Evidence base for exercise prehabilitation suggests favourable outcomes for patients undergoing surgery for non-small cell lung cancer despite being of low therapeutic quality: a systematic review and meta-analysis

Voorn, M.J.J.; Franssen, Ruud F. W.; Hoogeboom, Thomas J.; Boogaart, Vivian E M van Kampen-van den; Bootsma, Gerben; Bongers, Bart C.; Janssen‐Heijnen, M.L.G.

doi:10.1016/j.ejso.2023.01.024

Cited by 18 publications

(17 citation statements)

References 46 publications

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“…More recently, it has been observed that, in lung cancer, pre-habilitation may offer advantages in the management of perioperative complications and length of post-operative hospital stay. 37 However, there is currently no evidence available to support the individualization of exercise as precision medicine to tailor training to new treatments and cancer types.…”

Section: Referral To Corementioning

confidence: 99%

Cardio-oncology rehabilitation: are we ready?

Bisceglia,

Venturini,

Canale

et al. 2024

European Heart Journal Supplements

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Cardio-oncology rehabilitation (CORE) is not only an essential component of cancer rehabilitation but also a pillar of preventive cardio-oncology. Cardio-oncology rehabilitation is a comprehensive model based on a multitargeted approach and its efficacy has been widely documented; when compared with an ‘exercise only’ programme, comprehensive CORE demonstrates a better outcome. It involves nutritional counselling, psychological support, and cardiovascular (CV) risk assessment, and it is directed to a very demanding population with a heavy burden of CV diseases driven by physical inactivity, cancer therapy-induced metabolic derangements, and cancer therapy-related CV toxicities. Despite its usefulness, CORE is still underused in cancer patients and we are still at the dawning of remote models of rehabilitation (tele-rehabilitation). Not all CORE is created equally: a careful screening procedure to identify patients who will benefit the most from CORE and a multidisciplinary customized approach are mandatory to achieve a better outcome for cancer survivors throughout their cancer journey. The aim of this paper is to provide an updated review of CORE not only for cardiologists dealing with this peculiar population of patients but also for oncologists, primary care providers, patients, and caregivers. This multidisciplinary team should help cancer patients to maintain a healthy and active life before, during, and after cancer treatment, in order to improve quality of life and to fight health inequities.

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Section: Referral To Corementioning

confidence: 99%

Cardio-oncology rehabilitation: are we ready?

Bisceglia,

Venturini,

Canale

et al. 2024

European Heart Journal Supplements

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“…The rehabilitation of cancer patients through exercise has been a focus since the 1980s, 2 and it has been found that exercise can help patients tolerate higher doses of chemotherapy 3 . In recent years, multiple studies have confirmed that exercise can bring benefits to the quality of life and survival of cancer patients and is safe 4,5 . The American Cancer Society released the third edition of the Nutrition and Physical Activity Guidelines for Cancer Survivors, recommending 150–300 min of moderate‐intensity activity or 75–150 min of vigorous activity per week, and ≥2 days of muscle‐strengthening activities per week during and after treatment 6 .…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy evaluation of personalized exercise prescription during chemotherapy for lung cancer patients

Li,

Guo,

Cao

et al. 2024

Thoracic Cancer

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BackgroundTo explore the safety and effectiveness of personalized exercise intervention during chemotherapy for lung cancer patients who were relatively weak and with compromised cardiopulmonary function.MethodsThirty‐eight lung cancer patients treated with chemotherapy at Peking University Third Hospital were enrolled in this prospective study. The exercise group (N = 21) received individualized exercise guidance based on personal test results and exercised regularly, while the control group (N = 17) only received exercise education and planed exercise methods according to their own preferences. Both groups underwent three fitness tests and clinical indicator assessments at 0, 6, and 12 weeks after starting the exercise, and the differences in trends of various indicators between the two groups were compared.ResultsNo exercise‐related adverse events occurred during the 12‐week exercise period. After 12 weeks of exercise training, in terms of fitness, the exercise group showed significant improvements in 6‐min walk test (6MWT) (p < 0.001), peak oxygen consumption (VO2peak) (p = 0.005), muscle content (p < 0.001), muscle percentage (p < 0.001), and grip strength (p = 0.008) compared to the control group. In terms of clinical indicators, the exercise group showed significant improvements in vital capacity (p = 0.018), D‐dimer (p = 0.031), and C‐reactive protein (CRP) (p = 0.01), uric acid (p = 0.003), triglycerides (p < 0.001), functional average score (p < 0.001), and main symptom average score (p = 0.004) compared to the control group in trends over time.ConclusionRehabilitation exercises using individualized exercise prescriptions tailored by exercise prescription specialists during chemotherapy are safe for lung cancer patients. Adhering to exercise can achieve comprehensive improvements in physical fitness and quality of life at 12 weeks.

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“…Overall, the available body of evidence often focuses on cancer (10,12,16,14,17,18) or orthopaedic surgeries (11,19), and is predominantly of low quality. Moreover, recent systematic reviews did not identify any cost-effectiveness studies of prehabilitation in frail surgical patients of advanced age (20,15).…”

Section: Introductionmentioning

confidence: 99%

“…Research on the clinical effectiveness of prehabilitation has shown that prehabilitation can have a signi cant impact on patients' postoperative outcomes. Patients who undergo prehabilitation are more likely to experience improvement in functional capacity (10,11), a shorter hospital stay, fewer complications, and a faster recovery time (12). However, the evidence on the effectiveness of prehabilitation in frail surgical patients of advanced age is sparse.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

Eckhardt,

Quentin,

Silzle

et al. 2023

Preprint

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Background Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation for frail elderly patients before elective surgery compared to standard care (PRAEP-GO RCT). The aim is to determine the cost-effectiveness and cost-utility of prehabilitation for frail elderly before an elective surgery. Methods The planned health economic evaluation comprises cost-effectiveness, cost-utility, and cost-minimisation analyses. Analyses are conducted in the German context from different perspectives including the payer perspective, i.e. the statutory health insurance, the societal perspective and the health care provider perspective. Data on outcomes and costs, are collected alongside the ongoing PRAEP-GO RCT. The trial population includes frail or pre-frail patients aged ≥70 years with planned elective surgery. The intervention consists of frailty screening (Fried phenotype), a shared decision-making conference determining modality (physiotherapy and unsupervised physical exercises, nutrition counselling, etc.) and setting (inpatient, day care, outpatient etc.) of a 3-week individual multimodal prehabilitation prior to surgery. The control group receives standard preoperative care. Costs include the intervention costs, the costs of the index hospital stay for surgery, and health care resources consumed during a 12-month follow-up. Clinical effectiveness outcomes included in the economic evaluation are the level of care dependency, the degree of disability as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality-adjusted life years (QALY) derived from the EQ-5D-5L and the German utility set, and complications occurring during the index hospital stay. Each adopted perspective considers different types of costs and outcomes as outlined in the protocol. All analyses will feature Intention-To-Treat analysis. To explore methodological and parametric uncertainties, we will conduct probabilistic and deterministic sensitivity analyses. Subgroup analyses will be performed as secondary analyses. Discussion The health economic evaluation will provide insights into the cost-effectiveness of prehabilitation in older frail populations, informing decision-making processes and contributing to the evidence base in this field. Potential limitation includes a highly heterogeneous trial population. Trial registration PRAEP-GO RCT: NCT04418271; economic evaluation: OSF (https://osf.io/swn79/ registration initiated on 29.06.2023).

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Evidence base for exercise prehabilitation suggests favourable outcomes for patients undergoing surgery for non-small cell lung cancer despite being of low therapeutic quality: a systematic review and meta-analysis

Cited by 18 publications

References 46 publications

Cardio-oncology rehabilitation: are we ready?

Cardio-oncology rehabilitation: are we ready?

Safety and efficacy evaluation of personalized exercise prescription during chemotherapy for lung cancer patients

Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

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