Old Injury
Conditions
Keywords
Elderly, Prehabilitation, Cancer, Surgery
Brief summary
With the conjunction of increased life expectancy and the increasing incidence of cancer with aging, older patient represent an increasing proportion of cancer patients. Increasing age is also associated with increased risk of co-morbidities as well as a decline of functional reserve of multiple organ systems, eventually leading in the context of the disease-and/or the treatment-related stress to functional deconditioning or organ failure. Surgery or complex medico-surgical procedures - that associate chemotherapy and/or radiotherapy and surgery, can be considered as one proof-of principle of such risks, since major cancer surgery the older population is at higher risk of morbi-mortality and unplanned hospitalization for geriatric events In order to reduce complications after surgery, prehabilitation has often been considered, and 71% of the surgeons would accept a 4 weeks delay before surgery to improve patients' outcomes if shown to be beneficial. However, the actual level of evidence depends on the interventions: high for pre-operative nutrition, but low for physical exercise, due to heterogeneous programs with often bad adherence. In addition, geriatric validated interventions, in order to prevent iatrogenic event, may be added in a multi-interventional model of intervention.
Detailed description
PROADAPT pilot study is a standardized geriatric intervention constructed on a multi-professional and multi-disciplinary basis after a systematic analysis of published data. This intervention was designed to be implemented pragmatically in the centers according local habits in several distinct hospital contexts in different tumor contexts. It consists in: 1. before surgery: a prehabilitation of the patients including a nutritional, physical and educational preparation; 2. during the hospitalization for surgery: an optimisation of their treatments through a pharmaceutical conciliation, educational interventions, standardization of surgical procedures and enhanced rehabilitation after surgery; 3. bridging and post-discharge interventions for hospital-to-home transition.
Interventions
BEHAVIORALstandardized geriatric intervention
Nutritional care is based on: * A personalized evaluation of nutritional balance and nutritional needs of the patient * A weekly follow-up of weight and nutritional intake Total-body rehabilitation is based on: * 2 to 3 times a week: strength exercise * 2 to 3 times a week: endurance exercise, 20 to 45 min each sequence * 2 times a week: respiratory physiotherapy Pharmaceutical conciliation and optimization according STOPP/START criteria During peri-operative time, the nurse contacts the surgical team for transmission of patient's personal data, physical medication conciliation results During rehabilitation time and hospital-home transition time, the nurse contacts the rehabilitation team for transmission of patient's personal data and care course, physical (nutritional, functional and/or comorbidities), medication conciliation results.
Sponsors
Hospices Civils de Lyon
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient ≥70 year old OR patient ≥60 years with significant comorbid condition (modified Charlson index≥3) or disability (ADL score\<6/6); * Histologically or cytologically proven cancer. * Life expectancy \> 3 months. * Written informed consent obtained * Covered by a Health System where applicable.
Exclusion criteria
* Other malignancy within the last 5 years, except for adequately treated carcinoma in situ of the cervix or squamous carcinoma of the skin, or adequately controlled limited basal cell skin cancer. * Patient unable to be regularly followed for any reason (geographic, familial, social, psychologic). * Any mental or physical handicap at risk of interfering with the appropriate treatment. * Any administrative or legal supervision where applicable
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study | 12 months | Preoperative physical activity including strength and endurance exercise assessed by physical exercises accomplished under the supervision of a physiotherapist. Number of patients with at least 1 intervention achieved in the domain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post operative morbidity | 30 and 90 days | Post operative morbidity according Clavien-Dindo classification |
| Post-operative morbidity | 90 days | Post-operative morbidity according to NCI CTC v4.4 |
| Therapeutic strategy | 12 months | Treatment plan completion rate: Number of patients for whom the treatment plan was completed. |
| Progression-free Survival | 12 months | — |
| Post-treatment complication | 12 months | Post-treatment complication grade≥3 according the National Cancer Institute Common Toxicity Criteria version 4 (NCI-CTC-v4) |
Countries
France
Outcome results
None listed