong Le
- Department of Medicine, University of California, San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Greta Macaire
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Kelley C Wood
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA
| | - Erin L Van Blarigan
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
- Department of Urology, University of California, San Francisco, CA
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21
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Sier MAT, Cox MPPJ, Tweed TTTT, Servaas N, Greve JWM, Stoot JHMB. Participation and Compliance in a Multimodal Prehabilitation Program for Colorectal Cancer (PACE): A Qualitative Study. Patient Prefer Adherence 2024; 18:2709-2720. [PMID: 39759885 PMCID: PMC11697675 DOI: 10.2147/ppa.s481567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 11/11/2024] [Indexed: 01/07/2025] Open
Abstract
Purpose Interest in prehabilitation, the preoperative enhancement of patients' condition, is rising in the surgical field. Challenging factors appear to be patients' motivation to participate in and their compliance with prehabilitation programs. The aim of this qualitative study was to study the real-life experience of prehabilitation by assessing the lived experience and perceptions of participants in a multimodal prehabilitation program and to explore factors that influence participation and compliance during prehabilitation. Methods Patients who underwent surgery for colorectal cancer and who had participated in the 4-week multimodal prehabilitation program "BEFORE" feasibility study were recruited. Their lived experiences were collected through semi-structured, individual, in-depth interviews. Interviews were transcribed verbatim and analyzed using a thematical approach. As no new information emerged after the interviews, data were considered saturated. Results Six patients were interviewed. Seven main themes were discussed during the interviews, including information provision, motivation for participation, and content of the program. The results of this study emphasize the importance of adequate patient education, in-hospital exercise with the supervision of physiotherapists, and a patient-centered program. Logistical problems and the impact of cancer diagnosis were most frequently reported as barriers to participation. Conclusion Participation could be improved by providing adequate information and solving logistical issues. Patient-centeredness of the program is an important feature in improving adherence.
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Affiliation(s)
- Misha A T Sier
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Maud P P J Cox
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Thaís T T T Tweed
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6229 hX, The Netherlands
| | - Nick Servaas
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
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22
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Franssen R, Voorn M, Jetten E, Bongers BC, van Osch F, Janssen-Heijnen M. Real-life effectiveness of prehabilitation to improve postoperative outcomes in patients with colorectal cancer approaching surgery: A systematic review and meta-analyses of observational studies versus randomized controlled trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108708. [PMID: 39368273 DOI: 10.1016/j.ejso.2024.108708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 09/09/2024] [Accepted: 09/25/2024] [Indexed: 10/07/2024]
Abstract
INTRODUCTION Current evidence synthesis of prehabilitation studies in colorectal surgery is based on results of randomized controlled trials (RCT). Although RCTs are the gold standard for effectiveness research, observational studies probably better reflect real-life practice. The aims of the current study were to compare observational studies to RCTs regarding the association between prehabilitation and postoperative outcomes, and characteristics of included patients and interventions. METHODS A systematic search was conducted in PubMed, Embase, and CINAHL (until September 2023). Observational studies and RCTs investigating prehabilitation before colorectal surgery and reporting postoperative complications and/or length of stay (LoS) were included. Two reviewers independently assessed the risk of bias using the Cochrane Risk of Bias 2 tool for RCTs and the Cochrane ROBINS-I tool for observational studies. Meta(regression)-analyses were performed for postoperative complications and LoS. RESULTS Pooled results showed a statistically significant reduction in postoperative complications (OR 0.54; 95 % confidence interval (CI) 0.40 to 0.72) and LoS (mean difference (MD) -1.34 CI -2.57 to -0.12) after prehabilitation in observational studies but not in RCTs (complications OR 0.95; CI 0.53 to 1.72; LoS MD 0.16 CI -0.52 to 0.83). Patients included in observational studies were older and more often had an ASA score ≥3. In a meta-regression analysis, these characteristics were not statistically significantly associated with the main outcomes. CONCLUSION Observational studies in a real-life setting showed that prehabilitation can reduce postoperative complications and LoS. To further explore the real-life effectiveness of prehabilitation, specific observational study designs, like a target emulation trial could be used.
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Affiliation(s)
- Ruud Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Melissa Voorn
- Adelante Rehabilitation Centre, Venlo, the Netherlands; Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Evy Jetten
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands.
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
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23
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Clemons J, Zhou Z, Hoy SA, Gerber SQ, Nambiar A, Kwon A, Kin C. No thanks and not for me: A qualitative study of barriers to prehabilitation participation. Surgery 2024; 176:1697-1702. [PMID: 39306566 DOI: 10.1016/j.surg.2024.08.014] [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: 03/01/2024] [Revised: 07/23/2024] [Accepted: 08/20/2024] [Indexed: 11/15/2024]
Abstract
BACKGROUND Prehabilitation programs have been shown to improve functional status prior to surgery, postoperative recovery, and even long-term outcomes. However, these programs often lack participation, often by patients who seem to need it the most. This study aimed to identify the primary reasons for patients' declining enrollment or low adherence to a prehabilitation program. METHODS We recruited adult patients who had undergone or planned to undergo major abdominal surgery for semistructured one-on-one audio-recorded interviews. Interviews were transcribed verbatim and iteratively coded deductively and inductively. Thematic analysis was performed. RESULTS We interviewed 11 patients, at which point we reached thematic saturation. The patients were on average 53 years old (range 38-75) and 27% were women and 73% were men. The pooled kappa score was 0.81, indicating concordance among the coding researchers. Seven potential barriers to prehabilitation participation and adherence were identified: poorly timed recruitment efforts, misconceptions about prehabilitation diet recommendations, competing priorities that made prehabilitation less feasible, lack of family alignment, belief that prehabilitation would not be helpful, concerns over specific prehabilitation program components, and belief that prehabilitation is helpful for others but not for themselves. CONCLUSION Low participation and adherence limit the success and reach of many prehabilitation programs. Improved timing and content of communication by the prehabilitation team is critical for improving recruitment of patients. Flexibility and customization may reframe prehabilitation as feasible rather than a difficult chore, increasing participation and adherence. Understanding patients' concerns and readiness to adopt new health behaviors is a necessary component of any behavioral intervention.
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Affiliation(s)
- Jacob Clemons
- Department of Surgery, Stanford University School of Medicine, CA
| | - Zeyi Zhou
- Department of Surgery, Stanford University School of Medicine, CA
| | - Sydni Au Hoy
- Department of Surgery, Stanford University School of Medicine, CA
| | - Scott Q Gerber
- Department of Surgery, Stanford University School of Medicine, CA
| | - Anjali Nambiar
- Department of Surgery, Stanford University School of Medicine, CA
| | - Angela Kwon
- Department of Surgery, Stanford University School of Medicine, CA
| | - Cindy Kin
- Department of Surgery, Stanford University School of Medicine, CA.
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24
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Mayer A, Cibula D. Optimizing prehabilitation in gynecologic malignancies: Improving acceptance, overcoming barriers, and managing program complexity. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108739. [PMID: 39418833 DOI: 10.1016/j.ejso.2024.108739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/23/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024]
Abstract
Prehabilitation aims to improve patients' physical condition before a stressful event, such as surgery, and enhance recovery. Despite its potential benefits, many emerging prehabilitation programs face challenges in enrolling or retaining patients. In our prehabilitation study PHOCUS, which aims to prepare ovarian cancer patients for surgery, we have also encountered lower acceptance and retention rates. Particularly the most vulnerable patients, who are old and frail, and may benefit the most from the prehabilitation, decline participation due to the complexity of the proposed program. In our review we discussed obstacles and barriers that prevent patients' participation based on both literature and our experience. Among the main reasons are patient's low motivation, high intensity of the program and a lack of social support. To overcome these challenges, we suggest increasing the program's flexibility, adapting the program according to individual patient's needs and enhancing patients' education about the benefits of prehabilitation.
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Affiliation(s)
- Alexandra Mayer
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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Alves I, Moreira AP, Sousa T, Teles P, Magalhães BM, Goncalves F, Fernandes CS. The effect of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery: a randomized controlled trial. Support Care Cancer 2024; 32:794. [PMID: 39542974 PMCID: PMC11564271 DOI: 10.1007/s00520-024-09005-0] [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: 05/20/2024] [Accepted: 11/08/2024] [Indexed: 11/17/2024]
Abstract
PURPOSE Exergames, which combine digital games and physical exercise, have become increasingly popular for rehabilitation in the health domain. This study aimed to assess the effectiveness of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery. METHODS This randomized controlled trial evaluated the effectiveness of exergame rehabilitation on the quality of life of cancer patients who had undergone abdominal surgery. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcome was the quality of life, and data collection occurred at three different time points: upon admission, 48 h postoperatively, and on the 7th day after surgery. RESULTS Quality of life was evaluated using the WHOQOL-BREF Scale. At the third assessment, a statistically significant difference was observed between the two groups (p = 0.016), indicating that the intervention group had a higher quality of life than the control group. CONCLUSIONS The study showed a positive effect of exergames on the population under investigation. By the 7th day after surgery, the intervention group demonstrated an improvement in their quality of life compared to the control group. CLINICAL TRIAL REGISTRATION Center of Open Science OSF https://osf.io/286zb/ , registered in July, 2023.
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Affiliation(s)
- Isabel Alves
- Portuguese Institute of Oncology, Porto, Portugal
| | | | - Teresa Sousa
- Portuguese Institute of Oncology, Porto, Portugal
| | - Paulo Teles
- School of Economics, University of Porto, Dr. Roberto Frias, 4200-464, Porto, Portugal
| | - Bruno Miguel Magalhães
- Porto Higher Health School of Health, University of Trás-Os-Montes E Alto Douro (UTAD), Vila Real, Portugal
- Comprehensive Cancer Centre (Porto.CCC) RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Filipe Goncalves
- Faculty of Health Sciences, University of A Coruña, A Coruña, Spain
- APELA - Portuguese Amyotrophic Lateral Sclerosis Association, Porto, Portugal
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Chen Y, Sebio-García R, Iglesias-Garcia E, Reguart N, Martinez-Palli G, Bello I. Prehabilitation for patients undergoing neoadjuvant therapy prior to cancer resection: a systematic review and meta-analysis. Support Care Cancer 2024; 32:749. [PMID: 39466349 DOI: 10.1007/s00520-024-08941-1] [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: 03/07/2024] [Accepted: 10/13/2024] [Indexed: 10/30/2024]
Abstract
PURPOSE To determine the effectiveness of uni- or multimodal prehabilitation on several outcomes in patients undergoing neoadjuvant therapy before cancer surgery. METHODS A systematic search was carried on May 1, 2023, using four major databases (SCOPUS, Web of Science, Medline (Ovid and Pubmed)) and updated monthly until February 2024. Inclusion criteria included (i) any original articles (any design), (ii) adult patients undergoing neoadjuvant therapy (NAT) prior to surgical resection, (iii) participation in uni- or multimodal prehabilitation programs during NAT, and (iv) reporting on any functional, treatment-related, or perioperative outcome. Two reviewers independently conducted the search and screened all records. Risk of bias was assessed using the Johanna Briggs Institute Appraisal Tools independently by two reviewers. A random-effects meta-analysis was performed for all outcomes with two or more studies. RESULTS A total of 30 records met the inclusion criteria and were analyzed. Studies showed that prehabilitation during NAT can be feasible in most settings and increase or prevent the loss of cardiorespiratory fitness (CRF), maintain or improve muscle mass, and improve pathological response and treatment completion compared to no prehabilitation, but the certainty of the evidence is low to moderate. However, according to our findings, prehabilitation has little to no effect on postoperative complications and length of hospital stay as well as in health-related quality of life. CONCLUSIONS Prehabilitation during NAT might be feasible and associated with improvements in cardiorespiratory fitness, muscle mass, and treatment response/completion with low-to-moderate certainty of evidence. Insufficient data on safety is available at this stage.
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Affiliation(s)
- Y Chen
- Physical Medicine and Rehabilitation Department, Hospital Clinic de Barcelona, Casanova 160 Bis. 08036, Barcelona, Spain
| | - R Sebio-García
- Physical Medicine and Rehabilitation Department, Hospital Clinic de Barcelona, Casanova 160 Bis. 08036, Barcelona, Spain.
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain.
| | - E Iglesias-Garcia
- Physical Medicine and Rehabilitation Department, Hospital Clinic de Barcelona, Casanova 160 Bis. 08036, Barcelona, Spain
| | - N Reguart
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
- Department of Thoracic Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Martinez-Palli
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
- Department of Anaesthesia, Reanimation and Pain Management, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias CIBERES, Madrid, Spain
| | - I Bello
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
- Department of Thoracic Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
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Yang F, Yuan Y, Liu W, Tang C, He F, Chen D, Xiong J, Huang G, Qian K. Effect of prehabilitation exercises on postoperative frailty in patients undergoing laparoscopic colorectal cancer surgery. Front Oncol 2024; 14:1411353. [PMID: 39328202 PMCID: PMC11424377 DOI: 10.3389/fonc.2024.1411353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/26/2024] [Indexed: 09/28/2024] Open
Abstract
Background To improve perioperative frailty status in patients undergoing laparoscopic colorectal cancer surgery (LCCS), we explored a new intensive prehabilitation program that combines prehabilitation exercises with standard enhanced recovery after surgery (ERAS) and explored its impact. Methods We conducted a prospective randomized controlled trial. Between April 2021 to August 2021, patients undergoing elective LCCS were randomized into the standardized ERAS (S-ERAS) group or ERAS based on prehabilitation (group PR-ERAS). Patients in the PR-ERAS group undergoing prehabilitation exercises in the perioperative period in addition to standard enhanced recovery after surgery. We explored the effects of this prehabilitation protocol on frailty, short-term quality of recovery (QoR), psychological status, postoperative functional capacity, postoperative outcomes, and pain. Results In total, 125 patients were evaluated, and 95 eligible patients were enrolled and randomly allocated to the S-ERAS (n = 45) and PR-ERAS (n = 50) groups. The Fried score was higher in the PR-ERAS group on postoperative day (7 (2(2,3) vs. 3(2,4), P = 0.012). The QoR-9 was higher in the PR-ERAS group than in the S-ERAS group on the 1st, 2nd, 3rd, and 7th postoperative days. The PR-ERAS group had an earlier time to first ambulation (P < 0.050) and time to first flatus (P < 0.050). Conclusion Prehabilitation exercises can improve postoperative frailty and accelerate recovery in patients undergoing LCCS but may not improve surgical safety. Therefore, better and more targeted prehabilitation recovery protocols should be explored. Clinical trial registration www.clinicaltrials.org , identifier NCT04964856.
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Affiliation(s)
- Fuyu Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ye Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenwen Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenglin Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fan He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Defei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junjie Xiong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoquan Huang
- Department of Gastrointestinal Surgery, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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28
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Xu L, Zheng X, Yan Y, Wang B, Wang A. Effect of prehabilitation for patients undergoing gastric cancer surgery: a protocol of a systematic review and meta-analysis. BMJ Open 2024; 14:e083914. [PMID: 39260840 PMCID: PMC11409279 DOI: 10.1136/bmjopen-2024-083914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/30/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Gastric cancer is a high-risk cancer with surgical treatments often leading to significant postoperative complications and mortality. Prehabilitation, involving exercise, nutrition and psychological support before surgery, aims to boost patients' physical and mental health. While effective in other cancers, its benefits for gastric cancer need further study. This research will evaluate the impact of trimodal prehabilitation on patient outcomes in gastric cancer surgery, aiming to reduce complications and expedite recovery. METHODS AND ANALYSIS This study will systematically review randomised controlled trials and cohort studies evaluating the role of prehabilitation in people undergoing gastric cancer resection. The primary outcomes of interest will include overall postoperative complications and length of hospital stay. The secondary outcomes of interest will include mortality, readmission rate or functional recovery. Databases including PubMed, EMBASE, CINAHL, CENTRAL, Chinese BioMedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang database and Chinese Science and Technology Periodicals (VIP) will be searched. All studies will be screened and selected using the criteria described in 'population, intervention/exposure, comparison, outcome and study design' format. Two independent reviewers will screen studies for relevance and methodological validity. Data from included studies will be extracted through a customised, preset data extraction sheet. The Cochrane Review Manager (V.5.3, Nordic Cochrane Centre, Copenhagen, Denmark) software will be used to perform the meta-analysis. ETHICS AND DISSEMINATION Ethics approval is not required for this study as all results will be based on published papers. No primary data collection will be needed. Study findings will be presented at scientific conferences or published in a peer-reviewed scientific journal. PROSPERO REGISTRATION NUMBER CRD42023488469.
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Affiliation(s)
- Linyu Xu
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xutong Zheng
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yaxi Yan
- China Medical University, Shenyang, Liaoning Province, China
| | - Bei Wang
- China Medical University, Shenyang, Liaoning Province, China
| | - Aiping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Gill SS, Shukla A, Namireddy SR, Moin S. Exercise and recovery after surgery in patients with breast cancer: An analysis of the literature. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108525. [PMID: 38991288 DOI: 10.1016/j.ejso.2024.108525] [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: 04/01/2024] [Revised: 06/20/2024] [Accepted: 06/30/2024] [Indexed: 07/13/2024]
Abstract
This review explores the impact of exercise on post-surgical recovery in breast cancer patients. Breast cancer, the most prevalent cancer globally, necessitates treatments beyond conventional modalities such as surgery, chemotherapy, radiotherapy, and immunotherapy. While exercise as an adjuvant therapeutic tool is not novel, it is generally accepted for improving cancer outcomes. Yet, it is not included in current treatment guidelines. This study reviews literature using the FACT-B (Functional Assessment of Cancer Therapy - Breast) tool to evaluate quality of life in breast cancer patients undergoing exercise interventions post-surgery. Despite mixed results, with some studies showing significant improvements and others indicating no notable benefits, the general consensus suggests potential advantages of integrating structured exercise programs into recovery protocols. Standardizing the use of quality of life measures like FACT-B could enhance future research and clinical practices, leading to more effective patient care strategies.
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Affiliation(s)
- Saran S Gill
- Faculty of Medicine, Imperial College London, London, UK.
| | - Anushka Shukla
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Sarah Moin
- The Hillingdon Hospitals Foundation Trust, London, UK
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Ray H, Sexton E, Frowen J, Gough K, Turnbull S, Abo S, Ftanou M, Loeliger J. Study protocol for a single-site feasibility study evaluating the adoption and fidelity of Prep-4-RT: prehabilitation for head and neck cancer patients undergoing radiotherapy. Pilot Feasibility Stud 2024; 10:106. [PMID: 39095879 PMCID: PMC11295311 DOI: 10.1186/s40814-024-01531-2] [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: 07/04/2023] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Prep-4-RT is a co-designed stepped-care multimodal prehabilitation program for people scheduled to receive radiotherapy for head and neck cancer (HNC). Prehabilitation, which occurs between diagnosis and treatment commencement, aims to improve a patient's health to reduce the incidence and severity of current and future impairments. HNC treatment can be distressing and has detrimental impacts on function and quality of life. HNC patients have increased social vulnerabilities including higher rates of socio-economic disadvantage and engagement in lifestyle habits which increase cancer risk. High levels of physical and psychological impacts of HNC treatment and increased social vulnerabilities of this population warrant investigation of optimal pathways of care, such as prehabilitation. This paper describes a research protocol to evaluate the feasibility of Prep-4-RT, which was designed to prepare HNC patients for the physical and psychological impacts of radiotherapy. METHODS AND ANALYSIS At least sixty adult HNC patients, scheduled to receive radiotherapy (with or without chemotherapy), will be recruited over a five-month period. All participants will receive access to Prep-4-RT self-management resources. Participants identified through screening as high-risk will also be offered individualised interventions with relevant allied health professionals prior to the commencement of radiotherapy (psychologists, dietitians, speech pathologists and physiotherapists). Participants will complete evaluation surveys assessing their experiences with Prep-4-RT resources and interventions. Clinicians will also complete program evaluation surveys. Primary feasibility outcomes include adoption (uptake and intention to try) and fidelity (adherence to the specialist prehabilitation pathway). Secondary feasibility outcomes include acceptability (patient and clinician) of and satisfaction (patient) with Prep-4-RT as well as operational costs. Feasibility outcome data will be analysed using exact binomial and one-sample t tests, as appropriate. ETHICS AND DISSEMINATION Ethics approval has been obtained at the Peter MacCallum Cancer Centre in Melbourne, Australia. Results will be presented at national conferences and published in peer-reviewed journal(s) so that it can be accessed by clinicians involved in the care of HNC patients receiving radiotherapy. If the model of care is found to be feasible and acceptable, the transferability and scalability to other cancer centres, or for other cancer types, may be investigated. REGISTRATION DETAILS ANZCTA (Australian New Zealand Clinical Trials Registry) ACTRN12623000770662.
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Affiliation(s)
- H Ray
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - E Sexton
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Frowen
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - K Gough
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S Turnbull
- Consumer Register, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S Abo
- Physiotherapy & Occupational Therapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - M Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - J Loeliger
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
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Ubré M, Montané-Muntané M, Diéguez I, Martínez-Pallí G. 10 years of prehabilitation: From theory to clinical practice. Cir Esp 2024; 102:451-458. [PMID: 38718979 DOI: 10.1016/j.cireng.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/04/2024] [Indexed: 08/06/2024]
Abstract
In recent years, prehabilitation has generated high expectations as an innovative preoperative strategy to enhance clinical outcomes following surgery. Several studies have demonstrated that multimodal programs are effective in improving patients' health status and cardiopulmonary reserve, allowing them to undergo surgery in better conditions and, consequently, reducing the incidence of postoperative complications. Most publications describe proof-of-concept studies, and literature about their implementation is more limited. The implementation of these programs requires new resources and significant organizational effort. In this paper, we share our experience implementing a multimodal prehabilitation program as a mainstream service at a tertiary hospital. Although there are still many unknowns regarding the optimal selection of patients, as well as the duration and components of the program, this article describes our journey in this field, aiming to provide insight for teams interested in developing a similar project.
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Affiliation(s)
- Marta Ubré
- Department of Anesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Mar Montané-Muntané
- Department of Anesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Iago Diéguez
- Department of Anesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Graciela Martínez-Pallí
- Department of Anesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
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32
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Cooper L, Deal AM, Aman C, Page A, Muss H, Nyrop KA, Knowlton SE. Identifying pre-habilitation targets for the mitigation of long-term side effects of chemotherapy in patients with early breast cancer. Support Care Cancer 2024; 32:530. [PMID: 39028486 DOI: 10.1007/s00520-024-08739-1] [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: 04/17/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Pre-treatment characteristics of women with early breast cancer that are associated with persistent fatigue or suboptimal health-related quality of life (HRQOL) post-chemotherapy need to be identified as potential targets for pre-habilitation. PATIENTS AND METHODS Ancillary analysis of previously collected data from patients with newly diagnosed Stage I-III breast cancer scheduled to receive chemotherapy. The objective was to identify baseline (pre-chemotherapy) variables associated with meaningful deteriorations in fatigue and other measures of HRQOL from pre-treatment to 6 months after chemotherapy completion. Percentages are reported along with unadjusted and adjusted relative risks. RESULTS In a sample of 249 women post-chemotherapy, 32% reported worsening fatigue (FACIT-F), 35% worsening Physical Well-Being (PWB), 16% worsening Functional Well-Being (FWB), 8% worsening Emotional Well-Being (EWB), and 30% worsening Social Well-Being (SWB). In multivariable (MV) analysis, variables that were significant in univariate analysis - Black race, high BMI, and baseline poorer EWB - remained significant for worsening post-chemotherapy fatigue (FACIT-F). In MV analysis that included race, education, falls, and baseline EWB, Black race and a positive falls history remained significant for worsening PWB. In MV analysis inclusive of race, Short Physical Performance Battery (SPPB) and FWB, lower SPPB and FWB remained significant predictors of worsening FWB. In MV analysis that included baseline Mental Health Index-Anxiety, EWB and SWB, a higher SWB and lower EWB remained significant for worsening SWB. CONCLUSION Pre-chemotherapy characteristics in women with early-stage breast cancer that are associated with increased fatigue and reduced HRQOL post-treatment could be used to identify patients who may benefit from pre-habilitation interventions.
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Affiliation(s)
- Lyndsay Cooper
- School of Medicine, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Coral Aman
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Annie Page
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Hyman Muss
- School of Medicine, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Kirsten A Nyrop
- School of Medicine, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Sasha E Knowlton
- School of Medicine, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA.
- Department of Physical Medicine and Rehabilitation, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599, USA.
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García Sánchez F, Mudarra García N. Evaluation of postoperative results after a presurgical optimisation programme. Perioper Med (Lond) 2024; 13:73. [PMID: 39010120 PMCID: PMC11247769 DOI: 10.1186/s13741-024-00430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/24/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Presurgical optimisation programmes decrease the risk of postoperative complications, reduce hospital stays and speed up patient recovery. They usually involve a multidisciplinary team addressing physical, nutritional and psychosocial issues. The objective of this study was to assess the results of implementing a presurgical optimisation programme led by a liaison nurse in patients undergoing major surgery in a primary general hospital. METHODS An observational, retrospective, descriptive, cross-sectional, comparative study based on the revision of patients' health records undergoing major surgery between January 2019 and December 2022. Patients entering the presurgical optimisation programme (intervention group) were compared with patients receiving usual medical care (control group). The presurgical optimisation programme consisted of oral nutritional supplementation, physical exercise, strengthening of lung capacity and psychological and emotional support. Frequency (%) of surgery complications and use of healthcare resources (duration of hospitalisation, time spent in the intensive care unit (ICU), and readmission) at day 30 were recorded. Descriptive statistics were applied. RESULTS Two hundred eleven patients (58.5% men, mean age: 65.76 years (SD 11.5), 75.2%. non-smokers; mean body mass index (BMI): 28.32 (SD 5.38); mean Nutritional Risk Score (NRS) 3.71 (SD 1.35; oncology diagnosis: 88.6%) were included: 135 in the intervention group, and 76 in the control group. The average duration of the presurgical optimisation programme was 20 days (SD 5). Frequency of postoperative complications was 25% (n = 33) in the intervention group and 52.6% (n = 40) in the control group (p < 0.001) [odds ratio (OR) = 3.4; 95% confidence interval (CI) (1.8; 6.2)]. 14.5% (n = 19) of patients in the intervention group and 34.2% (n = 26) in the control group had remote postoperative complications [OR = 3.1; 95% CI (1.6; 6.2)]. Patients in the intervention group spent fewer days in the hospital [mean 8.34 (SD 6.70) vs 11.63 (SD 10.63)], and there were fewer readmissions at 30 days (7.6% vs 19.7%) compared with the control group. CONCLUSIONS A presurgical optimisation programme led by a liaison nurse decreases the rate of immediate and late surgical complications and reduces hospital stays and readmissions in patients undergoing major surgery.
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Affiliation(s)
- Francisco García Sánchez
- Surgical Prehabilitation Unit, Infanta Cristina University Hospital., Avenida 9 de Junio 2. Parla., Madrid, 28981, Spain.
- IDIPHISA. Medical Department. Faculty of Medicine, University Complutense of Madrid, Madrid, Spain.
| | - Natalia Mudarra García
- Surgical Prehabilitation Unit, Infanta Cristina University Hospital., Avenida 9 de Junio 2. Parla., Madrid, 28981, Spain
- IDIPHISA. Nurse Department. Faculty of Nurse. University Complutense of Madrid, Madrid, Spain
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Amirkhosravi F, Allenson KC, Moore LW, Kolman JM, Foster M, Hsu E, Sasangohar F, Dhala A. Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis. Sci Rep 2024; 14:16012. [PMID: 38992072 PMCID: PMC11239889 DOI: 10.1038/s41598-024-66633-6] [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: 06/21/2023] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran's Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (- 0.38 [- 0.75- - 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (- 0.96 [- 1.38- - 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (- 0.91 [- 1.67- - 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.
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Affiliation(s)
| | | | - Linda W Moore
- Department of Surgery, Houston Methodist, Houston, TX, USA
| | - Jacob M Kolman
- Office of Faculty and Research Development, Department of Academic Affairs, Houston Methodist, Houston, TX, USA
| | - Margaret Foster
- School of Medicine, Department of Medical Education, Texas A&M University, College Station, TX, USA
| | - Enshuo Hsu
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
- Center for Critical Care, Houston Methodist, Houston, TX, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist, Houston, TX, USA.
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Kovoor JG, Nann SD, Chambers C, Mishra K, Goel S, Thompson I, Koh D, Litwin P, Bacchi S, Harford PJ, Stretton B, Gupta AK. Prehabilitation before general surgery: Worth the effort? J Perioper Pract 2024; 34:219-225. [PMID: 38149496 DOI: 10.1177/17504589231214395] [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: 12/28/2023]
Abstract
Prehabilitation, or interventions before surgery aimed at improving preoperative health and postoperative outcomes, has various forms. Although it may confer benefit to patients undergoing general surgery, this is not certain. Furthermore, although it may yield a net monetary gain, it is also likely to require substantial monetary and non-monetary investment. The impact of prehabilitation is highly variable and dependent on multiple factors. Physical function and pulmonary outcomes are likely to be improved by most forms of prehabilitation involving physical and multimodal exercise programmes. However, other surgical outcomes have demonstrated mixed results from prehabilitation. Within this issue, the measures used for evaluating baseline patient biopsychosocial health are important, and collecting sufficient data to accurately inform patient-centred prehabilitation programmes is only possible through thorough clinical and laboratory investigation and synthesised metrics such as cardiopulmonary exercise testing. Although a multimodal approach to prehabilitation is the current gold standard, societal factors may affect engagement with programmes that require a significant in-person activity. However, this is weighed against the substantial financial and non-financial investment that accompanies many programmes. The overall effectiveness and optimal mode of intervention across the discipline of general surgery remains unclear, and further research is needed to prove prehabilitation's full worth.
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Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Silas D Nann
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Courtney Chambers
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kritika Mishra
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sahil Goel
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Isabella Thompson
- Gold Coast University Hospital, Gold Coast, QLD, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Dong Koh
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter Litwin
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Stephen Bacchi
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Philip J Harford
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Brandon Stretton
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Aashray K Gupta
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
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Shen Y, Cong Z, Ge Q, Huang H, Wei W, Wang C, Jiang Z, Wu Y. Effect of nutrition-based prehabilitation on the postoperative outcomes of patients with esophagogastric cancer undergoing surgery: A systematic review and meta-analysis. Cancer Med 2024; 13:e70023. [PMID: 39001679 PMCID: PMC11245637 DOI: 10.1002/cam4.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/17/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Meta-analyses have primarily focused on the effects of exercise-based prehabilitation on postoperative outcomes and ignored the role of nutritional intervention. In this study, we filled this gap by investigating the effect of nutrition-based prehabilitation on the postoperative outcomes of patients who underwent esophagectomy and gastrectomy. METHODS Five electronic databases, namely, PubMed, the Web of Science, Embase, Cochrane Library, and CINAHL, were searched. Adults diagnosed with esophagogastric cancer who were scheduled to undergo surgery and had undergone uni- or multimodal prehabilitation, with at least a week of mandatory nutritional intervention, were included. Forest plots were used to extract and visualize the data from the included studies. The occurrence of any postoperative complication was considered the primary endpoint. RESULTS Eight studies met the eligibility criteria, with five randomized controlled trials (RCTs) and three cohort studies. In total, 661 patients were included. Any prehabilitation, that is, unimodal (only nutrition) and multimodal prehabilitation, collectively decreased the risk of any postoperative complication by 23% (95% confidence interval [CI] = 0.66-0.90). A similar effect was exclusively observed for multimodal prehabilitation (risk ratio [RR] = 0.78, 95% CI = 0.66-0.93); however, it was not significant for unimodal prehabilitation. Any prehabilitation significantly decreased the length of hospital stay (LOS) (weighted mean difference = -0.77, 95% CI = -1.46 to -0.09). CONCLUSIONS Nutrition-based prehabilitation, particularly multimodal prehabilitation, confers protective effects against postoperative complications after esophagectomy and gastrectomy. Our findings suggest that prehabilitation slightly decreases LOS; however, the finding is not clinically significant. Therefore, additional rigorous RCTs are warranted for further substantiation.
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Affiliation(s)
- Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhuangzhuang Cong
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qiyue Ge
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hairong Huang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Wei Wei
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Changyong Wang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Zhisheng Jiang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Yuheng Wu
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
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Yu Y, Gong X, Wan W, Hu X, Xiong L, Gui S, Zeng L. Evaluation of the clinical effect of a multimodal pre-rehabilitation program guided by the behaviour change wheel in elderly women with breast cancer. Geriatr Nurs 2024; 58:44-51. [PMID: 38761587 DOI: 10.1016/j.gerinurse.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND This study aims to explore the nursing effect of a multimodal pre-rehabilitation programme guided by BCW theory on elderly women patients with breast cancer. METHODS The participants were divided into two groups. The study group was administered with the pre-rehabilitation model guided by BCW theory; the control group was administered with conventional methods. The rehabilitation effects of the two groups were compared.. RESULTS The scores of RISC, PTGI and FACT-B were higher in the study group(P < 0.05). The SUPPH score and ROM compliance rate were higher in the study group (P < 0.05) (96% vs 72%). The avoidance score and yield score were lower in the study group(P < 0.05). CONCLUSION A multimodal pre-rehabilitation program guided by BCW theory can significantly improve the quality of life and functional status of elderly women patients with breast cancer, and its popularisation and application are recommended.
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Affiliation(s)
- YanHua Yu
- Third Department of Breast, The Third Hospital of Nanchang City, Jiangxi Province, China
| | - XinZhi Gong
- Department of Orthopedics, The 908 Hospital of the People's Liberation Army Joint Service Support Force, China.
| | - Wei Wan
- Third Department of Breast, The Third Hospital of Nanchang City, Jiangxi Province, China
| | - XiaoLi Hu
- Third Department of Breast, The Third Hospital of Nanchang City, Jiangxi Province, China
| | - LiLi Xiong
- Third Department of Breast, The Third Hospital of Nanchang City, Jiangxi Province, China
| | - ShiMin Gui
- Third Department of Breast, The Third Hospital of Nanchang City, Jiangxi Province, China
| | - Lin Zeng
- Third Department of Breast, The Third Hospital of Nanchang City, Jiangxi Province, China
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Casanovas-Álvarez A, Sebio-Garcia R, Masià J, Mateo-Aguilar E. Experiences of Patients with Breast Cancer Participating in a Prehabilitation Program: A Qualitative Study. J Clin Med 2024; 13:3732. [PMID: 38999298 PMCID: PMC11242540 DOI: 10.3390/jcm13133732] [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: 05/27/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Breast cancer (BC) is the most prevalent cancer diagnosis among women worldwide. Several randomized controlled trials and systematic reviews have shown the benefits of exercise before, during, and after cancer treatment to manage side effects related to cancer and its therapies. However, these are poorly implemented across the disease-span, specifically, during the preoperative setting. Methods: Patients diagnosed with BC and participating in a randomized controlled trial on the effects of a prehabilitation program based on Nordic walking, muscle strengthening, and therapeutic education were invited to participate in this qualitative substudy. Two groups of eight patients each were recorded, transcript and analyzed using a specialized software (Atlas-Ti®, version 24). Results: During the axial codification phase, 22 unique codes and 6 main themes were identified related to their experience with the program, namely, (1) information received prior to participating; (2) motivation to participate; (3) barriers; (4) facilitators; (5) perceived degree of support from healthcare workers as well as peers; and (6) satisfaction with the characteristics of the prehabilitation program. Conclusions: Patients interviewed showed great interest in prehabilitation as a way to prepare both physically and mentally for surgery. In order to implement these interventions, healthcare systems need to acknowledge barriers and facilitators as well as the need for these programs to be supervised and monitored to avoid adverse events.
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Affiliation(s)
- Anabel Casanovas-Álvarez
- Department of Health Sciences TecnoCampus, Universitat Pompeu Fabra, 08302 Mataró, Spain; (A.C.-Á.); (E.M.-A.)
- Research Group in Chronic Care and Health Innovation (GRACIS) TecnoCampus, Universitat Pompeu Fabra, 08302 Mataró, Spain
- Physical Therapy Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
| | - Raquel Sebio-Garcia
- Department of Physical Medicine and Rehabilitation, Hospital Clinic de Barcelona, 08036 Barcelona, Spain
| | - Jaume Masià
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain;
| | - Ester Mateo-Aguilar
- Department of Health Sciences TecnoCampus, Universitat Pompeu Fabra, 08302 Mataró, Spain; (A.C.-Á.); (E.M.-A.)
- Research Group in Chronic Care and Health Innovation (GRACIS) TecnoCampus, Universitat Pompeu Fabra, 08302 Mataró, Spain
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Tustumi F, Pereira MA, Lisak AS, Ramos MFKP, Ribeiro Junior U, Dias AR. THE VALUE OF PREOPERATIVE PROGNOSTIC NUTRITIONAL INDEX IN GASTRIC CANCER AFTER CURATIVE RESECTION. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1805. [PMID: 38896701 PMCID: PMC11182628 DOI: 10.1590/0102-6720202400012e1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/23/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Predicting short- and long-term outcomes of oncological therapies is crucial for developing effective treatment strategies. Malnutrition and the host immune status significantly affect outcomes in major surgeries. AIMS To assess the value of preoperative prognostic nutritional index (PNI) in predicting outcomes in gastric cancer patients. METHODS A retrospective cohort analysis was conducted on patients undergoing curative-intent surgery for gastric adenocarcinoma between 2009 and 2020. PNI was calculated as follows: PNI=(10 x albumin [g/dL])+(0.005 x lymphocytes [nº/mm3]). The optimal cutoff value was determined by the receiver operating characteristic curve (PNI cutoff=52), and patients were grouped into low and high PNI. RESULTS Of the 529 patients included, 315 (59.5%) were classified as a low-PNI group (PNI<52) and 214 (40.5%) as a high-PNI group (PNI≥52). Older age (p=0.050), male sex (p=0.003), American Society of Anesthesiologists score (ASA) III/IV (p=0.001), lower hemoglobin level (p<0.001), lower body mass index (p=0.001), higher neutrophil-lymphocyte ratio (p<0.001), D1 lymphadenectomy, advanced pT stage, pN+ and more advanced pTNM stage were related to low-PNI patient. Furthermore, 30-day (1.4 vs. 4.8%; p=0.036) and 90-day (3.3 vs. 10.5%; p=0.002) mortality rates were higher in low-PNI compared to high-PNI group. Disease-free and overall survival were worse in low-PNI patients compared to high-PNI (p<0.001 for both). ASA III/IV score, low-PNI, pT3/T4, and pN+ were independent risk factors for worse survival. CONCLUSIONS Preoperative PNI can predict short- and long-term outcomes of patients with gastric cancer after curative gastrectomy. Low PNI is an independent factor related to worse disease-free and overall survival.
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Affiliation(s)
- Francisco Tustumi
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Marina Alessandra Pereira
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - André Safatle Lisak
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Marcus Fernando Kodama Pertille Ramos
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ulysses Ribeiro Junior
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - André Roncon Dias
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
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Fish R, Blackwell S, Knight SR, Daniels S, West MA, Pearson I, Moug SJ. Defining standards and core outcomes for clinical trials in prehabilitation for colorectal surgery (DiSCO): modified Delphi methodology to achieve patient and healthcare professional consensus. Br J Surg 2024; 111:znae056. [PMID: 38888991 PMCID: PMC11185089 DOI: 10.1093/bjs/znae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/26/2023] [Accepted: 02/06/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Rebecca Fish
- Department of Surgery, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | | | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Daniels
- Department of Surgery, Sheffield Teaching Hospitals NHS Foundation, University of Sheffield, Sheffield, UK
| | - Malcolm A West
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Iona Pearson
- The University of Edinburgh, Undergraduate Medical School, Edinburgh, UK
| | - Susan J Moug
- Departments of Surgery, Royal Alexandra Hospital, Paisley and Golden Jubilee National Hospital, Clydebank, and University of Glasgow, UK
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Wee IJY, Seow-En I, Chok AY, Sim E, Koo CH, Lin W, Meihuan C, Tan EKW. Postoperative outcomes after prehabilitation for colorectal cancer patients undergoing surgery: a systematic review and meta-analysis of randomized and nonrandomized studies. Ann Coloproctol 2024; 40:191-199. [PMID: 38752322 PMCID: PMC11362756 DOI: 10.3393/ac.2022.01095.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 07/02/2024] Open
Abstract
PURPOSE Prehabilitation (PH) is purported to improve patients' preoperative functional status. This systematic review and meta-analysis sought to compare short-term postoperative outcomes between patients who underwent a protocolized PH program and the existing standard of care among colorectal cancer patients awaiting surgery. METHODS A search in MEDLINE/PubMed, the Cochrane Library, Embase, Scopus, and CINAHL was conducted to identify relevant articles. Repetitive and exhaustive combinations of MeSH search terms ("prehabilitation," "colorectal cancer," "colon cancer," and "rectal cancer") were used to identify randomized and nonrandomized studies comparing PH versus standard of care for colorectal cancer patients awaiting surgery. The primary outcomes included postoperative morbidity, length of hospital stay, and readmission rates. RESULTS Seven studies including 1,042 colorectal cancer patients (PH, 382) were included. No significant differences were found in intraoperative outcomes. The postoperative complication rates were comparable between groups (Clavien-Dindo grades I and II: risk ratio, 0.82; 95% confidence interval, 0.62-1.07; P=0.15; Clavien-Dindo grades ≥III: risk ratio, 1.02; 95% confidence interval, 0.72-1.44; P=0.92). There were also no significant differences in length of hospital stay (P=0.21) or the risk of 30-day readmission (P=0.68). CONCLUSION Although PH does not appear to improve short-term postoperative outcomes following colorectal cancer surgery, the quality of evidence is impaired by the limited trials and heterogeneity. Thus, further large-scale trials are warranted to draw definitive conclusions and establish the long-term effects of PH.
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Affiliation(s)
- Ian Jun Yan Wee
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Eileen Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | - Chee Hoe Koo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Wenjie Lin
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Chang Meihuan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Jack S, Andritsch E, Joaquim A, Kreissl M, Locati L, Netea-Maier R, Reverter J, Elisei R. Current landscape and support for practical initiation of oncological prehabilitation translatable to thyroid cancer: A position paper. Heliyon 2024; 10:e30723. [PMID: 38813200 PMCID: PMC11133508 DOI: 10.1016/j.heliyon.2024.e30723] [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: 06/12/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Despite a growing body of evidence for the effectiveness of prehabilitation, the uptake of prehabilitation in Europe remains low. Contributing factors range from limited awareness and understanding of prehabilitation to a lack of supporting infrastructure and reimbursement challenges. In this position paper, the authors propose a new comprehensive definition of prehabilitation and identify differentiated thyroid cancer as a type of cancer particularly well-suited for prehabilitation. To support clinicians with the implementation of prehabilitation programs in their clinics, the authors discuss the following practical solutions: a) find the most appropriate prehabilitation program for each patient; b) raise awareness among peers; c) develop evidence to demonstrate the effectiveness of prehabilitation; d) expand the interdisciplinary team; e) expand your network and make use of existing assets; f) utilize learnings from the COVID-19 pandemic.
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Affiliation(s)
- S. Jack
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - E. Andritsch
- Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036, Graz, Austria
| | - A. Joaquim
- ONCOMOVE®, Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
| | - M.C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Universitatsplätz 2, 39106, Magdeburg, Germany
| | - L. Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, S. da Nuova, 65, 27100, Pavia, PV, Italy
- Medical Oncology Unit, IRCCS ICS, Maugeri, Via Salvatore Maugeri, 10, 27100 Pavia PV, Italy
| | - R.T. Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 28, 6525, GA, Nijmegen, the Netherlands
| | - J.L. Reverter
- Endocrinology and Nutrition Department, Germans Trias i Pujol University Hospital, Universidad Autónoma de Barcelona, Placa Civica, 08193, Bellaterra, Barcelona, Spain
| | - R. Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126, Pisa, PI, Italy
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Dal Bello S, Mancin S, Morales Palomares S, Lopane D, Di Gianfrancesco L, Soligo C, Tarantino T, Perdonò P, Hurle R, Bernardini B, Piccioni F, Pastore M, Pellegrinelli A, Porreca A, Mazzoleni B. Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review. Nutrients 2024; 16:1682. [PMID: 38892615 PMCID: PMC11174884 DOI: 10.3390/nu16111682] [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: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND/AIM Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy. METHODS A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence. RESULTS Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73-0.93; p = 0.0029) and decrease postoperative complications (-36.7%; p = 0.008) and readmission rates (-15.38%; p = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (-1 day; p < 0.01), a reduction in the length of hospital stay (-1.75 days; p = 0.01), an improvement in handgrip strength (+6.8%, p < 0.001), an increase in bone mass (+0.3 kg, p = 0.04), and a better BMI value (+2.3%, p = 0.001). CONCLUSIONS Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results.
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Affiliation(s)
- Susy Dal Bello
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | | | - Sara Morales Palomares
- Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, 87036 Rende, Italy
| | - Diego Lopane
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Luca Di Gianfrancesco
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Chiara Soligo
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Tommaso Tarantino
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Paolo Perdonò
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | | | | | | | | | - Angelo Porreca
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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Vu J, Koh C, Solomon M, Brown K, Karunaratne S, Cole R, Smith P, Raichurkar P, Denehy L, Riedel B, Steffens D. Patients' and carers' views on research priorities in prehabilitation for cancer surgery. Support Care Cancer 2024; 32:378. [PMID: 38787478 PMCID: PMC11126464 DOI: 10.1007/s00520-024-08585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The views of patients and carers are important for the development of research priorities. This study aimed to determine and compare the top research priorities of cancer patients and carers with those of multidisciplinary clinicians with expertise in prehabilitation. MATERIALS AND METHODS This cross-sectional study surveyed patients recovering from cancer surgery at a major tertiary hospital in Sydney, Australia, and/or their carers between March and July 2023. Consenting patients and carers were provided a list of research priorities according to clinicians with expertise in prehabilitation, as determined in a recent International Delphi study. Participants were asked to rate the importance of each research priority using a 5-item Likert scale (ranging from 1 = very high research priority to 5 = very low research priority). RESULTS A total of 101 patients and 50 carers participated in this study. Four areas were identified as research priorities, achieving consensus of highest importance (> 70% rated as "high" or "very high" priority) by patients, carers, and clinical experts. These were "optimal composition of prehabilitation programs" (77% vs. 82% vs. 88%), "effect of prehabilitation on surgical outcomes" (85% vs. 90% vs. 95%), "effect of prehabilitation on functional outcomes" (83% vs. 86% vs. 79%), and "effect of prehabilitation on patient reported outcomes" (78% vs. 84% vs. 79%). Priorities that did not reach consensus of high importance by patients despite reaching consensus of highest importance by experts included "identifying populations most likely to benefit from prehabilitation" (70% vs. 76% vs. 90%) and "defining prehabilitation core outcome measures" (66% vs. 74% vs. 87%). "Prehabilitation during neoadjuvant therapies" reached consensus of high importance by patients but not by experts or carers (81% vs. 68% vs. 69%). CONCLUSION This study delineated the primary prehabilitation research priorities as determined by patients and carers, against those previously identified by clinicians with expertise in prehabilitation. It is recommended that subsequent high-quality research and resource allocation be directed towards these highlighted areas of importance.
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Affiliation(s)
- Jennifer Vu
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Kilian Brown
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Ruby Cole
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
| | - Phillippa Smith
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Pratik Raichurkar
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Bernhard Riedel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.
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Marchegiani F, Pham J, Roberge M, Beaucaire F, Alberto Schena C, Lacaze L, de Angelis N. [Prehabilitation and enhanced recovery after surgery: a continuum for the benefit of the patient]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2024; 69:22-25. [PMID: 38614514 DOI: 10.1016/j.soin.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Improved recovery after surgery leads to a significant reduction in postoperative morbidity, but this is concentrated in the intra- and postoperative periods. Prehabilitation complements this, by taking charge of the pre-operative phase. Its aim is to improve pre-operative functional capacity and physical, nutritional and psychosocial status. Interdisciplinary collaboration is a key element of this integrated approach.
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Affiliation(s)
- Francesco Marchegiani
- Hôpital Beaujon, AP-HP, 100 boulevard du Général-Leclerc, 92110 Clichy, Paris, France.
| | - Julie Pham
- Hôpital Beaujon, AP-HP, 100 boulevard du Général-Leclerc, 92110 Clichy, Paris, France
| | - Magali Roberge
- Hôpital Beaujon, AP-HP, 100 boulevard du Général-Leclerc, 92110 Clichy, Paris, France
| | - Françoise Beaucaire
- Hôpital Beaujon, AP-HP, 100 boulevard du Général-Leclerc, 92110 Clichy, Paris, France
| | - Carlo Alberto Schena
- Hôpital Beaujon, AP-HP, 100 boulevard du Général-Leclerc, 92110 Clichy, Paris, France
| | - Laurence Lacaze
- Hôpital Beaujon, AP-HP, 100 boulevard du Général-Leclerc, 92110 Clichy, Paris, France
| | - Nicola de Angelis
- Hôpital Beaujon, AP-HP, 100 boulevard du Général-Leclerc, 92110 Clichy, Paris, France
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Jiang W, Brown KGM, Koh C, Karunaratne S, Solomon M, Beckenkamp PR, Cole R, Steffens D. Outcome Heterogeneity in Prehabilitation Trials-Are We Comparing Apples and Oranges? J Surg Res 2024; 296:366-375. [PMID: 38306943 DOI: 10.1016/j.jss.2023.12.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/11/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Over the last decade, the number of prehabilitation randomised controlled trials (RCTs) has increased significantly. Therefore, this review aimed to describe the outcomes reported in prehabilitation RCTs in patients undergoing cancer surgery. METHODS A search was conducted in Embase, Allied and Complementary Medicine Database, The Cochrane Library, PsycINFO, MEDLINE, and Cumulated Index to Nursing and Allied Health Literature from inception to July 2021. We included RCTs evaluating the effectiveness of preoperative exercise, nutrition, and psychological interventions on postoperative complications and length of hospital stay in adult oncology patients who underwent thoracic and gastrointestinal cancer surgery. The verbatim outcomes reported in each article were extracted, and each outcome was assessed to determine whether it was defined and measured using a validated tool. Verbatim outcomes were grouped into standardized outcomes and categorized into domains. The quality of outcome reporting in each identified article was assessed using the Harman tool (score range 0-6, where 0 indicated the poorest quality). RESULTS A total of 74 RCTs were included, from which 601 verbatim outcomes were extracted. Only 110 (18.3%) of the verbatim outcomes were defined and 270 (44.9%) were labeled as either "primary" or "secondary" outcomes. Verbatim outcomes were categorized into 119 standardized outcomes and assigned into one of five domains (patient-reported outcomes, surgical outcomes, physical/functional outcomes, disease activity, and intervention delivery). Surgical outcomes were the most common outcomes reported (n = 71 trials, 95.9%). The overall quality of the reported outcomes was poor across trials (median score: 2.0 [IQR = 0.00-3.75]). CONCLUSIONS Prehabilitation RCTs display considerable heterogeneity in outcome reporting, and low outcome reporting quality. The development of standardized core outcome sets may help improve article quality and enhance the clinical utility of prehabilitation following cancer surgery.
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Affiliation(s)
- Wilson Jiang
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia
| | - Kilian G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
| | - Ruby Cole
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia.
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Harris E, Marignol L. Prehabilitation for Patients with Cancer Undergoing Radiation Therapy: a Scoping Review. Clin Oncol (R Coll Radiol) 2024; 36:254-264. [PMID: 38350785 DOI: 10.1016/j.clon.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
AIMS Prehabilitation is a process of identifying and assessing factors that could compromise the physical and psychological health of patients undergoing cancer treatment and implementing an intervention to combat such concerns. The use of prehabilitation in cancer surgery has yielded positive outcomes in rectal, lung and abdominal cancers. Prehabilitation strategies have potential to improve the management of patients receiving radiation therapy or chemoradiation. The aim of the present study was to map the evidence of the assessment and evaluation of prehabilitation for radiation therapy patients. MATERIALS AND METHODS A database search using EMBASE and PubMed was conducted. The PRISMA guidelines were adhered to. Keywords included prehabilitation, radiation therapy/radiotherapy, chemoradiotherapy/chemoradiation, intervention and exercise. Types of prehabilitation strategy, their purposes and impact, according to cancer site, were analysed. RESULTS Prehabilitation is most commonly evaluated in head and neck cancer, whereby unimodal, physical interventions manage dysphagia. Prehabilitation for lung cancer demonstrated its ability to widen treatment options for patients. Physical prehabilitation is administered to combat adverse effects of neoadjuvant chemoradiation therapy in patients with rectal cancer. CONCLUSION Prehabilitation is adaptive and tailored to specific patient and site needs; thus it is applied across a wide range of cancer sites. More interventions by which radiation therapy is the definitive treatment modality and larger sample sizes within these studies are warranted to increase prehabilitation utilisation for patients undergoing radiation therapy.
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Affiliation(s)
- E Harris
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - L Marignol
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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Ciumărnean L, Bancoș MD, Orășan OH, Milaciu MV, Alexescu T, Vlad CV, Para I, Hirișcău EI, Dogaru G. Age-related trends in colorectal cancer diagnosis: focus on
evaluation of prehabilitation and rehabilitation programs. BALNEO AND PRM RESEARCH JOURNAL 2024; 15:661-661. [DOI: 10.12680/balneo.2024.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
Abstract
Abstract: The increase in the prevalence of both colon and rectal cancer in recent years poses challenges for the medical system in terms of patient management and indirectly incurs significant financial burdens. Purpose: The aim of this paper is to track the changes in the prevalance of the colon and rectal cancer at a tertiary clinic in Romania over time and to identify complementary methods to improve the prognosis and quality of life of cancer patients. Material and methods: We conducted an observational, longitudinal, population-based study, including all patients newly diagnosed with colon or rectal neoplasia within the time frame from 1 January 2013 to 1 January 2024 in a tertiary medical clinic in Romania. For each case included in the study, we gathered demographic data (age at the time of cancer diagnosis, gender, place of origin), location of the tumor, duration until surgical intervention, alternative treatment methods employed (such as ra-diation or chemotherapy, and immunotherapy), and the length of survival. We also assess the feasiblity of physical prehabilitation and rehabilitation programs for inpatients diagnosed with malignant neoplasms of the colon or rectum. Results: The study found significant differences in patient ages and the execution of prehabilitation and rehabilitation practices between those ad-mitted for colon and rectal cancer during the periods 2013-2018 and 2019-2023, with a notable shift in the prevalence of colon versus rectal cancer over these periods. Conclusions: Prehabilitation and rehabilitation practices for colorectal cancer patients are underdocumented or suboptimal, with recent improvements in documentation, especially for rectal cancer due to colostomy needs, and an observed increase in patient age due to COVID-19 pandemic protocols. Additional research and the development of standardized protocols are needed.
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Affiliation(s)
- Lorena Ciumărnean
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca
| | | | - Olga-Hilda Orășan
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca
| | - Mircea Vasile Milaciu
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca
| | - Teodora Alexescu
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca
| | - Călin-Vasile Vlad
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca
| | - Ioana Para
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca
| | - Elisabeta Ioana Hirișcău
- Department of Nursing, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca
| | - Gabriela Dogaru
- Department of Medical Rehabilitation, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca
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Kassymova G, Sydsjö G, Borendal Wodlin N, Nilsson L, Kjølhede P. The Impact of Symptoms of Depression, Anxiety, and Low Stress-Coping Capacity on the Effects of Telephone Follow-Up on Recovery Measures After Hysterectomy. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:304-318. [PMID: 38558946 PMCID: PMC10979684 DOI: 10.1089/whr.2023.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 04/04/2024]
Abstract
Background To investigate if symptoms of depression, anxiety, and stress-coping capacity have an impact on the effect of telephone follow-up (TFU) on trajectories of six recovery measures after hysterectomy and influence the occurrence of unplanned telephone contacts (uTCs) and unplanned visits (uVs) to health care providers. Material and Methods A post hoc nonrandomized analysis of participants enrolled in a randomized, four-armed, single-blinded, controlled multicenter intervention study comprising 487 women where the women were allocated 1:1:1:1 to one of four TFU models. The Swedish Postoperative Symptom Questionnaire (SPSQ) and two health-related quality of life questionnaires, the EuroQoL-5 dimension with three levels (EQ-5 D-3 L) and the Short-Form-Health Survey (SF-36) assessed the recovery measures. The six recovery measures consisted of the EQ-5D-3L health index, the SF-36 physical component summary (PCS) and mental component summary (MCS), and the maximum and average pain intensity, and symptom sum score obtained from the SPSQ. Psychological distress was evaluated by the psychometric forms, the Hospital Anxiety and Depression Scale and the Stress Coping Inventory. The occurrence of uTC and uV within the 6 weeks of follow-up was registered. Results Preoperative anxiety, depression, and stress-coping capacity did not modify the effects of the TFU models on the trajectories of the recovery measures, although anxiety and depression were strongly associated with all six recovery measures. uTCs, but not uVs occurred more often in the women with anxiety. Conclusions Preoperative anxiety, depression, and stress-coping capacity did not appear to influence the effects of TFU contacts on the recovery measures after hysterectomy. Preoperative anxiety seemed to increase the occurrence of uTC. Clinical Trials Registration: ClinicalTrials.gov (NCT01526668).
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Affiliation(s)
- Gulnara Kassymova
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
| | - Ninnie Borendal Wodlin
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
- Department of Anesthesiology and Intensive Care, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
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50
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Lopez-Lopez V, Gongora E, Miura K, Kuemmerli C, Hernández-Kakauridze S, Eshmuminov D, Birrer D, García-Zafra V, López-Conesa A, Brusadin R, Navarro Á, Monteagudo M, Robles-Campos R. Multimodal prehabilitation program in patients with resectable perihilar cholangiocarcinoma: keypoints for an implementation protocol and literature review. Langenbecks Arch Surg 2024; 409:61. [PMID: 38353791 DOI: 10.1007/s00423-024-03251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Postoperative complications after perihilar cholangiocarcinoma surgical procedure are still very high. The implementation of a multimodal prehabilitation program could improve these outcomes. Based on our experience and that of the literature in hepatobiliary and pancreatic surgery, we propose a protocol to promote its implementation. METHODS First, we performed a retrospective analysis of the implementation feasibility of a multimodal prehabilitation program in patients' candidates for elective perihilar cholangiocarcinoma surgery in our center. Second, we conducted a literature search of publications in PubMed until December 2022. Relevant data about hepato-pancreato-biliary surgery and prehabilitation programs in features and postoperative outcomes was analyzed. RESULTS Since October 2020, 11 patients were evaluated for prehabilitation in our hospital. Two of them could not be resected intraoperatively due to disease extension. The median hospital stay was 10 days (iqr, 7-11). There were no major complications and 1 patient died. Of a total of 17 articles related to prehabilitation in hepato-biliary-pancreatic surgery, no reports focusing exclusively on perihilar cholangiocarcinoma were found. Six of the studies had nutritional therapies in addition to physical interventions, and 12 studies used home-based exercise therapy. CONCLUSIONS Based on our experience and the data obtained from other studies, a prehabilitation program could be useful to improve perioperative physical and mental fitness in patients' candidates for elective perihilar cholangiocarcinoma surgery. However, more well-designed studies are needed to allow us to obtain more evidence.
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Affiliation(s)
- Victor Lopez-Lopez
- Department of General and Digestive Surgery, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Ctra. Madrid-Cartagena, S/N, 30120, El Palmar, Murcia, Spain.
- Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.
| | - Ester Gongora
- Department of Rehabilitation, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain.
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Christoph Kuemmerli
- Department of Surgery, Clarunis - University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | | | - Dilmurodjon Eshmuminov
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Birrer
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria García-Zafra
- Department of Endocrinology, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Asuncion López-Conesa
- Department of General and Digestive Surgery, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Ctra. Madrid-Cartagena, S/N, 30120, El Palmar, Murcia, Spain
- Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Roberto Brusadin
- Department of General and Digestive Surgery, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Ctra. Madrid-Cartagena, S/N, 30120, El Palmar, Murcia, Spain
- Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Álvaro Navarro
- Department of General and Digestive Surgery, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Ctra. Madrid-Cartagena, S/N, 30120, El Palmar, Murcia, Spain
- Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Maria Monteagudo
- Department of Rehabilitation, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General and Digestive Surgery, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Ctra. Madrid-Cartagena, S/N, 30120, El Palmar, Murcia, Spain
- Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
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