PREOPERATIVE PHYSICAL ACTIVITY LEVELS AND POSTOPERATIVE BURDEN IN CANCER PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY
Introduction: There is a growing interest to understand the impact of preoperative physical activity (PA) levels in postoperative morbidity and mortality. The aim of this study is to assess the levels of PA in patients with head/neck or gastric cancer through accelerometry and compare postoperative burden among those “complying” or “not complying” with PA recommendations.
Methods: We conducted an observational, longitudinal and prospective study in newly diagnosed patients with gastric or head/ neck cancer, recruited at IPO-Porto. The levels of PA were evaluated through accelerometry. Data about postoperative burden (complications, length of hospital stay and mortality) were collected from clinical records.
Results: A total of 81 patients were recruited, mostly men (76.5%), with an average age 61.8±11.55 years, 69.08±15.55 kg of weight and a BMI of 25.82±5.29 kg/m2. Fifty-four patients had a diagnosis of gastric cancer (66.7%) and 27 had head/neck cancer (33.3%). Patients spent 54% of their wearing time in sedentary behavior, 42% in light PA, and 4% in moderate to vigorous PA. Their median weekly MVPA was 132 (3-1860) min, and only 46.9% of patients accomplished the minimum amount of MVPA/week recommendations. No differences were noted among gastric and head/neck cancer patients. Regarding postoperative burden, 23.4% of patients had minor complications and 12.5% had major complications. The length of hospital stay was 13.86 ± 15.58 days and 9.9% deaths occurred after surgery. Postoperative mortality was superior among those patients “not complying” with international recommendations of PA (7 vs. 1 death).
Conclusion: Our data suggests that high preoperative PA levels may decrease the risk of postoperative mortality. Assessing preoperative levels of PA could bring value to identify those patients at greater risk of surgical burden and guide them to intervention designed to mitigate that risk by increasing their physical activity, such as prehabilitation.
2. Ethun, C.G., et al., Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA: A Cancer Journal for Clinicians, 2017. 67(5): p. 362-377.
3. Tevis, S.E. and G.D. Kennedy, Postoperative complications and implications on patient-centered outcomes. J Surg Res, 2013. 181(1): p. 106-13.
4. Jhanji, S., et al., Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia, 2008. 63(7): p. 695-700.
5. Ferraris, V.A., et al., Identification of patients with postoperative complications who are at risk for failure to rescue. JAMA Surg, 2014. 149(11): p. 1103-8.
6. Papenfuss, W.A., et al., Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol, 2014. 21(9): p. 3008-14.
7. Chiu, H.C., et al., The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients. J Int Med Res, 2017. 45(2): p. 691-705.
8. Vonlanthen, R., et al., The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg, 2011. 254(6): p. 907-13.
9. Krarup, P.-M., et al., Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer: A Nationwide Cohort Study. Annals of Surgery, 2014. 259(5): p. 930-938.
10. Mavros, M.N., et al., Impact of complications on long-term survival after resection of colorectal liver metastases. Br J Surg, 2013. 100(5): p. 711-8.
11. Artinyan, A., et al., Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg, 2015. 261(3): p. 497-505.
12. Pinto, A., et al., Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis. BMJ Open, 2016. 6(2): p. e007224.
13. Lynch, B.M., et al., Don’t take cancer sitting down. Cancer, 2013. 119(11): p. 1928-1935.
14. McTiernan, A., et al., Physical Activity in Cancer Prevention and Survival: A Systematic Review. Med Sci Sports Exerc, 2019. 51(6): p. 1252-1261.
15. CAMPBELL, K.L., et al., Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine & Science in Sports & Exercise, 2019. 51(11): p. 2375-2390.
16. Sarfati, D., B. Koczwara, and C. Jackson, The impact of comorbidity on cancer and its treatment. CA: A Cancer Journal for Clinicians, 2016. 66(4): p. 337-350.
17. Christensen, J.F., C. Simonsen, and P. Hojman, Exercise Training in Cancer Control and Treatment. Compr Physiol, 2018. 9(1): p. 165-205.
18. Steffens, D., et al., Is preoperative physical activity level of patients undergoing cancer surgery associated with postoperative outcomes? A systematic review and meta-analysis. Eur J Surg Oncol, 2019. 45(4): p. 510-518.
19. Vassbakk-Brovold, K., et al., Cancer patients participating in a lifestyle intervention during chemotherapy greatly over-report their physical activity level: a validation study. BMC Sports Sci Med Rehabil, 2016. 8: p. 10.
20. Chen, K.Y. and D.R. Bassett, Jr., The technology of accelerometry-based activity monitors: current and future. Med Sci Sports Exerc, 2005. 37(11 Suppl): p. S490-500.
21. Sasaki, J.E., D. John, and P.S. Freedson, Validation and comparison of ActiGraph activity monitors. J Sci Med Sport, 2011. 14(5): p. 411-6.
22. Aguilar-Farías, N., W.J. Brown, and G.M. Peeters, ActiGraph GT3X+ cut-points for identifying sedentary behaviour in older adults in free-living environments. J Sci Med Sport, 2014. 17(3): p. 293-9.
23. Clavien, P.A., et al., The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009. 250(2): p. 187-96.
24. Baba, Y., et al., Prognostic Impact of Postoperative Complications in 502 Patients With Surgically Resected Esophageal Squamous Cell Carcinoma: A Retrospective Single-institution Study. Ann Surg, 2016. 264(2): p. 305-11.
25. Yamashita, K., et al., Postoperative Infectious Complications are Associated with Adverse Oncologic Outcomes in Esophageal Cancer Patients Undergoing Preoperative Chemotherapy. Ann Surg Oncol, 2016. 23(6): p. 2106-14.
26. Malleo, G. and C.M. Vollmer, Jr., Postpancreatectomy Complications and Management. Surgical Clinics, 2016. 96(6): p. 1313-1336.
27. Baehring, E. and R. McCorkle, Postoperative complications in head and neck cancer. Clinical journal of oncology nursing, 2012. 16(6): p. 203-209.
28. Ciesielski, M., et al., Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor. Przeglad gastroenterologiczny, 2017. 12(3): p. 215-221.
29. Alves, A., et al., Postoperative Mortality and Morbidity in French Patients Undergoing Colorectal Surgery: Results of a Prospective Multicenter Study. Archives of Surgery, 2005. 140(3): p. 278-283.
30. Bhattacharyya, N. and M.P. Fried, Benchmarks for Mortality, Morbidity, and Length of Stay for Head and Neck Surgical Procedures. Archives of Otolaryngology–Head & Neck Surgery, 2001. 127(2): p. 127-132.
31. Schultz, P., et al., Perioperative mortality in oncologic head and neck surgery. J Otolaryngol, 2005. 34(3): p. 160-5.
32. Mason, M.C., et al., Preoperative cancer cachexia and short-term outcomes following surgery. J Surg Res, 2016. 205(2): p. 398-406.
33. Tønnesen, H., et al., Smoking and alcohol intervention before surgery: evidence for best practice. BJA: British Journal of Anaesthesia, 2009. 102(3): p. 297-306.
34. Campbell, K.L., et al., Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc, 2019. 51(11): p. 2375-2390.
35. Douma, J.A.J., et al., Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer. Acta Oncologica, 2020. 59(3): p. 342-350.
36. Steindorf, K., et al., Change patterns and determinants of physical activity differ between breast, prostate, and colorectal cancer patients. Supportive Care in Cancer, 2020. 28(7): p. 3207-3218.
37. Dronkers, J.J., et al., The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia, 2013. 68(1): p. 67-73.
38. Moran, J., et al., The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery, 2016. 160(5): p. 1189-1201.
39. Gillis, C., et al., Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology, 2018. 155(2): p. 391-410.e4.
40. Kamarajah, S.K., et al., Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: A systematic review and meta-analysis. Surgery, 2020. 167(3): p. 540-549.
41. Hughes, M.J., et al., Prehabilitation Before Major Abdominal Surgery: A Systematic Review and Meta-analysis. World J Surg, 2019. 43(7): p. 1661-1668.
42. Vasavada, B. and H. patel, Non surgical procedure related postoperative Complications independently predicts perioperative mortality, in gastrointestinal and Hpb surgeries.- A retrospective Analysis of prospectively maintained data. medRxiv, 2020: p. 2020.04.17.20068940.
43. Barberan-Garcia, A., et al., Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg, 2018. 267(1): p. 50-56.