Physical and Nutritional Prehabilitation in Older Patients With Colorectal Carcinoma: A Systematic Review

Looijaard, S.M.L.M.; Slee-Valentijn, Monique S.; Otten, René; Maier, Andrea B.

doi:10.1519/jpt.0000000000000125

Cited by 46 publications

(34 citation statements)

References 43 publications

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“…Future research needs to clarify the prognostic value of these measures in addition to CT‐based body composition measures over time, to predict the risk of adverse outcomes in older patients with CRC. This is also important in the development of preoperative interventions, also known as prehabilitation, which can be effective in older patients with CRC .…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Looijaard¹,

Meskers²,

Slee-Valentijn³

et al. 2019

The Oncologist

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Background Current literature is inconsistent in the associations between computed tomography (CT)‐based body composition measures and adverse outcomes in older patients with colorectal cancer (CRC). Moreover, the associations with consecutive treatment modalities have not been studied. This study compared the associations of CT‐based body composition measures with surgery‐ and chemotherapy‐related complications and survival in older patients with CRC. Materials and Methods A retrospective single‐center cohort study was conducted in patients with CRC aged ≥65 years who underwent elective surgery between 2010 and 2014. Gender‐specific standardized scores of preoperative CT‐based skeletal muscle (SM), muscle density, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue, IMAT percentage, SM/VAT, and body mass index (BMI) were tested for their associations with severe postoperative complications, prolonged length of stay (LOS), readmission, and dose‐limiting toxicity using logistic regression and 1‐year and long‐term survival (range 3.7–6.6 years) using Cox regression. Bonferroni correction was applied to account for multiple testing. Results The study population consisted of 378 patients with CRC with a median age of 73.4 (interquartile range 69.5–78.4) years. Severe postoperative complications occurred in 13.0%, and 39.4% of patients died during follow‐up. Dose‐limiting toxicity occurred in 77.4% of patients receiving chemotherapy (n = 53). SM, muscle density, VAT, SM/VAT, and BMI were associated with surgery‐related complications, and muscle density, IMAT, IMAT percentage, and SM/VAT were associated with long‐term survival. After Bonferroni correction, no CT‐based body composition measure was significantly associated with adverse outcomes. Higher BMI was associated with prolonged LOS. Conclusion The associations between CT‐based body composition measures and adverse outcomes of consecutive treatment modalities in older patients with CRC were not consistent or statistically significant. Implications for Practice Computed tomography (CT)‐based body composition, including muscle mass, muscle density, and intermuscular, visceral, and subcutaneous adipose tissue, showed inconsistent and nonsignificant associations with surgery‐related complications, dose‐limiting toxicity, and overall survival in older adults with colorectal cancer. This study underscores the need to verify whether CT‐based body composition measures are worth implementing in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Looijaard¹,

Meskers²,

Slee-Valentijn³

et al. 2019

The Oncologist

Self Cite

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“…A burgeoning body of research is investigating the utility of preoperative interventions, known as prehabilitation, to optimize posttreatment health outcomes. Numerous reviews of the prehabilitation literature in cancer populations demonstrate several important benefits, including improved preoperative and postoperative physical function, reduced hospital length of stay, and fewer postoperative complications (18)(19)(20)(21)(22)(23)(24). However, this literature exists almost exclusively in people undergoing tumor resection for thoracoabdominal malignancies, with breast cancer prehabilitation remaining largely unexamined.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Prehabilitation Prior to Breast Cancer Surgery: A Mixed-Methods Study

et al. 2020

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Background: Breast cancer surgery results in numerous acute and long-term adverse outcomes; the degree to which these can be mitigated or prevented through prehabilitation is unknown. Methods: We conducted a longitudinal, single-arm, mixed-methods study to examine the feasibility of prehabilitation in 22 women undergoing breast cancer surgery. All participants received an individualized exercise prescription including upper quadrantspecific resistance and mobility training and aerobic exercise for the duration of their surgical wait time. Feasibility was assessed by recruitment, adherence, attrition, and intervention-related adverse event rates. An exploratory investigation of intervention efficacy was conducted via a 6-min walk test, upper-quadrant strength and range of motion, volumetric chances associated with lymphedema, and participant-reported quality of life, fatigue, pain, and disability. Outcome assessments were conducted at baseline, prior to surgery, and at six and 12 weeks after surgery. Semi-structured interviews with a subset of participants (n = 5) and health-care providers (H; n = 2) were conducted to provide further insights about intervention feasibility. Qualitative data were analyzed using a hybrid inductive and deductive thematic analysis approach. Results: Recruitment and attrition rates were 62 and 36%, respectively. Average prehabilitation duration was 31 days (range = 7-69 days). Seventy six percent of participants complied with at least 70% of their prehabilitation prescription. There was a clinically significant increase in the 6-min walk distance from baseline to the preoperative assessment (57 m, 95% CI = −7.52, 121.7). The interviews revealed that the intervention was favorably received by participants and HCPs and included suggestions that prehabilitation (i) should be offered to all surgical candidates, (ii) is an avenue to regain control in the preoperative period, (iii) is a facilitator of postoperative recovery, and (iv) is an opportunity to provide education regarding postoperative rehabilitation protocols. A preference for multimodal prehabilitation (including dietetic and psychological counseling) was also highlighted.

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“…No significant effect of the protein‐rich meal service at home was found on nutrition status, hand grip strength, SPPB, quality of life, complications, or LOS, which is in line with studies on home‐delivered meal services 31 . It is suggested that combining a nutrition intervention (energy‐, protein‐, and/or carbohydrate supplements) with exercise (resistance and aerobic) could be effective to improve physical and clinical outcomes, but sufficient evidence is lacking 32,33 . A recent review on patients with colorectal cancer concluded that such prehabilitation programs have not shown a significant reduction of complications or hospital LOS 32 .…”

Section: Discussionmentioning

confidence: 60%

Effect of a Preoperative Home‐Delivered, Protein‐Rich Meal Service to Improve Protein Intake in Surgical Patients: A Randomized Controlled Trial

IJmker-Hemink

Wanten

Nes

et al. 2020

J Parenter Enteral Nutr

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Background The preoperative period likely provides an important opportunity to improve postoperative recovery, as suggested by the finding that low nutrition status is a predictor of increased postoperative complications and longer length of stay (LOS). It was investigated whether a home‐delivered, protein‐rich meal service improves protein intake relative to requirements within 3 weeks prior to surgery compared to usual care (UC). Methods This randomized controlled trial included adults (n = 126) with planned surgery performed at the orthopedics, urology, gynecology, or general surgery departments. The intervention group received 6 protein‐rich dishes per day for 3 weeks, and the control group sustained their usual diet. Dietary intake, nutrition status, hand grip strength, physical performance, and quality of life were assessed at baseline and after 3 weeks. Patient satisfaction was reported after 3 weeks, and data on complications and LOS were reported 30 days after surgery. Results Protein intake relative to requirements significantly improved by 16%, and energy intake relative to requirements increased by 19% for the meal service, as compared with UC. The intervention group experienced significantly less stress with preparing meals and were more satisfied with the presentation of the meals than the control group. No significant effects of the intervention were detected on other secondary outcomes. Conclusion The home‐delivered, protein‐rich meal service was successfully implemented before surgery and improved protein and energy intake relative to requirements within 3 weeks while patient satisfaction maintained. The preoperative period serves as a window of opportunity to prepare patients before hospitalization.

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Physical and Nutritional Prehabilitation in Older Patients With Colorectal Carcinoma: A Systematic Review

Cited by 46 publications

References 43 publications

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Feasibility of Prehabilitation Prior to Breast Cancer Surgery: A Mixed-Methods Study

Effect of a Preoperative Home‐Delivered, Protein‐Rich Meal Service to Improve Protein Intake in Surgical Patients: A Randomized Controlled Trial

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