STRONG for Surgery & Strong for Life - Against All Odds: Intensive Prehabilitation for Risk Reduction in Cancer Surgery
- Conditions
- Risk ReductionUrological CancerSurgeryLife Style
- Interventions
- Behavioral: Prehabilitation
- Registration Number
- NCT04088968
- Lead Sponsor
- Bispebjerg Hospital
- Brief Summary
Despite knowledge about the effect of preventive measures in lifestyle, smoking,nutrition, alcohol and physical activity (SNAP), there is a lack of systematic assessment of the overall lifestyle of the patient before surgery and knowledge about how lifestyle interventions can be organized in connection with cancer surgery. The intention with prehabilitation is to optimize the individual's risk factors and personal burdens that can affect the clinical and patient reported outcomes after surgery. The aim of this study is to evaluate the efficacy of intensive SNAP interventions compared to treatment as usual (TAU) in ptt undergoing urological cancer surgery on surgical risk reduction.
- Detailed Description
The project contains three clinical intervention studies, in total including 100 urological cancer patients screened positive for at least 1 SNAP factor:
I. Efficacy and preferences of intensive SNAP-Interventions among patients with at least one SNAP factor and undertaking neo-adjuvant chemotherapy before radical cystectomy. A randomised controlled trial with nested interviews (42 patients).
II. Implementation and preferences of intensive SNAP-Interventions among patients with kidney cancer undergoing nephrectomy/partial nephrectomy. An implementation feasibility study including interviews (20 patients).
III. Reach out and effect as well as preferences of perioperative intensive smoking cessation intervention via the municipality clinic compared to the surgical department among smokers with non-invasive bladder cancer treated with Trans-Urethral Resection of the Bladder (TUR-B). A randomised controlled trial with nested interviews (38 patients).
The intervention groups receive minimum five educational sessions tailored to individual needs over six weeks perioperatively. The control groups receive standard care.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 100
- Patients > 18 years scheduled for cystectomy due to bladder cancer
- Referral to neoadjuvant chemotherapy
- Screened positive for minimum 1 SNAP factor
- Signed informed consent
- Pregnancy and breastfeeding
- Allergy to pharmaceutical support (Nicotine Replacement Therapy, Disulfiram)
- Contraindications to exercise.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Prehabilitation Prehabilitation Intervention: Patients allocated to the intervention group receive weekly counselling sessions in 6 weeks as an integrated prehabilitation program tailored to meet the individual patient's need for risk reduction at surgery. It is introduced via the surgical 'Engage in the process of change'. The smoking and alcohol cessation intervention follows the Gold Standard Programme and patients in the intervention group are introduced to a standardized exercise training programme taking individualized needs into account. Nutritional support is also individualized.
- Primary Outcome Measures
Name Time Method Number of patients with risk reduction at surgery End of intervention/ at surgery Corresponding at least 1 step for 1 or more risky lifestyles (but only smoking in study III) on the ASA-score (American Society of Anaesthesiologists physical status classification from 1-5, lower is better)
- Secondary Outcome Measures
Name Time Method Number of successful tobacco quitters 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months Successful quitting smoking: Study I+ II+ III
* Successful quitting alcohol intake at 6 weeks and below risky limits at 6 months: Study I.
* Physical activity at least 30 minutes per day: Study I.
* Malnutrition: Not at risk of malnutrition: Study I. Obesity: 5% -10 % loss of body fat mass and below 1% gain of body fat mass at 6 months (without developing malnutrition)Health related quality of life (HRQoL) 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months Mean difference of HRQoL between groups measured with EQ5D (5 level quality of life score (level 1 =no problems, level 2-5 =problems)
Number of patients not at risk of malnutrition 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months NRS2002 (Nutritional Risk Screening 2002) score\>2. Lower is better: Study I+II
Number of patients with any reduction in lifestyle 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months Measured by yes/no. Study I+II+III
Number of patients being physical active at least 30 min per day 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months Minutes physical active measured by an accelerometer (longer time is better) : Study I+II
Number of patients with improved frailty level 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months Measured by Lammers definition: Lower is better: Study I+II+III
Number of patients with any postoperative complication 30 days Scored by the Comprehensive Complication Index, a linear scale ranging from 0 (no complication) to 100 (death)
Number of patients not at risk of obesity 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months BMI (Body Mass Index)\<30. Lower is better : Study I+II
Number of successful alcohol quitters 6 weeks/day at surgery, at 1 month and through study completion, an average of 6 months Successful quitting alcohol: Study I+II
Trial Locations
- Locations (1)
Dept Urology 2112, Copenhagen University Hospital, Rigshospitalet
🇩🇰Copenhagen, Region H, Denmark