Two-Week Multimodal Prehabilitation Program Improves Perioperative Functional Capability in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial

Liu, Zijia; Qiu, Tian; Pei, Lijian; Zhang, Yuelun; Xu, Li; Cui, Yuming; Liang, Ning; Li, Shanqing; Chen, Wei; Huang, Yuguang

doi:10.1213/ane.0000000000004342

Cited by 113 publications

(140 citation statements)

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“…Both short-term outcomes of treatment as well as long-term behavioral changes can be altered [ 3 ]. It leads to an improved functional capacity [ 4 ], [ 5 ], [ 6 ], [ 7 ], improved nutritional [ 8 ], [ 9 ] and mental status [ 9 ], [ 10 ], reduction of complications [ 11 ], [ 12 ], [ 13 ], faster recovery [ 7 ], [ 14 ], [ 15 ], a reduced length of stay in the hospital [ 16 ], an improved quality of life [ 10 ], [ 17 ], and potentially a reduction in costs. While the evidence for improvement of clinical outcomes is growing, prehabilitation is at the threshold of worldwide implementation and already included in guidelines [ 18 ], [ 19 ], [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Prehabilitation, making patients fit for surgery – a new frontier in perioperative care

Molenaar

Papen-Botterhuis

Herrle

et al. 2019

Innovative Surgical Sciences

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Optimizing a patients’ condition before surgery to improve the postoperative outcome can be achieved by using prehabilitation; preoperative interventions focusing on modifiable risk factors to improve the physical, nutritional, and mental status of the patient. A multimodal, multidisciplinary approach induces a synergistic effect between the various interventions and affects the outcome postoperatively. While awaiting higher-quality evidence, the worldwide implementation of prehabilitation programs has started, resulting in a true revolution in perioperative care.

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Section: Introductionmentioning

confidence: 99%

Prehabilitation, making patients fit for surgery – a new frontier in perioperative care

Molenaar

Papen-Botterhuis

Herrle

et al. 2019

Innovative Surgical Sciences

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“…To our knowledge, only one randomised controlled trial with a multimodal prehabilitation programme in a NSCLC population has been published, however, this concerned a non-supervised home-based programme with less interventions compared to our study (12). In the Netherlands, we experience a growing interest in prehabilitation prior to surgery, yet to date there are no formal public prehabilitation programmes available for lung surgery patients.…”

Section: Discussionmentioning

confidence: 95%

“…This is monitored by the Dutch Institute for Clinical Auditing (DICA) through the compulsory Dutch Lung Cancer Audit -Surgery (DLCAs), which records and benchmarks the percentage of operations performed within three weeks from the multidisciplinary team meeting con rming diagnosis (11). The window of opportunity prior to surgery to optimise the patient's condition is therefore limited, yet meaningful interventions seem not impossible, as was demonstrated in a recently published randomised controlled trial with a multimodal prehabilitation programme in a home-based setting of only two weeks (12).…”

Section: Introductionmentioning

confidence: 99%

Multimodal Prehabilitation in Patients with Non-Small Cell Lung Cancer Undergoing Anatomical Resection: Protocol of a Non-Randomised Feasibility Study

Molenaar

Meyenfeldt

Betue

et al. 2020

Preprint

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BackgroundThe preoperative period can be used to enhance a patient’s functional capacity with multimodal prehabilitation and, consequently improve and fasten postoperative recovery. Especially non-small cell lung cancer (NSCLC) surgical patients may benefit from this intervention, since the affected and resected organ is an essential part of the cardiorespiratory fitness. Drafting a prehabilitation programme is a challenge, since many disciplines are involved, and time between diagnosis of NSCLC and surgery is limited. We designed a multimodal prehabilitation programme prior to pulmonary surgery and conduct a study to assess feasibility and efficacy of the programme. Publication of this protocol may help other health care facilities to implement such a programme. MethodsThe multimodal prehabilitation programme consists of an exercise programme, nutritional support, mental support, smoking cessation programme, patient empowerment and respiratory optimisation. In two Dutch teaching hospitals, 40 adult patients with proven or suspected NSCLC will be included. In a non-randomised fashion, 20 patients follow the multimodal prehabilitation programme and 20 will be assessed in the control group, according to patient preference. Assessments take place at four time points: baseline, week before surgery, six weeks postoperatively and three months postoperatively. Feasibility and efficacy of the prehabilitation programme will be assessed as primary outcomes. DiscussionSince the time between diagnosis of NSCLC and surgery is limited, it is a challenge to implement a prehabilitation programme. This study will assess whether this is feasible and effective. The non-randomised fashion of the study might result in a selection bias. However, the control group is necessary, to put the prehabilitation group in perspective and to assess feasibility further. By publishing this protocol of our feasibility study, we aim to facilitate others to evaluate and implement a multimodal prehabilitation programme for surgical lung cancer patients.Trial registrationThis feasibility study is registered as NL8080 in the Netherlands Trial Register on the 10th of October 2019, https://www.trialregister.nl/trial/8080. Secondary identifiers: CCMO (Central Committee on Research Involving Human Subjects) number NL70578.015.19, reference number of the Medical Ethical Review Committee of Máxima MC W19.045.

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“…The study designs were as follows: 27% (n = 10) were protocols (18-27), 14% (n = 5) were pilot studies (8, 28-31), 5% (n = 2) were descriptions of prehabilitation programs (32, 33), 3% (n = 1) were case reports (34), 3% (n = 1) were feasibility studies (35), and 3% were qualitative studies (36). Of these 37 studies, 30% (n = 11) were cohort studies (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) and 16% (n = 6) were RCTs (48)(49)(50)(51)(52)(53).…”

Section: Prehabilitation Studies With a Nutrition Treatment Componentmentioning

confidence: 99%

Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review

et al. 2021

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Background: Prehabilitation aims to improve functional capacity prior to cancer treatment to achieve better psychosocial and clinical outcomes. Prehabilitation interventions vary considerably in design and delivery. In order to identify gaps in knowledge and facilitate the design of future studies, we undertook a scoping review of prehabilitation studies to map the range of work on prehabilitation being carried out in any cancer type and with a particular focus on diet or nutrition interventions.Objectives: Firstly, to describe the type of prehabilitation programs currently being conducted. Secondly, to describe the extent to which prehabilitation studies involved aspects of nutrition, including assessment, interventions, implementation, and outcomes.Eligibility Criteria: Any study of quantitative or qualitative design that employed a formal prehabilitation program before cancer treatment (“prehabilitation” listed in keywords, title, or abstract).Sources of Evidence: Search was conducted in July 2020 using MEDLINE, PubMed, EMBASE, EMCARE, CINAHL, and AMED.Charting Methods: Quantitative data were reported as frequencies. Qualitative nutrition data were charted using a framework analysis that reflects the Nutrition Care Process Model: assessment, intervention, and monitoring/evaluation of the nutrition intervention.Results: Five hundred fifty unique articles were identified: 110 studies met inclusion criteria of a formal prehabilitation study in oncology. prehabilitation studies were mostly cohort studies (41%) or randomized-controlled trials (38%) of multimodal (49%), or exercise-only (44%) interventions that were applied before surgery (94%). Nutrition assessment was inconsistently applied across these studies, and often conducted without validated tools (46%). Of the 110 studies, 37 (34%) included a nutrition treatment component. Half of these studies provided the goal for the nutrition component of their prehabilitation program; of these goals, less than half referenced accepted nutrition guidelines in surgery or oncology. Nutrition interventions largely consisted of counseling with dietary supplementation. The nutrition intervention was indiscernible in 24% of studies. Two-thirds of studies did not monitor the nutrition intervention nor evaluate nutrition outcomes.Conclusion: Prehabilitation literature lacks standardized and validated nutritional assessment, is frequently conducted without evidence-based nutrition interventions, and is typically implemented without monitoring the nutrition intervention or evaluating the intervention's contribution to outcomes. We suggest that the development of a core outcome set could improve the quality of the studies, enable pooling of evidence, and address some of the research gaps identified.

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Two-Week Multimodal Prehabilitation Program Improves Perioperative Functional Capability in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial

Abstract: Supplemental Table 1. Detailed results from the mixed-effected models with interaction terms between the treatment effect and time Outcomes Variables Coefficient (95%CI) P Value 6MWD (m) Intervention 52.7 (22.9 to 82.6) 0.001

Cited by 113 publications

References 35 publications

Prehabilitation, making patients fit for surgery – a new frontier in perioperative care

Prehabilitation, making patients fit for surgery – a new frontier in perioperative care

Multimodal Prehabilitation in Patients with Non-Small Cell Lung Cancer Undergoing Anatomical Resection: Protocol of a Non-Randomised Feasibility Study

Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review

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