Cancer of Colon, Cancer of Rectum, Liver Metastases
Conditions
Keywords
prehabilitation, surgery, cardiopulmonary exercise testing, cytokines
Brief summary
To determine whether exercise and nutrition prehabilitation improves patient outcomes after cancer surgery
Detailed description
Preliminary qualitative and quantitative studies suggest that there are benefits (reduced length of stay, improved cardiorespiratory function, reduced postoperative complications and improved quality of life) when prehabilitation is used with the context of cancer care. In 2017 Macmillian Cancer Support developed a strategic 'Evidence and Insight' review on prehabilitation. The outcome of this was to incorporate prehabilitation into routine cancer care and to develop principles and guidance for prehabilitation. This study aims to support this vision and answer some of the questions on the patients who are most likely to benefit from prehabilitation and to quantify some of these benefits by investigating the molecular processes that influence clinical changes This study primarily seeks to assess the cardiovascular and biological impact of prehabilitation (exercise, nutrition) on patients undergoing hepatobiliary and colorectal cancer surgery. The investigators aim to assess whether there is an improvement in various cardiopulmonary exercise testing (CPET) variables such as maximum oxygen consumption and anaerobic threshold. The investigators also aim to study the inflammatory cytokines associated with cancer and how these markers respond to exercise. These inflammatory markers are thought to play a role in influencing some clinical outcomes such as wound infection and recovery. The study will also assess secondary outcomes including hospital stay, post operative complications and quality of life. The investigators aim to better understand the biological relationship between anti-inflammatory cytokine levels and the previously mentioned outcomes by measuring and analysing these mediators and performing selected muscle biopsies.
Interventions
OTHERPrehabilitation
exercise & multivitamin (nutritional/dietary advice)
Sponsors
Lancaster University
East Lancashire Hospitals NHS Trust
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
CPET clinician/physiologist will be blinded
Intervention model description
1:1 randomisation to standard care or prehabilitation
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Aged 18-85 * Sex: male/female * Radiological/tissue cancer diagnosis * Curative cancer of the colon, rectum, colorectal liver metastases (CRLM) of 2 or more segments * elective surgery (planned a minimum of 3 weeks from the date of first clinic meeting) * Access to digital technology(mobile phone, tablet or laptop, home computer) to participate in supervised home exercise
Exclusion criteria
Exclusion * Palliative disease * Haematological malignancy * Pregnancy * Emergency surgery * Physically unable to undergo CPET * Part of any other trial with similar interventions unless previously agreed on with all CIs * synchronous disease (operation on HPB & colorectal cancers at the same operation) * No access to digital technology(smart phone, tablet, laptop or home computer)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Anaerobic threshold (AT) measured in ml/kg/min and maximum oxygen consumption ( VO2 peak) measured in ml/kg/min | change in baseline AT & VO2 peak at 4 weeks | Cardiopulmonary exercise Test (CPET) variables |
| Inflammatory cytokines | change in baseline cytokines at 4 weeks | IL6 IL10 in muscle and blood measured in pg/ml |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of life measures (Illness Perception Questionnaire) | baseline and within 24 weeks after surgery | This questionnaire assesses perceptions on each of the five dimensions(Identity, Cause, Timeline, Consequences, Cure-Control) by asking patients for their own beliefs about their condition. High scores on the identity, consequences, timeline acute/ chronic and cyclical subscales represent strongly held beliefs about the number of symptoms attributed, the negative consequences, and the chronicity and cyclical nature of the illness. High scores on the identity and cure-control and coherence subscales represent positive beliefs about controllability and a personal understanding of the illness. |
| Clavien-Dindo complication rates | Up to 30 days from the day of operation | Grades I-IV |
| Quality of life measure (Mental Adjustment to Cancer Scale) | baseline and within 24 weeks after surgery | Assessment of participants mental adjustment to a cancer diagnosis. Designed to measure Fighting Spirit (FS), Anxious Preoccupation (AP), Helpless-hopelessness (HH) and Fatalism. This is a 40-item measure of specific psychological (Coping) responses that cancer patients may display in the process of adjusting to the diagnosis and treatment of their disease. A higher score represents higher endorsement of the adjustment response. |
| Hand Grip Strength measured in kg | baseline, immediately after the intervention, within 24 weeks after surgery | Measured by digital dynamometer |
| Length of hospital stay measured in days | 30 & 90-day mortality | Defined as duration of stay from date of operation to discharge |
Countries
United Kingdom
Outcome results
None listed