Methodological approach to perform systematic review on nutritional and physical prehabilitation in head and neck cancer patients
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Malnutrition is frequently observed among patients with head and neck cancer, adversely affecting overall health and treatment outcomes.Prehabilitation, both nutritional and physical, is emerging as a strategy to optimize the nutritional status of these patients before commencing anti-cancer treatments such as chemotherapy and radiotherapy.This review methodology is designed to guide a systematic review with clear objectives: to analyze the issue of malnutrition in patients undergoing anti-cancer treatments, identify prehabilitative interventions, both nutritional and physical, aimed at promoting an improvement in nutritional status, and ascertain the most effective prehabilitative interventions in the clinical setting.With the publication of this review protocol, the aim is to provide a foundation for future systematic reviews in this emerging discipline.Keywords:
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Abstract Introduction Evidence suggests that physical fitness interventions, mental health support and nutritional advice before surgery (prehabilitation) could reduce hospital stay and improve quality of life of patients with cancer. In this study we captured the opinions of a group of cancer patients undergoing these interventions after surgery to discover what a prehabilitation programme should encompass. Methods Patients from the Cancer and Rehabilitation Exercise (CARE) programme based in Nottingham took part in a 26-point online questionnaire about the design of prehabilitation programmes. Results The questionnaire was completed over a 2-week period by 54 patients from the CARE programme. Their responses were as follows: 44 patients (81%) would have participated in prehabilitation had it been available to them and 28 patients (52%) ranked physical exercise as the most important component. Forty patients (74%) believed the counselling aspect of prehabilitation would have contributed to a successful outcome and 35 (65%) thought dietary advice would have benefitted them before surgery. Thirty-one patients (57%) preferred the programme to take place in a fitness centre, rather than at home or hospital and 43 (80%) would have liked to have known about prehabilitation from their doctor at the time of diagnosis. Conclusion Patients are interested in prehabilitation to become more physically fit and mentally prepared for surgery. They express the need for a focus on physical exercise, counselling to improve mental health and personalised nutritional advice. Tailoring a prehabilitation programme, with input from patients, could contribute to improving patient outcomes following cancer treatments.
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The cornerstone in the treatment of colorectal cancer is surgery. A surgical event poses a significant risk of decreased functional decline and impaired health-related quality of life. Prehabilitation is defined as the multimodal preoperative enhancement of a patient's condition. It may serve as a strategy to improve postoperative outcomes. Prehabilitation requires a multidisciplinary effort of medical health care professionals and a behavioral change of the patient.The goal of prehabilitation is threefold: (1) to reduce postoperative complications, (2) to enhance and accelerate the recovery of the patient, and (3) to improve overall quality of life. In this article, we introduce the FIT model illustrating a possible framework toward the implementation of both evidence-based and tailor-made prehabilitation for patients undergoing surgery for colorectal cancer.The model is composed of three pillars: "facts" (how to screen patients and evidence on what content to prescribe), "integration" (data of own questionnaires assessing motivation of patients and specialists), and finally "tools" (which outcome measurements to use).Developing implementable methods and defining standardized outcome instruments will help establish a solid base for patient-centered prehabilitation programs. Any party introducing prehabilitation requiring multidisciplinary teamwork and behavioral change can potentially use this framework.
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Extensive preventive strategies in the perioperative period are popular worldwide. Novel “prehabilitation” approaches are being defined for every individual surgical discipline. With intention to reduce perioperative morbidity, “prehabilitation” was developed to increase “physical wellness” considering exercise capacity, nutritional status, and psychological support. Thus, prehabilitation could be well-suited for patients undergoing lung cancer surgery. Theoretically, improving physical condition may increase the chances of having a better post-operative course, especially among frail patients. In this review, we describe the concept of prehabilitation with possible benefits, its role in the Enhanced Recovery After Surgery protocols, and its potential for the future.
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The goal of this article is to provide a pragmatic approach to implementing a prehabilitation pathway and service guide.The article presents data from peer-reviewed scientific articles (ie, reviews and original studies) and narrative reviews, as well as professional insights and experiences of the author in setting up a prehabilitation clinic.Successful setup of a prehabilitation unit is highly feasible and rewarding, if led by enthusiastic idealists who work in cooperation with a passionate multidisciplinary team (MDT) with clear vision to collectively improve patient outcomes and experiences. It requires a well-integrated MDT to deliver a successful prehabilitation service.Nurses are the supporting pillar in many areas of the health care system. The field of prehabilitation is no exception to this with the mainstay contribution nursing provides. A combination of patient care, medical knowledge, and administrative capabilities are required to modify the perioperative pathway and introduce the concept of prehabilitation. Nursing staff are ideally positioned to be strong advocates to developing and delivering an effective MDT prehabilitation clinical pathway.
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Objective To understand perspectives on and acceptability of prehabilitation among patients undergoing complex abdominal cancer surgery (cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy). Methods Seventy-nine patients admitted to a Danish colorectal or ovarian cancer centre participated in qualitative semi-structured interviews and/or registered their prehabilitation activities based on preoperative recommendations presented in a leaflet. Malterud's principles of systematic text condensation were used to analyse the interview data, and descriptive statistics were used to describe the activity registrations. Results Five domains clarify central aspects of the patients' perspectives on and acceptability of prehabilitation: the preoperative period, attitudes towards prehabilitation, the actual prehabilitation performed, motivation to take action and the need for support. Conclusion Patients undergoing major abdominal cancer surgery are interested in and positive towards prehabilitation, but it has to be on their terms. The patients need support and supervision, but it has to be provided in a setting and in a way that are in line with the patient's preferences, resources and values. Thus, patient involvement is necessary to create prehabilitation programmes that are feasible and fit into patients' everyday lives.
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Prehabilitation is a rather new method of approach to the physical therapy setting in which patients attend therapy sessions to prepare for their upcoming surgery. Researchers hypothesize that if patients enter a procedure with higher levels of strength and function, they will be able to recover from their surgery quicker and more successfully. This literature review assesses different approaches that numerous studies have taken with regards to prehabilitation for patients about to undergo a Total Knee Arthroplasty. Majority of the studies conclude that there needs to be further research done to yield consistent results. Based on what has been done, prehabilitation does not yield enough statistically significant results to justify the implementation of such a program for all individuals. The current discourse analyzes the impact of prehabilitation on objective measurements of the knee however, should shift towards analyzing the impact prehabilitation has on future health-care spending for patients.
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