A HOME-BASED PREHABILITATION PROGRAM, DELIVERED THROUGH AN INTERNET-BASED PLATFORM, IN PATIENTS WITH LOCALLY ADVANCED GASTROESOPHAGEAL JUNCTION AND STOMACH ADENOCARCINOMA, UNDERGOING PERIOPERATIVE CHEMOTHERAPY: PROTOCOL FOR A FEASIBILITY AND ACCEPTABILITY
DOI:
https://doi.org/10.34635/rpc.938Keywords:
Home-based prehabilitation, telehealth, cancer, surgeryAbstract
Introduction: Prehabilitation is a multimodal strategy implemented in the preoperative period, aiming to increase preoperative functional reserve, leading to better postoperative functional recovery and reduced incidence of complications. The majority of the prehabiliation programs are developed under supervision in an outpatient clinic, which might be an obstacle for those patients with geographical and/or travelling constrains. Home-based programs, with the support of telehealth resources, could be a convenient way to surpass these barriers.
Methods: Patients with locally advanced, potentially resectable gastric or GEJ adenocarcinoma, undergoing perioperative chemotherapy with FLOT regimen will be recruited at IPO-Porto and Hospital Garcia de Orta. Patient will be invited to undergo a prehabilitation program (PREHAB) in addition to their usual (medical optimization, nutritional and psychological care). Exercise intervention will comprise aerobic and resistance training. An internet-based platform (iTerapy) via computer or mobile devices, will be used to deliver and monitor the intervention. The primary outcome of this study is to test the acceptability, feasibility and safety of the intervention. As secondary outcomes, we intend to assess the impact of home- based prehabilitation on functional capacity, frailty status, quality of life, disability, postoperative complications and mortality, length of hospital stay, need of ICU, hospital readmission and place of discharge.
Conclusion: This study will inform for a future randomized clinical trial to assess the role of prehabilitation to reduce postoperative morbidity and mortality in this population.
Downloads
References
2. Ronellenfitsch, U., et al., Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database of Systematic Reviews, 2013(5).
3. Steffens, D., et al., Is preoperative physical activity level of patients undergoing cancer surgery associated with postoperative outcomes? A systematic review and meta-analysis. Ejso, 2019. 45(4): p. 510-518.
4. 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.
5. Vester-Andersen, M., et al., Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients: a population-based cohort study. Br J Anaesth, 2014. 112(5): p. 860-70.
6. Merkow, R.P., et al., Effect of Postoperative Complications on Adjuvant Chemotherapy Use for Stage III Colon Cancer. Annals of Surgery, 2013. 258(6): p. 847-853.
7. Handforth, C., et al., The prevalence and outcomes of frailty in older cancer patients: a systematic review. Annals of Oncology, 2015. 26(6): p. 1091-1101.
8. Carli, F. and C. Scheede-Bergdahl, Prehabilitation to enhance perioperative care. Anesthesiol Clin, 2015. 33(1): p. 17-33.
9. 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.
10. Cavalheri, V. and C. Granger, Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev, 2017. 6: p. CD012020.
11. 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.
12. Schmitz, K.H., et al., Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: A Cancer Journal for Clinicians, 2019. 69(6): p. 468-484.
13. Thomas, R.J., et al., Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 2019. 140(1):p. e69-e89.
14. Chan, A.W., et al., SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ, 2013. 346: p. e7586.
15. Fletcher, G.F., et al., Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation, 2013. 128(8): p. 873-934.
16. Bauer, J., S. Capra, and M. Ferguson, Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr, 2002. 56(8): p. 779-85.
17. Arends, J., et al., ESPEN guidelines on nutrition in cancer patients. Clin Nutr, 2017. 36(1): p. 11-48.
18. Vlaescu, G., et al., Features and functionality of the Iterapi platform for internet-based psychological treatment. Internet Interv, 2016. 6: p. 107-114.
19. Mendes-Santos, C., et al., A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol. Internet Interventions, 2019. 17: p. 100236.
20. Fernandes, A., et al., Development of a preoperative risk score on admission in surgical intermediate care unit in gastrointestinal cancer surgery. Perioper Med (Lond), 2020. 9: p. 23.
21. Rikli, R.E. and C.J. Jones, Development and validation of a functional fitness test for community-residing older adults. Journal of Aging and Physical Activity, 1999. 7(2): p. 129-161.
22. Rikli, R.E. and C.J. Jones, Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 2013. 53(2): p. 255-67.
23. Moriello, C., et al., Validating the six-minute walk test as a measure of recovery after elective colon resection surgery. Archives of Physical Medicine and Rehabilitation, 2008. 89(6): p. 1083-1089.
24. Pecorelli, N., et al., The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties. Surgical Endoscopy and Other Interventional Techniques, 2016. 30(6): p. 2199-2206.
25. Hattori, K., et al., Preoperative six-minute walk distance is associated with pneumonia after lung resection. Interactive Cardiovascular and Thoracic Surgery, 2018. 26(2): p. 277-283.
26. Fried, L.P., et al., Frailty in older adults: Evidence for a phenotype. Journals of Gerontology Series a-Biological Sciences and Medical Sciences, 2001. 56(3): p. M146-M156.
27. Makary, M.A., et al., Frailty as a Predictor of Surgical Outcomes in Older Patients. Journal of the American College of Surgeons, 2010. 210(6): p. 901-908.
28. Bouillon, K., et al., Measures of frailty in population-based studies: an overview. BMC Geriatr, 2013. 13: p. 64.
29. Aaronson, N.K., et al., The European-Organization-for-Research-and-Treatment-of-Cancer Qlq-C30 – a Quality-of-Life Instrument for Use in International Clinical-Trials in Oncology. Journal of the National Cancer Institute, 1993. 85(5): p. 365-376.
30. Ustun, T.B., et al., Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ, 2010. 88(11): p. 815-23.
31. Shulman, M.A., et al., Measurement of disability-free survival after surgery. Anesthesiology, 2015. 122(3): p. 524-36.
32. Bowling, C.B., et al., Prevalence of Activity Limitations and Association with Multimorbidity Among US Adults 50 to 64 Years Old. J Gen Intern Med, 2019. 34(11): p. 2390-2396.
33. Grocott, M.P.W., et al., The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. Journal of Clinical Epidemiology, 2007. 60(9): p. 919-928.
34. Dindo, D., N. Demartines, and P.A. Clavien, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004. 240(2): p. 205-13.
35. Slankamenac, K., et al., The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg, 2014. 260(5): p. 757-62; discussion 762-3.
36. Hayes, S.C., et al., The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management. J Sci Med Sport, 2019. 22(11): p. 1175-1199.
Downloads
Published
Issue
Section
License
Para permitir ao editor a disseminação do trabalho do(s) autor(es) na sua máxima extensão, o(s) autor(es) deverá(ão) assinar uma Declaração de Cedência dos Direitos de Propriedade (Copyright). O acordo de transferência, (Transfer Agreement), transfere a propriedade do artigo do(s) autor(es) para a Sociedade Portuguesa de Cirurgia.
Se o artigo contiver extractos (incluindo ilustrações) de, ou for baseado no todo ou em parte em outros trabalhos com copyright (incluindo, para evitar dúvidas, material de fontes online ou de intranet), o(s) autor(es) tem(êm) de obter, dos proprietários dos respectivos copyrights, autorização escrita para reprodução desses extractos do(s) artigo(s) em todos os territórios e edições e em todos os meios de expressão e línguas. Todas os formulários de autorização devem ser fornecidos aos editores quando da entrega do artigo.