Use of a Pre-Surgical Toolkit in Improving Surgical Care and Outcomes in Older Participants With Cancer

Not Applicable

Active, not recruiting

Conditions: Malignant Neoplasm
Carcinoma
Surgical Procedure, Unspecified
Health Care Provider

Interventions: Other: Informational Intervention
Other: Best Practice
Other: Questionnaire Administration
Other: Informational Intervention with Coaching

Registration Number: NCT03857620

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: This trial studies how well the use of a pre-surgical toolkit (OPTI-Surg) works in improving surgical care and outcomes in older participants with cancer. In many elderly patients, surgery can greatly affect physical condition and the ability to return to pre-surgery levels of physical functioning. Providing pre-surgical recommendations may help improve participants' recovery rate and functioning after surgery.

Detailed Description: PRIMARY OBJECTIVES:

I. To compare 8-week postoperative function among elderly patients between sites randomized to implement the OPTI-Surg toolkit with or without a coach versus sites randomized to usual care.

SECONDARY OBJECTIVES:

I. To compare postoperative morbidity between sites randomized to implement the OPTI-Surg toolkit with or without a coach versus sites randomized to usual care.

II. To compare the penetration of the OPTI-Surg toolkit between sites randomized to implement the OPTI-Surg toolkit with a coach versus sites randomized to implement the OPTI-Surg toolkit without a coach.

Trial Design:

OUTLINE: Healthcare providers/institutions are randomized to 1 of 3 arms. Patients/participants receive the intervention based on which arm their healthcare provider is in.

ARM I: Healthcare providers/institutions perform usual care.

ARM II: Healthcare providers/institutions receive OPTI-Surg training and informational materials.

ARM III: Healthcare providers/institutions receive OPTI-Surg training and informational materials and meet with a coach.

After conclusion of study, participants are followed up at 8 and 12 weeks post surgery, and healthcare providers/institutions are followed up 6-9 months after the last patient is registered.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 325

Inclusion Criteria

Patients must have known or suspected cancer diagnosis and have one of the following cancer-directed operations planned:
- Gastrectomy
- Colectomy
- Proctectomy
- Esophagectomy
- Pancreatectomy
- Hepatectomy
- Total cystectomy
- Partial or total nephrectomy
- Lung lobectomy/pneumonectomy
Patients with known metastatic disease with a plan for curative intent resection are eligible (e.g. curative liver resection for metastatic colorectal cancer).
Patients with double primaries undergoing planned curative operation for both are eligible (e.g. synchronous colon cancers undergoing colectomy to treat both).
Patients must be able to speak and complete questionnaires in English.

Exclusion Criteria

Patients undergoing emergent surgery are not eligible.
Patients under active treatment such as chemotherapy, targeted therapy, immunotherapy, radiation treatment, etc. for second primary, are not eligible.
Patients with second primary are not eligible.
Patients with known metastatic disease who are undergoing palliative resection are not eligible.
Patients with psychiatric illness or other mental impairment that would preclude their ability to give informed consent or to participate in the prehabilitation program are not eligible.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (usual care)	Questionnaire Administration	Healthcare providers/institutions perform usual care.
Arm II (OPTI-Surg training and materials)	Informational Intervention	Healthcare providers/institutions receive OPTI-Surg training and informational materials.
Arm II (OPTI-Surg training and materials)	Questionnaire Administration	Healthcare providers/institutions receive OPTI-Surg training and informational materials.
Arm I (usual care)	Best Practice	Healthcare providers/institutions perform usual care.
Arm III (OPTI-Surg training and materials, coach)	Questionnaire Administration	Healthcare providers/institutions receive OPTI-Surg training and informational materials and meet with a coach.
Arm III (OPTI-Surg training and materials, coach)	Informational Intervention with Coaching	Healthcare providers/institutions receive OPTI-Surg training and informational materials and meet with a coach.

Primary Outcome Measures

Name	Time	Method
Physical Function 8 Weeks Post-surgery as Measured by the Caloric Expenditure Scale Per Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire	8 weeks post surgery	The CHAMPS questionnaire includes 41 questions that measures frequency and duration of activities. The primary endpoint is the estimated Caloric Expenditure Per Week measure from the CHAMPS, which is calculated by weighting the duration variable of the 28 exercise-related activities using the corresponding metabolic equivalents (METs) value, then multiplying by 60 to convert METs/minute to METs/hour, then multiplying by participant weight in kg/200 to calculate the caloric expenditure/week score, and then summing the individual item caloric expenditure scores across all 28 items. This scale score was transformed into the unit of kcal. The minimum possible value of the scale is 0 and there is not a defined maximum possible value. Higher scores equate to more kilocalories burned per week, which is a better outcome in the context of this trial.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants With Postoperative Complications (Clavien-Dindo Grades I-V)	12 weeks	Postoperative complications were assessed at 12 weeks following surgery using the Clavien-Dindo classification: Grade I: Any deviation from the normal postoperative course w/out the need for pharmacological treatment or surgical, endoscopic, and radiological interventions Grade II: Requiring pharmacological treatment w/ drug other than such allowed for Grade I complications Grade III: Requiring surgical, endoscopic or radiological intervention Grade IIIa: Intervention not under general anesthesia Grade IIIb: Intervention under general anesthesia Grave IV: Life-threatening complication Grade IVa: Single organ dysfunction Grade IVb: Multiorgan dysfunction Grave V: Death A generalized linear mixed model (with logit link function) with random practice effect to account for clustering within practice will be used to compare postoperative complications within 12 weeks of surgery between the combined OPTI-Surg no-coach \& coach arms vs usual care followed by pairwise comparisons
Compliance Rate With Administration of Edmonton Frail Scale (EFS)	Day of surgical consult	EFS is a validated measure of frailty that identifies distinct frailty domains that are potential targets for additional pre-operative optimization. For frailty domains that score 1 or 2 points, optimization referrals will be recommended. Clinic or research staff at sites randomized to OPTI-Surg intervention arms will screen and identify eligible patients for administration of the EFS and provide printed surgery preparation materials. A generalized linear mixed model (with logit link function) with a random practice effect to account for clustering within practice will be used to compare compliance rate for screening between the no-coach and coach arms.

Trial Locations

Locations (44): Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Ascension Southeast Wisconsin Hospital - Franklin
🇺🇸
Franklin, Wisconsin, United States
Overlook Hospital
🇺🇸
Summit, New Jersey, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸
Eau Claire, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Augusta University Medical Center
🇺🇸
Augusta, Georgia, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Marshfield Medical Center-River Region at Stevens Point
🇺🇸
Stevens Point, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸
Weston, Wisconsin, United States
MedStar Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
Advocate Christ Medical Center
🇺🇸
Oak Lawn, Illinois, United States
Montefiore Medical Center-Einstein Campus
🇺🇸
Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸
Bronx, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸
New York, New York, United States
Novant Health Forsyth Medical Center
🇺🇸
Winston-Salem, North Carolina, United States
Miami Valley Hospital South
🇺🇸
Centerville, Ohio, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
Ascension Southeast Wisconsin Hospital - Elmbrook Campus
🇺🇸
Brookfield, Wisconsin, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸
Westwood, Kansas, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
University of Kansas Cancer Center
🇺🇸
Kansas City, Kansas, United States
Sanford Roger Maris Cancer Center
🇺🇸
Fargo, North Dakota, United States
LSU Healthcare Network / Metairie Multi-Specialty Clinic
🇺🇸
Metairie, Louisiana, United States
Louisiana State University Health Science Center
🇺🇸
New Orleans, Louisiana, United States
Morristown Medical Center
🇺🇸
Morristown, New Jersey, United States
Prisma Health Greenville Memorial Hospital
🇺🇸
Greenville, South Carolina, United States
Helen F Graham Cancer Center
🇺🇸
Newark, Delaware, United States
Baptist Memorial Hospital and Cancer Center-Desoto
🇺🇸
Southhaven, Mississippi, United States
Baptist Memorial Hospital and Cancer Center-Memphis
🇺🇸
Memphis, Tennessee, United States
Aurora Saint Luke's Medical Center
🇺🇸
Milwaukee, Wisconsin, United States
VCU Massey Cancer Center at Stony Point
🇺🇸
Richmond, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸
Richmond, Virginia, United States