Fig 3 - available from: Trials
This content is subject to copyright. Terms and conditions apply.
Source publication
Background
To evaluate the effect of a smoking-, alcohol- or combined-cessation intervention starting shortly before surgery and lasting 6 weeks on overall complications after radical cystectomy. Secondary objectives are to examine the effect on types and grades of complications, smoking cessation and alcohol cessation, length of hospital stay, hea...
Similar publications
Background
Despite smoking and risky alcohol drinking being modifiable risk factors for cancer as well as postoperative complications, perioperative cessation counselling is often ignored. Little is known about how cancer patients experience smoking and alcohol interventions in relation to surgery. Therefore the aim of this study was to explore how...
Citations
... Importantly, alcohol-associated adverse surgical outcomes are not specific to certain surgeries or subpopulations; instead, they are evident across heterogeneous patients and surgery types [3,5]. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications [7][8][9][10][11][12][13]. Likewise, abstinence of 5 to 6 weeks after surgery is recommended to reduce one's risk of experiencing complications such as delayed wound healing, infection, and impaired cardiac function [11,14]. ...
... Importantly, alcohol-associated adverse surgical outcomes are not specific to certain surgeries or subpopulations; instead, they are evident across heterogeneous patients and surgery types [3,5]. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications [7][8][9][10][11][12][13]. Likewise, abstinence of 5 to 6 weeks after surgery is recommended to reduce one's risk of experiencing complications such as delayed wound healing, infection, and impaired cardiac function [11,14]. In addition, the majority of surgical patients receive an opioid prescription after surgery [15,16], for which concurrent alcohol use is dangerous and even lethal [17,18]. ...
Background:
High-risk alcohol use is a common preventable risk factor for postoperative complications, admission to intensive care, and longer hospital stays. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications.
Objective:
The study aimed to explore the acceptability and feasibility of 2 brief counseling approaches to reduce alcohol use in elective surgical patients with high-risk alcohol use in the perioperative period.
Methods:
A semistructured interview study was conducted with a group of "high responders" (who reduced alcohol use ≥50% postbaseline) and "low responders" (who reduced alcohol use by ≤25% postbaseline) after their completion of a pilot trial to explore the acceptability and perceived impacts on drinking behaviors of the 2 counseling interventions delivered remotely by phone or video call. Interview transcripts were analyzed using thematic analysis.
Results:
In total, 19 participants (10 high responders and 9 low responders) from the parent trial took part in interviews. Three main themes were identified: (1) the intervention content was novel and impactful, (2) the choice of intervention modality enhanced participant engagement in the intervention, and (3) factors external to the interventions also influenced alcohol use.
Conclusions:
The findings support the acceptability of both high- and low-intensity brief counseling approaches. Elective surgical patients are interested in receiving alcohol-focused education, and further research is needed to test the effectiveness of these interventions in reducing drinking before and after surgery.
Trial registration:
ClinicalTrials.gov NCT03929562; https://clinicaltrials.gov/ct2/show/NCT03929562.
... We also identified a minimal impact of the social gradient after a successful intensive smoking cessation intervention [39]. In addition, the social inequality in health promotion success could be minimised through positive/selective involving procedures and support during the total intervention [40]. Our STRONG programme will build on these results. ...
... Prehabilitation and pathophysiology/functionality improvement ( Fig. 1) Lifestyle intervention as introduced by the operational model [41], and delivered as the "Gold-Standard Program" (GSP) for smoking cessation intervention [42], translated and evaluated for perioperative alcohol intervention [40] and other lifestyles and patient groups [43] Preference among patients, relatives and staff ...
... STRONG is introduced with the surgical recommendations in 'Engage in the process of change' [41]. The smoking follows the Gold Standard Programme (GSP) [42], which also has been translated to the standardised alcohol cessation intervention [40], exercise training programme and nutritional intervention [43]. ...
Background
There is a large unused potential for risk reduction in the preoperative period via effective lifestyle intervention targeting co-existing risky lifestyles: Smoking, malNutrition, obesity, risky Alcohol intake and insufficient Physical activity (SNAP).
This trial compares the efficacy of the integrated STRONG programme with standard care on preoperative risk reduction and secondly on SNAP factor improvement and frailty, postoperative complications and quality of life. A nested interview study explores the patient preferences and the multi-perspective view of patients, relatives and health professionals.
Methods
In total, 42 surgical patients with ≥1 SNAP factor are allocated to individually tailored STRONG programme or usual care during adjuvant chemotherapy prior to radical bladder cancer surgery. The STRONG programme has ≥6 weekly sessions with patient education, motivational and pharmaceutical support. It is based on intensive smoking and alcohol cessation interventions reporting perioperative quit rates > 50%.
Surgical risk reduction is measured as ≥1 step for 1 or more risky lifestyles on the ASA-score, secondly as having no risky SNAP factors, and as any SNAP improvement. The outcomes are validated by measurements and biomarkers. Postoperative complications are categorised according to the Clavien-Dindo classification. Health-related quality of life is measured by EQ-5D.
The patients are followed up after 6 weeks at surgery and 6 weeks and 6 months postoperatively.
A representative sample of the participants, their relatives and the clinical staff are interviewed until data saturation. Transcription, triangulated analyses and data management are conducted using NVivo computer software.
Discussion
The surgical agenda is characterised by fixed dates for surgery focusing on clear risk reduction within a short time. This requires a clinical useful lifestyle intervention programme with a high effect and coverage as well as containing all SNAP factors and tailored to individual needs.
The STRONG programme seems to meet these requirements. After development in multi-professional collaboration, STRONG is delivered by a specially trained nurse as part of the surgical patient journey.
Overall, this study will bring important new knowledge about risk reduction in a frail patient group undergoing major cancer surgery.
Trial registration
Registration at www.clintrials.gov (NCT04088968)
The manuscript form from https://trialsjournal.biomedcentral.com/bmc/journal and the SPIRIT guidelines are followed.
... Quitting for more than 10 years decreases the risk of recurrence (51) and as successful quitting is most likely to happen when smoking cessation is offered at the time of bladder cancer diagnosis (52), attention should be paid to the importance of encouraging bladder cancer patients to quit as early as possible. Smoking cessation will benefit the health of the patient even in the short term, underlining the need to support patients undergoing RC to quit smoking (53,54), while continued smoking is associated with increased risk of surgical complications after RC (55,56). ...
Objective:
The efficacy of prehabilitation or rehabilitation interventions on radical cystectomy (RC) patient reported outcomes (PROs), and patient centered outcome has not yet been thoroughly explored in prior reviews, therefore the aim of this review is to evaluate the efficacy of a single or multi-modal prehabilitation or/and postoperative rehabilitation interventions compared to standard treatment on postoperative complications after RC.
Methods:
We performed a three-step search strategy in PubMed, Cinahl, Embase, Cochrane Library, and Web of Science. We used Covidence for the screening of articles, risk of bias assessment, and data-extraction. GRADE was used to assess the risk of bias in outcomes across studies. Where meta-analysis was possible, we used the random effect method due to substantial heterogeneity. The remaining outcomes were summarized narratively.
Results:
We identified fourteen studies addressing one of the outcomes. None of the studies provided evidence to support that prehabilitation and/or rehabilitation interventions can improve global health related quality of life (HRQoL) in RC surgery or can reduce postoperative complications significantly. However, preoperative and postoperative education in stoma care can significantly improve self-efficacy and we found significant added benefits of sexual counseling to intracavernous injections compared to injection therapy alone. Likewise, an intensive smoking and alcohol cessation intervention demonstrated a significant effect on quit rates. Physical exercise is feasible and improves physical functioning although it does not reduce the postoperative complications.
Conclusions:
Currently, no evidence of efficacy of prehabilitation and/or rehabilitation interventions to improve the overall HRQoL or postoperative complications after RC exists. We found evidence that education in stoma care improved self-efficacy significantly. Adequately powered randomized controlled trials (RCTs) are needed to generate high-quality evidence in this field.
... Patients were asked to decide a stopdate as soon as possible and not later than the day before surgery. The intervention has been described in detail elsewhere [14]. ...
Background
Evidence concerning the reduction of postoperative complications due to smoking and alcohol drinking in patients undergoing radical cystectomy is incomplete.
Objective
To evaluate the efficacy of a 6-wk smoking and/or alcohol cessation intervention, initiated shortly before surgery and continued until 4 wk after, in reducing complications.
Design, setting, and participants
Between 2014 and 2018, we enrolled 104 patients with high-risk bladder cancer who were daily smokers or consuming at least 3 units of alcohol daily in a multicentre randomised clinical trial.
Intervention
Patients were randomised to a 6-wk intensive smoking and/or alcohol cessation intervention or treatment as usual.
Outcome measurements and statistical analysis
The primary endpoint was the number of patients developing any postoperative complication, or death, within 30 d after surgery. The secondary endpoints were successful quitters, health-related quality of life, length of stay, time back to habitual activity, and mortality. An intention-to-treat analysis was applied to evaluate treatment effect.
Results and limitations
There were some differences in baseline demographic and lifestyle characteristics. Postoperatively, 64% in the intervention group versus 70% in the control group (risk ratio [RR] 0.91, confidence interval [CI] 0.68–1.21, p = 0.51) developed complications. Significantly fewer patients developed three or more complications after 30 d (RR 0.39; CI 0.18–0.84, p = 0.01). The rates of successful quitting were 51% in the intervention group and 27% in the control group (RR 2, CI 1.14–3.51, p = 0.01). The external validity of this trial may be limited because 53% of eligible patients refused participation.
Conclusions
Despite a significant effect on the quit rate at completion of the intervention, this multimodal prehabilitation did not show a significant difference regarding our primary outcome postoperative complications.
Patient summary
A 6-wk smoking and alcohol cessation intervention in relation to bladder cancer surgery did not reduce postoperative complications, but it was effective in supporting people to quit in the short term.
... Smoking has been shown to lead to poor outcomes for many cancers, but the mechanisms remain unclear. [16][17][18][19] Studies have shown that these effects may be due to the release of reactive oxygen species that cause damage at the cellular and tissue levels. Smoking also affects normal tissue perfusion, [20,21] impairs microcirculation, [22][23][24] increases oxidative stress, induces vascular injury, [25] reduces red blood cell velocity in the mesenteric vasculature and enhances venule pressure. ...
Most smokers are males, and smoking has been indicated as a risk factor for many cancers as well as postoperative complications after cancer surgery. However, little is known about whether smoking is a risk factor for postoperative ileus (POI) after radical rectal cancer resection in males. The aim of this study was to assess whether smoking is a risk factor for POI after radical resection in male rectal cancer patients.
Data of 1486 patients who underwent radical resection for rectal cancer were extracted from the clinical medical system in our hospital and were statistically analyzed. POI was defined as nausea, vomiting or pain, failure to have bowel function for more than 4 days postoperatively, and absence of a mechanical bowel obstruction.
The rate of POI was 12.79%. Univariate analysis showed that patients in the POI group were more likely to have a history of smoking and drinking and receive intraperitoneal chemotherapy and had a larger intraperitoneal chemotherapy dosage. In the multivariable analysis, smoking remained significantly associated with a higher incidence of POI (OR 2.238, 95% CI [1.545–3.240], P = .000). The results also showed that patients who received postoperative patient-controlled intravenous analgesia had a lower incidence of POI.
Male patients with a history of smoking who undergo elective radical resection for rectal cancer have an increased risk for POI complications.
... For heterogeneity, a part of our records, four cross-sectional studies [80][81][82][83] reported on the overall cystitis AEs and complications, allowing for different time intervals relative to the treatment of patients with high-risk T1G3 BC (TURBT-Radiation therapy versus TURBT-BCG Immunotherapy). We excluded all BC types and stages different than T1G3 (cross-sectional studies). ...
Predicting potential cancer treatment side effects at time of prescription could decrease potential health risks and achieve better patient satisfaction. This paper presents a new approach, founded on evidence-based medical knowledge, using as much information and proof as possible to help a computer program to predict bladder cancer treatment side effects and support the oncol-ogist's decision. This will help in deciding treatment options for patients with bladder malignancies. Bladder cancer knowledge is complex and requires simplification before any attempt to represent it in a formal or computerized manner. In this work we rely on the capabilities of OWL ontologies to seamlessly capture and conceptualize the required knowledge about this type of cancer and the underlying patient treatment process. Our ontology allows case-based reasoning to effectively predict treatment side effects for a given set of contextual information related to a specific medical case. The ontology is enriched with proofs and evidence collected from online biomedical research databases using "web crawlers". We have exclusively designed the crawler algorithm to search for the required knowledge based on a set of specified keywords. Results from the study presented 80.3% of real reported bladder cancer treatment side-effects prediction and were close to really occurring adverse events recorded within the collected test samples when applying the approach. Evidence-based medicine combined with semantic knowledge-based models is prominent in generating predictions related to possible health concerns. The integration of a diversity of knowledge and evidence into one single integrated knowledge-base could dramatically enhance the process of predicting treatment risks and side effects applied to bladder cancer oncotherapy.
... 87 In general, complete alcohol cessation 4 to 8 weeks before surgery seems to reduce the number of complications after planned surgery, although no effect was found on number of deaths and length of stay. 88 An article describing the protocol for a study evaluating the effect of an intensive alcohol and smoking cessation intervention in patients undergoing RC was identified, 89 but results have not yet been published. To reduce postoperative complications preoperative interventions is needed if the patient is a daily smoker and/or currently drink more than 2 units (24 g) daily. ...
... 87 In general, complete alcohol cessation 4 to 8 weeks before surgery seems to reduce the number of complications after planned surgery, although no effect was found on number of deaths and length of stay. 88 An article describing the protocol for a study evaluating the effect of an intensive alcohol and smoking cessation intervention in patients undergoing RC was identified, 89 but results have not yet been published. To reduce postoperative complications preoperative interventions is needed if the patient is a daily smoker and/or currently drink more than 2 units (24 g) daily. ...
... Only one study has explored patients' involvement in a smoking cessation intervention in relation to RC, 86 but the results of the intervention have not yet been published. 87 A smoking cessation intervention is seen as a relevant offer for patients undergoing major bladder cancer surgery, and side effects of surgery like nausea, oral thrush, or changes in taste due to medication were factors supporting cessation. Despite the fact that cessation during hospitalization felt easy for all participants, returning to everyday life challenged their continued smoking abstinence, and this points to the importance of addressing smoking cessation at each follow-up meeting in the urological outpatient clinic. ...
Purpose of review:
To identify components representing optimal delivery of follow-up care after radical cystectomy because of bladder cancer and report the current level of evidence.
Methods:
We conducted a systematic literature search of the following databases: Cochrane, MEDLINE, Embase, CINAHL, Web of Science, Physiotherapy Evidence Database and ClinicalTrials.gov. The search results were managed in Covidence Reference Manager and abstracts were screened by title. Articles relevant to the subject of interest were included and the results are reported narratively.
Results:
Several studies have evaluated the positive impact of enhanced recovery after surgery (ERAS) on length of stay, albeit not on the further impact on 90-day postoperative complication rate, functional recovery, or mortality. Minimally invasive surgery may result in a slighter shorter length of stay compared to open surgery. Physical training combined with nutritional intervention can improve functional recovery up to one year after surgery. Nutritional supplements can preserve muscle and bone mass, and potentially improve recovery. Patient education in stoma care and prevention of infection can significantly improve self-efficacy and avoid symptoms of infection postoperatively. Moreover, specific devices like applications (apps) can support these efforts. Continued smoking increases the risk of developing postoperative complications while no evidence was found on the impact of continued alcohol drinking. Currently, there is no evidence on psychological well-being, sexual health, or shared decision making interventions with an impact on rehabilitation after radical cystectomy.
Conclusion:
Data are scarce but indicate that peri- and postoperative multi-professional interventions can reduce prevalence of sarcopenia, and improve functional recovery, physical capacity, nutritional status, and self-efficacy in stoma care (level 1 evidence). Continued smoking increases the risk of complications, but the effects of a smoking and alcohol intervention remain unclear (level 3 evidence). The results of this review provide guidance for future directions in research and further attempts to develop and test an evidence-based program for follow-up care after radical cystectomy.
... 87 In general, complete alcohol cessation 4 to 8 weeks before surgery seems to reduce the number of complications after planned surgery, although no effect was found on number of deaths and length of stay. 88 An article describing the protocol for a study evaluating the effect of an intensive alcohol and smoking cessation intervention in patients undergoing RC was identified, 89 but results have not yet been published. To reduce postoperative complications preoperative interventions is needed if the patient is a daily smoker and/or currently drink more than 2 units (24 g) daily. ...
Objective
The growing recognition of prehabilitation has caused an emerging paradigm shift in surgical cancer care and an integrated component of the cancer care continuum. This narrative review aims to update and inform the urological community of the potential of prehabilitation before radical cystectomy.
Data Sources
A nonsystematic narrative review was performed through a database search in PubMed, and CINAHL using the following search terms: enhanced recovery after surgery (ERAS); Frailty; Prehabilitation and/or Rehabilitation; Physical Activity and/or exercises; Nutrition; Nutritional Care; Smoking cessation; Alcohol cessation; Prevention; Supportive Care; and combined with Radical Cystectomy.
Conclusion
A multimodal and multi-professional approach during the preoperative period may offer an opportunity to preserve or enhance physiological integrity and optimize surgical recovery. Studies indicate a positive effect of prehabilitation on postoperative functional capacity and earlier return to daily activities and health related quality of life. Meaningful outcomes that reflect recovery from a patient's perspective and clinical outcome measures, as well as validating metrics, are necessary to establish whether prehabilitation diminish the risk of developing long-term disability in high-risk patients.
Implications for Nursing Practice
Uro-oncology nurses are at the forefront in every ERAS program and vital in screening patients ahead of surgery for common risk factors, current impairments, and limitations that can compromise baseline functional capacity. The growing movement to standardize clinical implementation of prehabilitation, indicate there is a clear need for further investigation, optimization of a multimodal approach and an open discussion between health care providers from different areas of expertise who might best support and promote these initiatives.
