Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation The effects of prehabilitation versus usual care to reduce postoperative complications in high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: study protocol of a randomized controlled trial Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES):A randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue Supervised physical exercise to improve the quality of life of cancer patients: the EFICANCER randomised controlled trial Quality-of-life and surgical treatments for rectal cancer--a longitudinal analysis using the California Cancer Registry. CRITICS-II: a multicentre randomised phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo-adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo-adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers Randomised controlled trial of a supervised exercise rehabilitation program for colorectal cancer survivors immediately after chemotherapy: study protocol Iyengar-Yoga Compared to Exercise as a Therapeutic Intervention during (Neo)adjuvant Therapy in Women with Stage I–III Breast Cancer: Health-Related Quality of Life, Mindfulness, Spirituality, Life Satisfaction, and Cancer-Related Fatigue Perioperative rehabilitation in operation for lung cancer (PROLUCA) – rationale and design Randomized controlled trial to evaluate the effects of progressive resistance training compared to progressive muscle relaxation in breast cancer patients undergoing adjuvant radiotherapy: the BEST study EnROL: A multicentre randomised trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': A feasibility study PEACH Trial: Prescribed exercise after chemotherapy Safety, feasibility and effects of an individualised walking intervention for women undergoing chemotherapy for ovarian cancer: a pilot study Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Effects of systematic rehabilitation programs on quality of life in patients undergoing lung resection. Antecedents of domain-specific quality of life after colorectal cancer. Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation Health-related quality of life and postoperative length of stay for patients with colorectal cancer. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. Cognitive behavioral therapy and physical exercise for climacteric symptoms in breast cancer patients experiencing treatment-induced menopause: design of a multicenter trial
Background Colorectal cancer ( CRC ) is the second most prevalent type of cancer in the world . Surgery is the only curative option . However , postoperative complications occur in up to 50 % of patients and are associated with higher morbidity and mortality rates , lower health related quality of life ( HRQoL ) and increased expenditure in health care . The number and severity of complications are closely related to preoperative functional capacity , nutritional state , psychological state , and smoking behavior . Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes . However , recent evidence shows that the preoperative period might be the optimal moment for intervention . This study will determine the impact of multimodal prehabilitation on patients ’ functional capacity and postoperative complications . Methods / design This international multicenter , prospect i ve , r and omized controlled trial will include 714 patients undergoing colorectal surgery for cancer . Patients will be allocated to the intervention group , which will receive 4 weeks of prehabilitation ( group 1 , prehab ) , or the control group , which will receive no prehabilitation ( group 2 , no prehab ) . Both groups will receive perioperative care in accordance with the enhanced recovery after surgery ( ERAS ) guidelines . The primary outcomes for measurement will be functional capacity ( as assessed using the six-minute walk test ( 6MWT ) ) and postoperative status determined with the Comprehensive Complication Index ( CCI ) . Secondary outcomes will include HRQoL , length of hospital stay ( LOS ) and a cost-effectiveness analysis . Discussion Multimodal prehabilitation is expected to enhance patients ’ functional capacity and to reduce postoperative complications . It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer . Trial registration Trial Registry : NTR5947 – date of registration : 1 August 2016 Background Of all older patients that opt for elective colorectal surgery , approximately one-third has one or more postoperative complications , particularly those patients with a low cardiorespiratory fitness ( ventilatory anaerobic threshold ( VAT ) < 11 mL/kg/min ) . A physical exercise training program prior to surgery ( prehabilitation ) can improve their cardiorespiratory fitness . It remains to be seen whether prehabilitation also reduces postoperative complications , as most of the studies so far were rather underpowered , heterogeneous , and biased toward selection of patients with a lower risk of postoperative complications . The primary objective of this study is to evaluate the effects of a three-week prehabilitation program on 30-day postoperative complications in patients with a VAT < 11 mL/kg/min planned for elective colorectal resection for colorectal cancer or dysplasia . Methods In this multicenter prospect i ve r and omized controlled trial , patients ≥ 60 years with colorectal cancer or dysplasia grade I , II , or III , planned for elective colorectal resection in two hospitals in the Netherl and s , will be recruited . Eligible patients must have a score ≤ 7 metabolic equivalents on the veterans-specific activity question naire , and should be able to perform a cardiopulmonary exercise test . A total of 86 patients will be r and omized ( block-stratified r and omization ) to prehabilitation ( intervention group ) or usual care ( control group ) . For final inclusion , VAT should be < 11 mL/kg/min . Three times a week for 3 weeks , a 60-min supervised prehabilitation session will be completed in community physical therapy practice s by the 43 patients in the prehabilitation group , consisting of moderate-to-high intensity interval training to improve cardiorespiratory fitness , and resistance training to improve peripheral muscle strength . Additionally , patients perform home exercises twice a week on a moderate intensity level . The 43 patients in the usual care group will receive usual care . Discussion Optimizing preoperative physical fitness may decrease the postoperative complication rate , may lead to fewer reoperations , less intense clinical care , a shorter length of stay , a more effective surgical planning ( process-optimization ) , fewer readmissions , less intense rehabilitation , shorter rehabilitation period , earlier resumption of work , enhance patient perceived health-related quality of life , and promote performance in daily life . Cost-effectiveness should therefore be expected and evaluated . Trial registration Medical Ethics Committee Twente , Enschede , the Netherl and s ( NL45001.044.13 , September 3 , 2013 ) ; Netherl and s Trial Register ( NTR ; NTR4032 , June 14 , 2013 ) Background Cancer chemotherapy is frequently associated with a decline in general physical condition , exercise tolerance , and muscle strength and with an increase in fatigue . While accumulating evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining cardiorespiratory fitness and strength , the results of studies conducted to date have not been consistent . Additional research is needed to determine the optimal intensity of exercise training programs in general and in particular the relative effectiveness of supervised , outpatient ( hospital- or physical therapy practice -based ) versus home-based programs . Methods This multicenter , prospect i ve , r and omized trial will evaluate the effectiveness of a low to moderate intensity , home-based , self-management physical activity program , and a high intensity , structured , supervised exercise program , in maintaining or enhancing physical fitness ( cardiorespiratory fitness and muscle strength ) , in minimizing fatigue and in enhancing the health-related quality of life ( HRQoL ) .  Patients receiving adjuvant chemotherapy for breast or colon cancer ( n = 360 ) are being recruited from twelve hospitals in the Netherl and s , and r and omly allocated to one of the two treatment groups or to a  ' usual care ' control group .  Performance-based and self-reported outcomes are assessed at baseline , at the end of chemotherapy and at six month follow-up . Discussion This large , multicenter , r and omized clinical trial will provide additional empirical evidence regarding the effectiveness of physical exercise during adjuvant chemotherapy in enhancing physical fitness , minimizing fatigue , and maintaining or enhancing patients ' quality of life . If demonstrated to be effective , exercise intervention programs will be a welcome addition to the st and ard program of care offered to patients with cancer receiving chemotherapy . Trial registration This study is registered at the Netherl and s Trial Register ( NTR 2159 Background The optimal form of exercise for individuals with cancer has yet to be identified , but there is evidence that exercise improves their quality of life . The aim of this study is to assess the efficacy and efficiency of an innovative physical exercise programme , for individuals undergoing chemotherapy for breast , gastrointestinal or non-small cell lung tumours , for improving quality of life , reducing level of fatigue , and enhancing functional capacity over time . Design / Methods We will conduct a clinical trial in 66 patients with stage IV breast , gastrointestinal or non-small cell lung cancer , recruited by the Department of Oncology of the referral hospital from 4 primary care health centres of the Basque Health Service ( Osakidetza ) . These patients will be r and omised to one of two groups . The treatment common to both groups will be the usual care for cancer : optimized usual drug therapies and strengthening of self-care ; in addition , patients in the intervention group will participate in a 2-month exercise programme , including both aerobic and strength exercises , supervised by nurses in their health centre . The principal outcome variable is health-related quality of life , measured blindly with the 30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Question naire and Short Form-36 four times : at baseline , and 2 , 6 and 12 months later . The secondary outcome variables are fatigue ( Functional Assessment of Chronic Illness Therapy-Fatigue question naire ) , functional capacity ( 6-Minute Walk Test and cardiorespiratory test ) , muscle strength ( h and -held dynamometry and sit-to-st and test ) , radiological response to treatment ( Response Evaluation Criteria In Solid Tumors ) and progression-free and overall survival . Age , sex , diagnosis , chemotherapy regimen , Eastern Cooperative Oncology Group performance status and smoking status will be considered as predictive variables . Data will be analysed on an intention-to-treat basis , comparing changes at each time point between groups , adjusting for baseline values by analysis of covariance . Discussion As well as achieving the objectives set , this study will provide us with information on patient perception of the care received and an opportunity to develop a project based on collaborative action between the primary care and oncology professionals . Trial registration Clinical Trials.gov Identifier : NCT01786122 Registration date : 02/05/2013 BACKGROUND Heterogeneous results for research investigating health-related quality of life ( HRQL ) in patients undergoing sphincter-ablating procedures for rectal cancer are likely due to single institution experiences and measurement of HRQL . To address this heterogeneity , we evaluated HRQL in patients with rectal cancer by type of surgery , location of tumor , and receipt of adjuvant therapy using an HRQL instrument that has not been used to address rectal cancer patients in a population -based sample over time . METHODS The Functional Assessment of Cancer Therapy-Colorectal instrument was administered at 9 and 19 months after diagnosis to a consecutive sample of 160 patients in Northern California identified by the California Cancer Registry . A broad multidimensional interpretation of HRQL was used to examine the impact of tumor location and treatment status , stage of disease , age , and gender . RESULTS In general , men had lower social well-being scores , and younger patients had lower physical and emotional well-being scores and colorectal concerns scores . We found no differences in HRQL by either tumor location or type of surgery , at either 9 or 19 months after diagnosis . Lower physical well-being and greater adverse colorectal concerns were reported at 9 months among patients who received adjuvant therapy ; however , only adverse colorectal concerns persisted over time . CONCLUSIONS This study provides additional evidence that sphincter-ablating procedures do not necessarily reduce quality of life in patients with rectal cancer . Distinctive features of this study include a broad multidimensional interpretation of HRQL , the 19 months of longitudinal follow-up , and a prospect i ve population -based study design Background Although radical surgery remains the cornerstone of cure in resectable gastric cancer , survival remains poor . Current evidence -based (neo)adjuvant strategies have shown to improve outcome , including perioperative chemotherapy , postoperative chemoradiotherapy and postoperative chemotherapy . However , these regimens suffer from poor patient compliance , particularly in the postoperative phase of treatment . The CRITICS-II trial aims to optimize preoperative treatment by comparing three treatment regimens : ( 1 ) chemotherapy , ( 2 ) chemotherapy followed by chemoradiotherapy and ( 3 ) chemoradiotherapy . Methods In this multicentre phase II non-comparative study , patients with clinical stage IB-IIIC ( TNM 8th edition ) resectable gastric adenocarcinoma are r and omised between : ( 1 ) 4 cycles of docetaxel+oxaliplatin+capecitabine ( DOC ) , ( 2 ) 2 cycles of DOC followed by chemoradiotherapy ( 45Gy in combination with weekly paclitaxel and carboplatin ) or ( 3 ) chemoradiotherapy . Primary endpoint is event-free survival , 1 year after r and omisation ( events are local and /or regional recurrence or progression , distant recurrence , or death from any cause ) . Secondary endpoints include : toxicity , surgical outcomes , percentage radical ( R0 ) resections , pathological tumour response , disease recurrence , overall survival , and health related quality of life . Exploratory endpoints include translational studies on predictive and prognostic biomarkers . Discussion The aim of this study is to select the most promising among three preoperative treatment arms in patients with resectable gastric adenocarcinoma . This treatment regimen will subsequently be compared with the st and ard therapy in a phase III trial . Trial registration clinical trials.gov NCT02931890 ; registered 13 October 2016 . Date of first enrolment : 21 December 2017 Objective : To establish reliable st and ards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living ( ADL ) and quality of life ( QOL ) . Summary Background Data : ADL and QOL are important outcomes of surgery for the elderly . However , there has been only limited evidence on the natural course of recovery of functional independence . Methods : Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospect ively examined .  Physical conditions , ADL , and QOL  were evaluated preoperatively and at the first , third , and sixth postoperative month . Results : The mortality and morbidity rates were 0.4 % and 28 % , respectively . Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively , but most patients recovered from this transient reduction , with only 3 % showing a decline at the sixth postoperative month ( 6POM ) . ADL of these patients was likely to decrease after discharge from the hospital . QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores . Conclusions : Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer , only a few showed a protracted decline in ADL and most exhibited better QOL after surgery . This indicates that surgical treatment should be considered , whenever needed , for elderly patients 75 years old or older with gastric or colorectal cancer . Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability ; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients Background Colorectal cancer ( CRC ) diagnosis and the ensuing treatments can have a substantial impact on the physical and psychological health of survivors . As the number of CRC survivors increases , so too does the need to develop viable rehabilitation programs to help these survivors return to good health as quickly as possible . Exercise has the potential to address many of the adverse effects of CRC treatment ; however , to date , the role of exercise in the rehabilitation of cancer patients immediately after the completion of treatment has received limited research attention . This paper presents the design of a r and omised controlled trial which will evaluate the feasibility and efficacy of a 12-week supervised aerobic exercise program ( ImPACT Program ) on the physiological and psychological markers of rehabilitation , in addition to biomarkers of st and ard haematological outcomes and the IGF axis . Methods / Design Forty CRC patients will be recruited through oncology clinics and r and omised to an exercise group or a usual care control group .  Baseline assessment will take place within 4 weeks of the patient completing adjuvant chemotherapy treatment . The exercise program for patients in the intervention group will commence a week after the baseline assessment . The program consists of three supervised moderate-intensity aerobic exercise sessions per week for 12 weeks . All participants will have assessment s at baseline ( 0 wks ) , mid-intervention ( 6 wks ) , post-intervention ( 12 wks ) and at a 6-week follow-up ( 18 wks ) . Outcome measures include cardio-respiratory fitness , biomarkers associated with health and survival , and indices of fatigue and quality of life . Process measures are participants ' acceptability of , adherence to , and compliance with the exercise program , in addition to the safety of the program . Discussion The results of this study will provide valuable insight into the role of supervised exercise in improving life after CRC . Additionally , process analyses will inform the feasibility of implementing the program in a population of CRC patients immediately after completing chemotherapy . Trial registration This study aims to test the effects of yoga on health-related quality of life , life satisfaction , cancer-related fatigue , mindfulness , and spirituality compared to conventional therapeutic exercises during (neo)adjuvant cytotoxic and endocrine therapy in women with breast cancer . In a r and omized controlled trial 92 women with breast cancer undergoing oncological treatment were r and omly enrolled for a yoga intervention ( YI ) ( n = 45 ) or for a physical exercise intervention ( PEI ) ( n = 47 ) . Measurements were obtained before ( t 0 ) and after the intervention ( t 1 ) as well as 3 months after finishing intervention ( t 2 ) using st and ardized question naires . Life satisfaction and fatigue improved under PEI ( p < 0.05 ) but not under YI ( t 0 to t 2 ) . Regarding quality of life ( EORTC QLQ-C30 ) a direct effect ( t 0 to t 1 ; p < 0.001 ) of YI was found on role and emotional functioning , while under PEI only emotional functioning improved . Significant improvements ( p < 0.001 ) were observed at both t 1 and t 2 also for symptom scales in both groups : dyspnea , appetite loss , constipation , and diarrhea . There was no significant difference between therapies for none of the analyzed variables neither for t 1 nor for t 2 . During chemotherapy , yoga was not seen as more helpful than conventional therapeutic exercises . This does not argue against its use in the recovery phase Background The purpose of the PROLUCA study is to investigate the efficacy of preoperative and early postoperative rehabilitation in a non-hospital setting in patients with operable lung cancer with special focus on exercise . Methods Using a 2x2 factorial design with continuous effect endpoint ( Maximal Oxygen Uptake ( VO2peak ) ) , 380 patients with non-small cell lung cancer ( NSCLC ) stage I-IIIa referred for surgical resection will be r and omly assigned to one of four groups : ( 1 ) preoperative and early postoperative rehabilitation ( starting two weeks after surgery ) ; ( 2 ) preoperative and late postoperative rehabilitation ( starting six weeks after surgery ) ; ( 3 ) early postoperative rehabilitation alone ; ( 4 ) today ’s st and ard care which is postoperative rehabilitation initiated six weeks after surgery . The preoperative rehabilitation program consists of an individually design ed , 30-minute home-based exercise program performed daily . The postoperative rehabilitation program consists of a supervised group exercise program comprising cardiovascular and resistance training two-hour weekly for 12 weeks combined with individual counseling . The primary study endpoint is VO2peak and secondary endpoints include : Six-minute walk distance ( 6MWD ) , one-repetition-maximum ( 1RM ) , pulmonary function , patient-reported outcomes ( PROs ) on health-related quality of life ( HRQoL ) , symptoms and side effects of the cancer disease and the treatment of the disease , anxiety , depression , wellbeing , lifestyle , hospitalization time , sick leave , work status , postoperative complications ( up to 30 days after surgery ) and survival . Endpoints will be assessed at baseline , the day before surgery , pre-intervention , post-intervention , six months after surgery and one year after surgery . Discussion The results of the PROLUCA study may potentially contribute to the identification of the optimal perioperative rehabilitation for operable lung cancer patients focusing on exercise initiated immediately after diagnosis and rehabilitation shortly after surgery . Trial Registration Background Cancer-related fatigue ( CRF ) is one of the most common and distressing side effects of cancer and its treatment . During and after radiotherapy breast cancer patients often suffer from CRF which frequently impairs quality of life ( QoL ) . Despite the high prevalence of CRF in breast cancer patients and the severe impact on the physical and emotional well-being , effective treatment methods are scarce . Physical activity for breast cancer patients has been reported to decrease fatigue , to improve emotional well-being and to increase physical strength . The pathophysiological and molecular mechanisms of CRF and the molecular-biologic changes induced by exercise , however , are poorly understood . In the BEST trial we aim to assess the effects of resistance training on fatigue , QoL and physical fitness as well as on molecular , immunological and inflammatory changes in breast cancer patients during adjuvant radiotherapy . Methods / design The BEST study is a prospect i ve r and omized , controlled intervention trial investigating the effects of a 12-week supervised progressive resistance training compared to a 12-week supervised muscle relaxation training in 160 patients with breast cancer undergoing adjuvant radiotherapy .  To determine the effect of exercise itself beyond potential psychosocial group effects , patients in the control group perform a group-based progressive muscle relaxation training . Main inclusion criterion is histologically confirmed breast cancer stage I-III after lumpectomy or mastectomy with indication for adjuvant radiotherapy . Main exclusion criteria are acute infectious diseases , severe neurological , musculosceletal or cardiorespiratory disorders . The primary endpoint is cancer-related fatigue ; secondary endpoints include immunological and inflammatory parameters analyzed in peripheral blood , saliva and urine . In addition , QoL , depression , physical performance and cognitive capacity will be assessed . Discussion The BEST study is the first r and omized controlled trial comparing progressive resistance training with muscle relaxation training in breast cancer patients during adjuvant radiotherapy . Based on the analysis of physiological , immunological and inflammatory parameters it will contribute to a better underst and ing of the physiological and psychosocial effects and the biological mechanisms of resistance training . The ultimate goal is the implementation of optimized intervention programs to reduce fatigue , improve quality of life and potentially the prognosis after breast cancer . Trial registration Clinical Trials.gov Background During the last two decades the use of laparoscopic resection and a multimodal approach known as an enhanced recovery programme , have been major changes in colorectal perioperative care . Clinical outcome improves using laparoscopic surgery to resect colorectal cancer but until recently no multicentre trial evidence had been reported regarding whether the benefits of laparoscopy still exist when open surgery is optimized within an enhanced recovery programme . The EnROL trial ( Enhanced Recovery Open versus Laparoscopic ) examines the hypothesis that laparoscopic surgery within an enhanced recovery programme will provide superior postoperative outcomes when compared to conventional open resection of colorectal cancer within the same programme . Methods / design EnROL is a phase III , multicentre , r and omised trial of laparoscopic versus open resection of colon and rectal cancer with blinding of patients and outcome observers to the treatment allocation for the first 7 days post-operatively , or until discharge if earlier . 202 patients will be recruited at approximately 12 UK hospitals and r and omised using minimization at a central computer system in a 1:1 ratio . Recruiting surgeons will previously have performed > 100 laparoscopic colorectal resections  and > 50  open total mesorectal excisions to minimize conversion . Eligible patients are those suitable for elective resection using either technique . Excluded patients include : those with acute intestinal obstruction and patients in whom conversion from laparoscopic to open procedure is likely . The primary outcome is physical fatigue as measured by the physical fatigue domain of the multidimensional fatigue inventory 20 ( MFI-20 ) with secondary outcomes including postoperative hospital stay ; complications ; reoperation and readmission ; quality of life indicators ; cosmetic assessment s ; st and ardized performance indicators ; health economic analysis ; the other four domains of the MFI-20 . Pathological assessment of surgical quality will also be undertaken and compliance with the enhanced recovery programme will be recorded for all patients . Discussion Should this trial demonstrate that laparoscopic surgery confers a significant clinical and /or health economic benefit this will further support the transition to this type of surgery , with implication s for the training of surgeons and re source allocation . Trial registration IS RCT N48516968 Background Many cancer survivors suffer a range of physical and psychological symptoms which may persist for months or years after cessation of treatment . Despite the known benefits of exercise and its potential to address many of the adverse effects of treatment , the role of exercise as well as optimum duration , frequency , and intensity in this population has yet to be fully eluci date d. Many cancer rehabilitation programmes presented in the literature are very long and have tight eligibility criteria which make them non-applicable to the majority of cancer survivors . This paper presents the protocol of a novel 8-week intervention which aims to increase fitness , and address other physical symptoms in a heterogeneous cancer survivor population . Methods / design The aim is to recruit 64 cancer survivors 2 - 6 months after completion of chemotherapy , usually adjuvant , with curative intent . Subjects will be recruited through oncology clinics in a single institution and r and omised to usual care or an exercise intervention .  The exercise intervention consists of two specifically tailored supervised moderate intensity aerobic exercise sessions weekly over 8-weeks . All participants will be assessed at baseline ( 0 weeks ) , at the end of the intervention ( 8 weeks ) , and at 3-month follow-up . The primary outcome measure is fitness , and secondary patient-related outcome measures include fatigue , quality of life , and morphological outcomes . A further secondary outcome is process evaluation including adherence to and compliance with the exercise program . Discussion This study will provide valuable information about the physical outcomes of this 8-week supervised aerobic programme . Additionally , process information and economic evaluation will inform the feasibility of implementing this program in a heterogeneous population post cessation of chemotherapy . Trial Registration Background Exercise interventions during adjuvant cancer therapy have been shown to increase functional capacity , relieve fatigue and distress and may assist rates of chemotherapy completion . These studies have been limited to breast , gastric and mixed cancer groups and it is not yet known if a similar intervention is even feasible among women with ovarian cancer . We aim ed to assess safety , feasibility and potential effect of a walking intervention in women undergoing chemotherapy for ovarian cancer . Methods Women newly diagnosed with ovarian cancer were recruited to participate in an individualised walking intervention throughout chemotherapy and were assessed pre- and post-intervention .  Feasibility measures included session adherence , compliance with exercise physiologist prescribed walking targets and self-reported program acceptability . Changes in objective physical functioning ( 6-minute walk test ) , self-reported distress ( Hospital Anxiety and Depression Scale ) , symptoms ( Memorial Symptom Assessment Scale - Physical ) and quality of life ( Functional Assessment of Cancer Therapy - Ovarian ) were calculated , and chemotherapy completion and adverse intervention effects recorded . Results Seventeen women were enrolled ( 63 % recruitment rate ) . Mean age was 60 years ( SD = 8 years ) , 88 % were diagnosed with FIGO stage III or IV disease , 14 women underwent adjuvant and three neo-adjuvant chemotherapy . On average , women adhered to > 80 % of their intervention sessions and complied with 76 % of their walking targets , with the majority walking four days a week at moderate intensity for 30 minutes per session . Meaningful improvements were found in physical functioning , physical symptoms , physical well-being and ovarian cancer-specific quality of life . Most women ( 76 % ) completed ≥85 % of their planned chemotherapy dose . There were no withdrawals or serious adverse events and all women reported the program as being helpful . Conclusions These positive preliminary results suggest that this walking intervention for women receiving chemotherapy for ovarian cancer is safe , feasible and acceptable and could be used in development of future work . Trial registration Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register BACKGROUND The clinical syndrome of frailty identified through the assessment of weight loss , gait speed , grip strength , physical activity , and physical exhaustion has been used to identify patients with reduced reserves . We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients . METHODS A prospect i ve study was conducted at 2 centers ( Singapore and Japan ) . All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty .  All these patients had already had their comorbidities optimized for surgery . The outcome measure was postoperative major complications ( defined as Clavien-Dindo type II and above complications ) . RESULTS Eighty-three patients were studied from February 2008 to April 2010 . The mean age was 81.5 years ( range 75 - 93 years ) . The mean comorbidity index was 3.37 ( range 0 - 11 ) . Twenty-six ( 31.3 % ) patients were an American Society of Anesthesiologists ( ASA ) score of 3 and above . Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 ( 95 % confidence interval , 1.433 - 11.638 ) when the patient satisfied the criteria for frailty . Albumin < 35 , ASA > 3 , comorbidity index > 5 , and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity ( POSSUM ) scores were not predictive of postoperative major complications . CONCLUSIONS Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity . Frailty can be used to identify elderly patients needing further optimization before major surgery The aim of this study was to investigate the effects of systematic rehabilitation programs on the quality of life ( QOL ) in patients undergoing lung resection of malignant lung lesions . In this prospect i ve population -based cohort study , QOL in patients prior to , as well as 3 and 6 months after surgery , was investigated . Using a single-group design , 48 patients ( 7 females and 41 males ) with suspected operable lung cancer were included in this study . The demographic characteristics and the clinical history of the patients were recorded . QOL [ assessed using the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core 3.0 ( EORTC QLQ-C30 ) ] was evaluated at baseline ( immediately before ) , and 3 and 6 months after surgical resection . The systematic rehabilitation program , including breathing control , breathing exercises , relaxation training , upper and lower extremity exercises , mobilization and additional incorporating physiotherapy programs , was design ed to meet each patient 's individual needs . The χ2 and Fisher 's tests showed no statistically significant difference in the two groups in terms of age , gender , behavior , clinical stage , adjuvant therapy and Karnofsky scores . QOL analysis of baseline was homogeneous between the experimental and control groups . Three months after the rehabilitation process , the experimental group demonstrated an increase in the general QOL functional scales and a decrease of symptom scales compared to the control group . These changes were statistically significant in the functional scales of global health ( P<0.01 ) , physical function ( P<0.01 ) , role function ( P<0.01 ) , emotional function ( P<0.05 ) , symptom scales of fatigue ( P<0.01 ) and appetite loss ( P=0.001 ) . Six months after the intervention , the outcome was the same as 3 months after the intervention in functional scale domains . However , in the symptom scales , the symptoms in the experimental group were improved compared to the control group . The domains had been significant in the scales of fatigue ( P<0.001 ) , dyspnea ( P<0.001 ) , pain ( P<0.001 ) , insomnia ( P<0.001 ) , appetite loss ( P<0.001 ) and constipation ( P<0.001 ) . Therefore , the two groups demonstrated a statistically significant difference in 10 domains . In addition , the experimental group demonstrated a significant recovery . In conclusion , systematic rehabilitation programs may be beneficial for lung cancer patients by reducing respiratory symptoms , pain , and improving health-related QOL . Consequently , the findings of this study suggest that systematic rehabilitation programs , prepared by taking into consideration the individual requirements of lung cancer patients , should be incorporated into lung cancer treatment OBJECTIVE The present study prospect ively assessed the influence of medical , socio-demographic , psychological , and lifestyle variables on physical , social/family , emotional , functional well-being and colorectal cancer-specific concerns in a population -based sample of colorectal cancer survivors . METHODS Participants ( n=1822 ) were assessed at 6 and 24 months post-diagnosis . Predictor variables assessed at 6 months included socio-demographic and medical variables , symptoms/side-effects , body mass index , physical activity , optimism , social support , and cancer threat appraisal .  Quality of life ( QOL ) was assessed at 6 and 24 months post-diagnosis using the Functional Assessment of Cancer Therapy - Colorectal ( FACT-C ) . RESULTS For each QOL subscale and for the overall FACT-C scale , 6 month scores were the strongest predictor of QOL scores at 24 months post-diagnosis ( e.g. beta=0.447 , p < 0.001 for overall QOL ) . Socio-demographic , medical , and psychosocial variables , but not lifestyle variables , differentially predicted domain specific QOL . Only cancer threat appraisal was associated with all five QOL domains . CONCLUSION Cancer threat appraisal presents as a potentially modifiable variable for interventions seeking to improve QOL . Symptom management and lifestyle strategies to ameliorate the effects of co-morbidities , disease stage and troublesome symptoms such as faecal incontinence on QOL should also be included Background The use of a mobile health care application , the delivery of health care or health care‐related services through the use of portable devices , to manage functional loss , treatment‐related toxicities , and impaired quality of life in cancer patients during chemotherapy through supervised self‐management has been increasing . The aim of the present study was to evaluate the efficacy and feasibility of comprehensive mobile health care using a tailored rehabilitation program for colorectal cancer patients undergoing active chemotherapy . Patients and Methods A total of 102 colorectal cancer patients undergoing chemotherapy underwent 12 weeks of  smartphone aftercare through provision of a mobile application and wearable device that included a rehabilitation exercise program and information on their disease and treatment .  The grip strength test , 30‐second chair st and test , 2‐minute walk test , amount of physical activity ( International Physical Activity Question naire short‐form ) , quality of life ( European Organization for Research and Treatment of Cancer Quality of Life Question naire C30 ) , and nutritional status ( Patient‐generated Subjective Global Assessment ) were assessed and measured at baseline , at mid‐intervention ( 6 weeks ) , and at completion of the intervention ( 12 weeks ) . The rehabilitation exercise intensity was adjusted by the test results at every assessment and through real‐time communication between the patients and clinicians . Results Of the 102 patients , 75 completed all 12 weeks of the smartphone aftercare rehabilitation program . The lower extremity strength ( P < .001 ) and cardiorespiratory endurance ( P < .001 ) was significantly improved . Fatigue ( P < .007 ) and nausea/vomiting ( P < .040 ) symptoms were significantly relieved after the program . Conclusion A tailored rehabilitation exercise program provided through a comprehensive mobile health care application was effective in improving patients ' physical capacity and treatment‐related symptoms even during active chemotherapy . Micro‐ Abstract The use of mobile health care applications is a method increasing in use in the cancer care continuum from cancer prevention to cancer diagnosis , cancer treatment , and cancer survivorship . However , no clinical study has yet investigated the effects and feasibility of a smartphone application‐based personalized exercise intervention for colorectal cancer patients undergoing chemotherapy . In 75 colorectal cancer patients undergoing active chemotherapy , a rehabilitation program using a mobile health care application on a wearable device was effective in improving physical function and relieving cancer‐ and cancer treatment‐related toxicities , regardless of the chemotherapy duration To evaluate the efficacy and economic efficiency of a multimedia , multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer . We conducted a r and omized trial with concurrent incremental cost-effectiveness analysis and blinded baseline , 3 , 6 and 12-month follow-up assessment s amongst women undergoing adjuvant therapy following surgery for breast cancer ( n = 89 ) . The intervention was a multimedia , multimodal exercise program comprising strength , balance and endurance training elements . The control was sham flexibility and relaxation program delivered using similar material s. The primary outcome was health-related quality of life ( EQ-5D & VAS , EORTC C30 , BR23 ) . Economic outcomes included direct health care costs and productivity gains and losses . Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [ mean ( sd ) EQ-5D VAS ( 0–100 ) baseline : 72.6 ( 15.6 ) , 3 month : 80.6 ( 11.6 ) ] when compared to control group participants [ baseline : 77.5 ( 13.5 ) , 3 month : 74.1 ( 20.6 ) , P = 0.006 ] and also improved more in terms of physical function [ mean ( sd ) EORTC C30 physical function scale intervention ( 0–100 ) baseline : 84.9 ( 14.8 ) , 3 month : 86.9 ( 10.7 ) , control baseline : 91.3 ( 9.6 ) , 3 month : 86.7 ( 14.9 ) , P = 0.02 ] . These improvements were not sustained beyond this point . Upper limb volumes were also lower amongst intervention group participants . However , there was low probability that the intervention would be both less costly and more effective than the control condition ( range probability = 0.05–50.02 % depending on approach ) . Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of question able economic efficiency BACKGROUND Length of stay ( LOS ) after surgery is a major determinant of re source utilization for colorectal cancer ( CRC ) . The purpose of this study was to examine the association between pretreatment  health-related quality of life ( HRQL ) scores and postoperative hospital LOS in a cohort of patients undergoing surgery for CRC . METHODS Seventy patients with biopsy-proven CRC were enrolled in an IRB-approved , prospect i ve study . Information was collected concerning st and ard perioperative variables . Prior to surgery , all patients also completed the CRC-specific module of the Functional Assessment of Cancer Therapy ( FACT-C ) . Perioperative variables and FACT-C scores were compared with LOS in both univariate and multivariate analysis . LOS for those patients scoring in the lowest quartile on FACT-C was compared with LOS for patients scoring in the remaining quartiles . RESULTS Median length of stay for the entire group was 6 ( range 3 - 25 ) days . In univariate analysis , surgical complications ( 10.6 vs 6.6 days ; P = 0.001 ) and with poorer FACT-C individual scale scores for Physical Well-Being ( 9.1 vs 7.3 days ; P = 0.04 ) , Functional Well-Being ( 9.6 vs 7.1 days ; P = 0.006 ) , and Colorectal Cancer Concerns ( 9.5 vs 7.1 days ; P = 0.01 ) were all significantly associated with increased length of stay . In multivariate analysis , surgical morbidity ( OR = 5.6 ; 95 % CI 1.5 - 21.4 ) , age > 72 ( OR = 6.0 ; 95 % CI 1.6 - 23.5 ) , and low FACT-C total score ( OR = 4.2 ; 95 % CI 1.1 - 15.6 ) were independently associated with increased LOS . CONCLUSIONS Pretreatment HRQL scores as measured by FACT-C may be of benefit in the prediction of LOS . Such information may be an important and currently neglected means of risk-adjusting population s undergoing surgery for colorectal cancer for this outcome OBJECTIVE --To assess the differences among surgeons in postoperative complications , postoperative mortality , and survival in patients undergoing surgery for colorectal cancer . DESIGN -- Prospect i ve study of patients with colorectal cancer managed by one of 13 consultant surgeons , none of whom had a special interest in colorectal surgery . SETTING --Royal Infirmary , Glasgow . PATIENTS --645 sequential patients with colorectal cancer presenting over the six years from 1974 to 1979 . MAIN OUTCOME MEASURES --Postoperative complications , postoperative mortality ( within 30 days ) , and survival ( up to 10 years ) ; predictive factors for postoperative mortality and survival ; and relative hazard rate ratios for individual surgeons . RESULTS --The proportion of patients undergoing apparently curative resection  varied among surgeons from 40 % to 76 % ; overall postoperative mortality varied from 8 % to 30 % . After curative resection  postoperative mortality varied from 0 % to 20 % , local recurrence from 0 % to 21 % , and the rate of anastomotic leak from 0 % to 25 % . Survival at 10 years in patients who underwent curative resection varied from 20 % to 63 % , two year survival in those who underwent palliative resection varied from 7 % to 32 % , and median survival in those who underwent palliative diversion varied from one to eight months . The hazard rate ratios among individual surgeons , taking into account the identified risk factors , varied from 0.56 to 2.03 , from 0.17 to 1.92 , and from 0.57 to 1.50 for curative resection , palliative resection , and palliative diversion , respectively . CONCLUSION --There were significant variations in patient outcome among surgeons after surgery for colorectal cancer ; such differences compromise survival . A considerable improvement in overall survival might be achieved if such surgery were undertaken by surgeons with a special interest in colorectal surgery or surgical oncology Background Premature menopause is a major concern of younger women undergoing adjuvant therapy for breast cancer . Hormone replacement therapy is contraindicated in women with a history of breast cancer . Non-hormonal medications show a range of bothersome side-effects . There is growing evidence that cognitive behavioral therapy ( CBT ) and physical exercise can have a positive impact on symptoms in naturally occurring menopause . The objective of this study is to investigate the efficacy of these interventions among women with breast cancer experiencing treatment-induced menopause . Methods / design In a r and omized , controlled , multicenter trial , we are evaluating the effectiveness of CBT/relaxation , of physical exercise and of these two program elements combined , in reducing menopausal symptoms , improving sexual functioning , reducing emotional distress , and in improving the health-related quality of life of younger breast cancer patients who experience treatment-induced menopause . 325 breast cancer patients ( aged < 50 ) are being recruited from hospitals in the Amsterdam region , and r and omly allocated to one of the three treatment groups or a ' waiting list ' control group . Self-administered question naires are completed by the patients at baseline , and at 12 weeks ( T1 ) and 6 months ( T2 ) post- study entry . Upon completion of the study , women assigned to the control group will be given the choice of undergoing either the CBT or physical exercise program . Discussion Cognitive behavioral therapy and physical exercise are potentially useful treatments among women with breast cancer undergoing treatment-induced , premature menopause . For these patients , hormonal and non-hormonal therapies are contraindicated or have a range of bothersome side-effects . Hence , research into these interventions is needed , before dissemination and implementation in the current health care system can take place . Trial registration The study is registered at the Netherl and s Trial Register ( NTR1165 ) and Clinical Trials.gov ( NCT00582244 )
Endurance training alone was found to increase both lower extremity strength and endurance capacity .
Colorectal cancer surgery results in considerable postoperative morbidity , mortality and reduced quality of life .
As many patients will undergo additional (neo)adjuvant therapy , it is imperative that each individual optimize their physical function .
To eluci date the potential of exercise in patient optimization , we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients .