Multiphasic Prehabilitation Across the Cancer Continuum: A Narrative Review and Conceptual Framework

Mina, Daniel Santa; Rooijen, Stefanus J. van; Minnella, Enrico Maria; Alibhai, Shabbir M.H.; Brahmbhatt, Priya; Dalton, Susanne Oksbjerg; Gillis, Chelsia; Grocott, Michael P.W.; Howell, Doris; Randall, Ian M; Sabiston, Catherine M.; Silver, Julie K.; Slooter, Gerrit D.; West, Malcolm A.; Jack, Sandy; Carli, Franco

doi:10.3389/fonc.2020.598425

Cited by 25 publications

(7 citation statements)

References 90 publications

(70 reference statements)

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“…Participants talked more about how they were prepared for and adjusted to their functional changes post‐operatively, who supported them during this time and how this experience made them feel as a person. This feeling described by participants is supported by other research (Dawson et al., 2019 ; Santa Mina et al., 2021 ) in which physical, social, functional and psychological principles of care can maximize function; with people remembering how interactions made them feel rather than the details of the clinical interventions provided. This aligns more closely to what the participants in this study see as important in their TL pathway and could be considered for integration in future ERAS laryngectomy models of care.…”

Section: Discussionsupporting

confidence: 58%

“…As a result, there are significant challenges in successfully implementing ERAS protocols in the acute post laryngectomy period; and it may be that ERAS in laryngectomy care needs to shift focus beyond the medical model alone. A potential option to consider is a ‘multiphasic prehabilitation’ model (Santa Mina et al., 2021 ). Whilst novel in its approach; multiphasic prehabilitation advocates a move beyond the medical model alone and incorporates principles of survivorship into prehabilitation models of care, that is, maximizing physical, social, psychological and vocational functioning within that individual's capacity following cancer treatment (Cromes & Fred 1978 ).…”

Section: Introductionmentioning

confidence: 99%

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Patient experience of the acute post‐surgical period following total laryngectomy during the COVID‐19 era

Watson

Hamilton

Patterson

2022

Intl J Lang & Comm Disor

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Background Total laryngectomy (TL) results in permanent functional changes requiring rapid development of complex new skills. A significant portion of this learning happens in the acute post‐surgical stage. There is increasing interest in enhanced recovery after surgery (ERAS) protocols in TL; however, implementation has been difficult. COVID‐19 has placed significant pressures on acute services, requiring rapid service changes for TL patients. Aims To understand the acute patient experience of having a TL both before and during COVID‐19. Methods & Procedures Semi‐structured interviews using a pre‐designed topic guide were conducted with 10 people who had undergone a TL within the last 2 years. Participants were recruited by their speech and language therapists using purposive sampling. Braun and Clarke's iterative approach to data collection and thematic analysis was used to generate key themes from the data. Outcomes & Results Thematic analysis identified four main themes: (1) pre‐operative information‐giving: ‘it was just words’; (2) decision‐making influences: ‘I just wanted them to get it all out and get it over with’; (3) coping with adjustment to the new normal: ‘this is part of me now’; and (4) the importance of relationship‐building: ‘when you've had something like this, you need some care and understanding’. Conclusions & Implications The need for an individualized approach to TL intervention which incorporates medical and psycho‐social approaches from pre‐treatment to acute discharge is vital. ERAS models should be reviewed to shift beyond the medical model alone. Rapid service changes due to COVID‐19 did not contribute any major changes to the acute patient‐reported experience. What this paper adds What is already known on the subject We know that ERAS protocols have the potential to improve patient outcomes following TL. However, the research does not consider anything other than the early oral feeding debate and it has therefore been difficult to implement ERAS protocols in current service models. COVID19 required head and neck cancer services to make quick changes to surgical pathways, with the potential that some ERAS protocols had been adopted inadvertently. In order to understand the impact of this, we need to understand the patient experience following TL both before and during COVID19. What this paper adds to existing knowledge This paper used qualitative interviews to understand the acute patient experience following TL both during and before COVID19. Findings from these interviews highlighted that people were on the most part, well prepared for the functional changes they would experience after surgery. However, people felt there were gaps in service delivery at the pre‐treatment and early discharge home period. Overall, the gaps identified were fr...

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Patient experience of the acute post‐surgical period following total laryngectomy during the COVID‐19 era

Watson

Hamilton

Patterson

2022

Intl J Lang & Comm Disor

View full text Add to dashboard Buy / Rent full text

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“…One study included in our review included prehabilitation, yet data increasingly support a role for prehabilitation in the cancer setting, for example, presurgery 11 . A multiphase prehabilitation approach may be needed by many individuals with cancer to prepare for subsequent treatments such as chemotherapy, 11 and evidence in early‐stage breast cancer suggests that higher baseline (prechemotherapy) cardiovascular fitness and muscular strength may be associated with higher rates of chemotherapy completion 12 . This supports the potential utility of multiphase, multimodal prehabilitation in AML management, which should be considered for further research in AML.…”

Section: Author/year Study Design/sample Size Study Aim Intervention/...mentioning

confidence: 99%

Non‐pharmacological supportive‐care interventions in acute myeloid leukaemia: a review of randomised controlled trials

et al. 2021

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ADL, activity of daily living; AML, acute myeloid leukaemia; BFI, brief fatigue inventory; EORTC, European organisation for research and treatment of cancer; FACT-F, functional assessment of cancer therapy-fatigue; FVC, forced vital capacity; Gln, glutamine dipeptide; HADS, hospital anxiety and depression scale; H(S)CT, haematopoietic (stem) cell transplantation; HRmax, maximum heart rate; HRR, heart rate reserve; IC induction chemotherapy; IMT, inspiratory muscle training; IV, intravenous; IVC, inspiratory vital capacity; LASA, linear analogue self assessment; LOS, length of stay; MISWT, multistage incremental shuttle walk test; OS, overall survival; POMS, profile of mood states; PST, problem-solving training; QLQ-C30, quality of life questionnaire core 30-item; QoL, quality of life; RCT, randomised controlled trial; RPE, rating of perceived exertion; STS, sit-to-standing; TUG, timed up and go; VO 2 , oxygen uptake; 6MWT, 6-minute walk test.

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“…The introduction of the Health-Circuit approach will facilitate a "connected experience" for both the patient and the healthcare professionals fostering engagement into the care management process. Moreover, this proposal has the potential to be adopted by programs supporting long-term management of cancer patients (17) and chronic patients, as well as prevention of multimorbidity in subjects at risk. The final milestone would be the optimization of long-term self-management programs with proven health value generation.…”

Section: Introductionmentioning

confidence: 99%

Digital Support to Multimodal Community-Based Prehabilitation: Looking for Optimization of Health Value Generation

et al. 2021

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Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collaborative care; iii) insufficient access to prehabilitation; iv) relevant percentage of program drop-outs; v) need for program personalization; and, vi) economical sustainability. Transferability of prehabilitation programs from the hospital setting to the community would potentially provide a new scenario with greater accessibility, as well as offer an opportunity to effectively address the aforementioned issues and, thus, optimize healthcare value generation. A core aspect to take into account for an optimal management of prehabilitation programs is to use proper technological tools enabling: i) customizable and interoperable integrated care pathways facilitating personalization of the service and effective engagement among stakeholders; ii) remote monitoring (i.e. physical activity, physiological signs and patient-reported outcomes and experience measures) to support patient adherence to the program and empowerment for self-management; and, iii) use of health risk assessment supporting decision making for personalized service selection. The current manuscript details a proposal to bring digital innovation to community-based prehabilitation programs. Moreover, this approach has the potential to be adopted by programs supporting long-term management of cancer patients, chronic patients and prevention of multimorbidity in subjects at risk.

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Multiphasic Prehabilitation Across the Cancer Continuum: A Narrative Review and Conceptual Framework

Cited by 25 publications

References 90 publications

Patient experience of the acute post‐surgical period following total laryngectomy during the COVID‐19 era

Patient experience of the acute post‐surgical period following total laryngectomy during the COVID‐19 era

Non‐pharmacological supportive‐care interventions in acute myeloid leukaemia: a review of randomised controlled trials

Digital Support to Multimodal Community-Based Prehabilitation: Looking for Optimization of Health Value Generation

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