Implementing a Multimodal Prehabilitation Program to Radical Cystectomy in a Comprehensive Cancer Center: A Pilot Study to Assess Feasibility and Outcomes

Jensen, Bente Thoft; Jensen, Jorgen Bjergaard; Love-Retinger, Nora; Bowker, Mallory; Retinger, Caitlyn; Dalbagni, Guido

doi:10.7257/1053-816x.2019.39.6.303

Cited by 14 publications

(13 citation statements)

References 36 publications

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“…A significant portion of these studies, notably, were undertaken within American populations (567 patients). In terms of research design, there were two randomized controlled trials (RCTs) [ 23 , 24 ], one quasi-experimental study [ 25 ], one cohort study [ 26 ], one case-control study [ 27 ], and one cross-sectional study [ 28 ]. The prevalence of the studies included in the analysis exhibited commendable methodological quality and a minimal risk of bias, as evaluated through the application of the JBI critical appraisal tools, as detailed in Supplementary File S1 .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies [ 25 , 27 ] employing ONSs in combination with nutritional counseling yielded positive outcomes ( Figure 3 ). In the study by Aldhaam et al [ 27 ], an ERAS prehabilitation pathway involving nutritional counseling 4 weeks before the RC coupled with ONS administration 4 days before the RC (specific portion/day not specified), compared to the control group (CG) receiving only nutritional counseling, demonstrated accelerated recovery of the bowel function (1 day faster, p < 0.01) and a reduction in length of hospital stay by 1.75 days ( p = 0.01).…”

Section: Resultsmentioning

confidence: 99%

“…In the study by Aldhaam et al [ 27 ], an ERAS prehabilitation pathway involving nutritional counseling 4 weeks before the RC coupled with ONS administration 4 days before the RC (specific portion/day not specified), compared to the control group (CG) receiving only nutritional counseling, demonstrated accelerated recovery of the bowel function (1 day faster, p < 0.01) and a reduction in length of hospital stay by 1.75 days ( p = 0.01). In a second study [ 25 ], involving a sample of 32 patients undergoing an RC, nutritional counseling combined with ONS administration (300 kcal, 12.5 g of protein, or in diabetic patients, 330 kcal, 16.5 g of protein) in two portions/day for 2 weeks before the RC, resulted in improvements in handgrip strength (+6.8%, p < 0.001), bone mass (+0.3 kg, p = 0.04), and better BMI value (+2.3%, p = 0.001).…”

Section: Resultsmentioning

confidence: 99%

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Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

Dal Bello,

Mancin,

Morales Palomares

et al. 2024

Nutrients

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

Dal Bello,

Mancin,

Morales Palomares

et al. 2024

Nutrients

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“…To our knowledge, this was the first randomized study reporting a 1-year follow-up on the efficacy of prehabilitation intervention in major bladder cancer surgery on physical functioning. Other studies in this specific population have reported follow-up outcomes after 8 weeks at maximum [3,12,24].…”

Section: Discussionmentioning

confidence: 97%

“…This study group has previously published and documented in an RCT study that multimodal prehabilitation before RC was feasible and led to a positive and significant change in patients' fitness and functional status compared with the standard protocols after surgery. Moreover, specific health-related quality-of-life items such as respiratory and abdominal function, as defined by the European Organization for Research and Treatment of Cancer (EORTC), were improved from a short-term perspective [3,[11][12][13]. Currently, only a short-term follow-up of eight weeks has been reported after multimodal prehabilitation.…”

Section: Introductionmentioning

confidence: 99%

One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy

Thoft Jensen,

Bjerggaard Jensen

2023

Cancers

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Multimodal prehabilitation is the process of enhancing physiological, nutritional, and psychological resilience to increase patients’ functional capacity before major cancer surgery and aims to empower the patient to withstand the pending stress of major surgery and ultimately to improve long-term outcomes. The effect of physical prehabilitation to counteract the physical decline in surgical cancer patients has been documented; however, long-term results have not yet been published. This follow-up study aims to evaluate 1-year results on the efficacy of physical prehabilitation after bladder cancer surgery. The efficacy of prehabilitation was measured over the course of 1 year in 107 patients randomized to (1) pre- and rehabilitation or (2) standard care divided by n = 50 in the intervention (I) and n = 57 in the standard group (S). Physical function was measured by muscle leg power, and nutritional status was expressed with handgrip strength. Prehabilitation in major bladder cancer surgery can significantly improve physical function with 19.8 Watt/kg (p = 0.04), lean body mass (p = 0.047) and body cell mass (p = 0.03), and regained nutritional status one year after surgery. The results demonstrate that the restoration of physical function is vital to a full recovery.

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Access, acceptance and adherence to cancer prehabilitation: a mixed-methods systematic review

Watts,

Courtier,

Fry

et al. 2024

J Cancer Surviv

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Purpose The purpose of this systematic review is to better understand access to, acceptance of and adherence to cancer prehabilitation. Methods MEDLINE, CINAHL, PsychINFO, Embase, Physiotherapy Evidence Database, ProQuest Medical Library, Cochrane Library, Web of Science and grey literature were systematically searched for quantitative, qualitative and mixed-methods studies published in English between January 2017 and June 2023. Screening, data extraction and critical appraisal were conducted by two reviewers independently using Covidence™ systematic review software. Data were analysed and synthesised thematically to address the question ‘What do we know about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups?’ The protocol is published on PROSPERO CRD42023403776 Results Searches identified 11,715 records, and 56 studies of variable methodological quality were included: 32 quantitative, 15 qualitative and nine mixed-methods. Analysis identified facilitators and barriers at individual and structural levels, and with interpersonal connections important for prehabilitation access, acceptance and adherence. No study reported analysis of facilitators and barriers to prehabilitation specific to people from ethnic minority communities. One study described health literacy as a barrier to access for people from socioeconomically deprived communities. Conclusions There is limited empirical research of barriers and facilitators to inform improvement in equity of access to cancer prehabilitation. Implications for Cancer Survivors To enhance the inclusivity of cancer prehabilitation, adjustments may be needed to accommodate individual characteristics and attention given to structural factors, such as staff training. Interpersonal connections are proposed as a fundamental ingredient for successful prehabilitation.

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Implementing a Multimodal Prehabilitation Program to Radical Cystectomy in a Comprehensive Cancer Center: A Pilot Study to Assess Feasibility and Outcomes

Cited by 14 publications

References 36 publications

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy

Access, acceptance and adherence to cancer prehabilitation: a mixed-methods systematic review

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