Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial

Bousquet-Dion, Guillaume; Awasthi, Rashami; Loiselle, Sarah-Ève; Minnella, Enrico Maria; Agnihotram, Ramanakumar V.; Bergdahl, Andreas; Carli, Francesco; Scheede‐Bergdahl, Celena

doi:10.1080/0284186x.2017.1423180

Cited by 129 publications

(255 citation statements)

References 34 publications

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“…Two studies scored 6 out of 7 on the Cochrane Collaboration tool (Appendix S4), implying a low risk of bias. Three studies scored in the moderate range with one scoring 4 out of 7 and two scoring 3 out of 7 on the assessment.…”

Section: Resultsmentioning

confidence: 99%

“…The six studies were published between 2009 and 2019; three were randomized control trials and three were prospective cohort studies (Table ). This review included 415 patients – 218 interventions and 197 controls.…”

Section: Resultsmentioning

confidence: 99%

“…Table summarizes the baseline patient characteristics. Colorectal cancer comprised 95.9% (286 of 298) of the indications for surgery in the five studies where indication was recorded. Other indications included diverticulitis and inflammatory bowel disease.…”

Section: Resultsmentioning

confidence: 99%

“…In the five studies that recorded patient gender, 185 of 298 patients were male (62.1%). These studies recorded body mass index measurements ranging from 26.6 to 27.5 in the intervention group and 25.3–28.5 in the control group.…”

Section: Resultsmentioning

confidence: 99%

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Effect of exercise prehabilitation on functional status of patients undergoing bowel resection: a systematic review

Teo

Turner

Self

2020

ANZ Journal of Surgery

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Background: Bowel resections have high morbidity and mortality rates and are becoming increasingly common in Australia. To reduce the burden on patients and the health system, measures for improving patient outcomes after resection must be investigated. One possible method for improving patient outcomes is prehabilitation with exercise. The aim of this systematic review is to determine the effect that exercise prehabilitation has on the functional status of patients undergoing colorectal resection. Method: Studies examining the effect of exercise prehabilitation on colorectal patients were gathered from online databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and the Australia New Zealand clinical trial registry. The study design, population, intervention and outcomes were extracted from each study. Results: This systematic review included six studies involving a total of 415 patients. Three studies were randomized control trials and three were prospective cohort studies. Those that tested participants post-operatively found that the intervention group improved their 6-min walking distance more than the control group. This result was statistically significant in three studies. Similarly, two studies found that self-reported physical activity was significantly greater in the intervention group than in control groups. The rate of complications and length of hospital stay were not significantly different between intervention and control groups in any study. Conclusion: Prehabilitation significantly improves functional capacity and self-reported physical activity but its effect on complication rate was not significant in this review.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 693-701ANZJSurg.com

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effect of exercise prehabilitation on functional status of patients undergoing bowel resection: a systematic review

Teo

Turner

Self

2020

ANZ Journal of Surgery

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“…will receive preoperative chemotherapy for adenocarcinoma) (24). All of these patients will be invited to participate, and it is hoped that enrolment will reach approximately 85-95% as already demonstrated by other prehabilitation studies, which employed home-based interventions (25)(26)(27). In this respect, a sample size of 40 also realistically represents the number of patients that might be expected to be recruited in a year.…”

Section: Study Outcomesmentioning

confidence: 97%

A pilot, feasibility and acceptability study to investigate the utility of a home-based exercise intervention during and after neo-adjuvant chemotherapy for oesophago-gastric cancer—the ChemoFit study protocol

Chmelo¹,

Phillips²,

Greystoke³

et al. 2020

Preprint

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BackgroundTreatment of locally advanced oesophago-gastric adenocarcinoma usually entails neo-adjuvant chemotherapy (NAC), and surgery. Surgery is associated with high morbidity and mortality.Cardiopulmonary reserve of patients having major surgery is related to postoperative outcomes.Complications are associated with poorer quality of life and may affect prognosis. Preventing complications may be beneficial to both of these and have cost implications. Prehabilitation may improve recovery from surgery by increasing a patients' fitness before surgery. Designing a potentially cost and resource effective regimen which improves cardiopulmonary reserve may have a beneficial impact on patient outcomes after surgery. MethodsThe ChemoFit study is a non-randomised, single-arm and single-centre pilot study designed to investigate the feasibility of a home-based prehabilitation exercise intervention for patients receiving neoadjuvant treatment prior to oesophago-gastric surgery. Forty patients will be recruited at a single high-volume centre. The simple, home-based exercise intervention involves patients increasing their daily step-count during and after NAC and in the weeks leading up to surgical resection of the cancer.Additionally, quality of life assessments (QLQ-C30 and QLQ-OG25), oncological treatment delivery and participant perceptions of the study assessed by focus groups and questionnaires will be performed.The primary outcomes are to assess feasibility of the exercise intervention. The secondary outcomes will evaluate changes in cardiopulmonary reserve, sarcopenia and fat composition. DiscussionIt is anticipated that during an important teachable moment, the diagnosis and treatment of cancer, our patients will be open to the possibility of improving their fitness during chemotherapy and before major cancer surgery. It is possible that the negative impact of NAC on cardiopulmonary fitness could be prevented by implementing a home-based prehabilitation programme during and after NAC, prior to surgery for oesophago-gastric adenocarcinoma. Trial registration

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Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer

et al. 2020

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IMPORTANCE Research supports use of prehabilitation to optimize physical status before and after colorectal cancer resection, but its effect on postoperative complications remains unclear. Frail patients are a target for prehabilitation interventions owing to increased risk for poor postoperative outcomes.OBJECTIVE To assess the extent to which a prehabilitation program affects 30-day postoperative complications in frail patients undergoing colorectal cancer resection compared with postoperative rehabilitation. DESIGN, SETTING, AND PARTICIPANTSThis single-blind, parallel-arm, superiority randomized clinical trial recruited patients undergoing colorectal cancer resection from September 7, 2015, through June 19, 2019. Patients were followed up for 4 weeks before surgery and 4 weeks after surgery at 2 university-affiliated tertiary hospitals. A total of 418 patients 65 years or older were assessed for eligibility. Of these, 298 patients were excluded (not frail [n = 290], unable to exercise [n = 3], and planned neoadjuvant treatment [n = 5]), and 120 frail patients (Fried Frailty Index,Ն2) were randomized. Ten patients were excluded after randomization because they refused surgery (n = 3), died before surgery (n = 3), had no cancer (n = 1), had surgery without bowel resection (n = 1), or were switched to palliative care (n = 2). Hence, 110 patients were included in the intention-to-treat analysis (55 in the prehabilitation [Prehab] and 55 in the rehabilitation [Rehab] groups). Data were analyzed from July 25 through August 21, 2019. INTERVENTIONS Multimodal program involving exercise, nutritional, and psychological interventions initiated before (Prehab group) or after (Rehab group) surgery. All patients were treated within a standardized enhanced recovery pathway. MAIN OUTCOMES AND MEASURESThe primary outcome included the Comprehensive Complications Index measured at 30 days after surgery. Secondary outcomes were 30-day overall and severe complications, primary and total length of hospital stay, 30-day emergency department visits and hospital readmissions, recovery of walking capacity, and patient-reported outcome measures. RESULTSOf 110 patients randomized, mean (SD) age was 78 (7) years; 52 (47.3%) were men and 58 (52.7%) were women; 31 (28.2%) had rectal cancer; and 87 (79.1%) underwent minimally invasive surgery. There was no between-group difference in the primary outcome measure, 30-day Comprehensive Complications Index (adjusted mean difference, -3.2; 95% CI, -11.8 to 5.3; P = .45). Secondary outcome measures were also not different between groups. CONCLUSIONS AND RELEVANCEIn frail patients undergoing colorectal cancer resection (predominantly minimally invasive) within an enhanced recovery pathway, a multimodal prehabilitation program did not affect postoperative outcomes. Alternative strategies should be considered to optimize treatment of frail patients preoperatively.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02502760

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Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial

Cited by 129 publications

References 34 publications

Effect of exercise prehabilitation on functional status of patients undergoing bowel resection: a systematic review

Effect of exercise prehabilitation on functional status of patients undergoing bowel resection: a systematic review

A pilot, feasibility and acceptability study to investigate the utility of a home-based exercise intervention during and after neo-adjuvant chemotherapy for oesophago-gastric cancer—the ChemoFit study protocol

Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer

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