Effectiveness of the Tailored, Early Comprehensive Rehabilitation Program (t-ECRP) based on ERAS in improving the physical function recovery for patients following minimally invasive esophagectomy: a prospective randomized controlled trial

Factors influencing exercise rehabilitation behavior in older patients with esophageal cancer: A qualitative study

Exercise rehabilitation programs have been proven to beneficially affect several health-related outcomes for cancer patients. However, adherence is important to achieve optimal effects. This study aimed to investigate the influencing factors of exercise rehabilitation behavior in older esophageal cancer patients participating in pre- and postoperative exercise rehabilitation programs in a hospital setting. A qualitative study with semistructured interviews was conducted based on the capability, opportunity, and motivation as determinants of behavior (COM-B) theoretical framework. Purposeful sampling was used (n = 16), and the interview data were analyzed following thematic analysis. The results revealed ten key themes: capability factors (physical discomfort, limited knowledge, and psychological burden), opportunity factors (grassroots medical and health services support, family support, peer support, and healthcare professionals support), and motivation factors (high exercise self-efficacy, awareness of benefits, and desire for normal life). Understanding these factors can help design more effective exercise rehabilitation programs in clinical practice.

Effectiveness of exercise interventions on functional outcomes in frail adults with a previous or current diagnosis of cancer: a systematic review and meta-analysis

PURPOSE

Exercise improves functional outcomes in individuals with frailty and individuals with cancer, but it is unknown how exercise impacts function in individuals with both cancer and frailty. This systematic review aimed to determine if adults with cancer who are frail and participate in an exercise program have better functional outcomes compared to those who do not.

METHODS

Five databases (OVID Medline, Embase, CINAHL, EMCARE, and Ageline) were searched from inception to March 2024 for RCTs that investigated the impact of exercise on functional outcomes in individuals with cancer who are frail and ≥ 18 years. Title/abstract, full text review, and data extraction were done in duplicate. Cochrane ROB2 was used to assess risk of bias and GRADE for certainty of results.

RESULTS

Eleven RCTs with 1419 participants were included in this review. Meta-analysis did not find a significant difference between intervention and control groups for submaximal walking tests (95% CI 0.24 (- 0.05-0.53), Short Physical Performance Battery (95% CI - 0.50 (- 1.15-0.15)), and grip strength (95% CI 1.83 (- 0.75 to 4.41). However, positive trends emerged for those participating in exercise programs related to submaximal walking test, grip strength, sit to stand, SPPB, and TUG scores.

CONCLUSION

There are few RCTs investigating exercise in this population, with high heterogeneity of existing interventions. This leads to low certainty in the results of the current study.

IMPLICATIONS FOR CANCER SURVIVORSHIP

Cancer survivors and patients need to be screened for frailty and be engaged in appropriate exercise. Further work should be done investigating appropriate parameters of exercise interventions for this population.

The impact of somatic symptoms on kinesiophobia after esophagectomy among cancer patients: the mediating roles of intrusive rumination and avoidant coping

PURPOSE

Kinesiophobia refers to an irrational fear of physical activities or functional exercise due to the fear of pain or reinjury. Cancer patients who undergo esophagectomy are prone to developing kinesiophobia, which adversely affects their disease prognosis and quality of life. Somatic symptoms are closely related to kinesiophobia, but the mechanisms underlying this relationship remain unclear. Therefore, the current study aimed to explore the chain-mediation roles of intrusive rumination and avoidant coping in the relationship between somatic symptoms and kinesiophobia in cancer patients who underwent esophagectomy.

METHODS

A cross-sectional study was conducted in China from February 2023 to December 2023. A total of 279 postesophagectomy cancer patients were evaluated using the Symptom Check List 90 (SCL-90), Event Related Rumination Inventory (ERRI), Medical Coping Modes Questionnaire (MCMQ), and Tampa Scale of Kinesiophobia (TSK-11).

RESULTS

Kinesiophobia was significantly positively correlated with somatic symptoms, intrusive rumination, and avoidant coping (p < 0.001). Somatic symptoms had a direct association with kinesiophobia (β = 0.280, 95% CI (0.200, 0.360), p < 0.001). Furthermore, our model showed that somatic symptoms had a significant indirect association with kinesiophobia through the separate mediating effects of intrusive rumination (β = 0.204, 95% CI (0.145, 0.267), p < 0.001) and avoidant coping (β = 0.049, 95% CI (0.019, 0.088), p < 0.001), as well as through the chain-mediated effects of intrusive rumination-avoidant coping (β = 0.026, 95% CI (0.012, 0.044), p < 0.001).

CONCLUSIONS

The findings of this study suggested that intrusive rumination and avoidant coping play separate and chain-mediated roles in the relationship between somatic symptoms and kinesiophobia in postesophagectomy cancer patients.

Impact of perioperative enhanced recovery after surgery on wound infection in patients undergoing orthopaedic surgery: A meta-analysis

The aim of this study was to evaluate the effects of perioperative application of enhanced recovery after surgery (ERAS) concepts on wound infections and post-operative complications in patients receiving orthopaedic surgery, to provide a theoretical basis for post-operative care. Randomised controlled trials (RCTs) on the application of ERAS to patients receiving orthopaedic surgery, published up to October 2023, were identified in PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases. Literature was screened and evaluated by two reviewers based on the inclusion and exclusion criteria, and data were extracted from the final included articles. Data were analysed using RevMan 5.4 software. A total of 20 RCTs were included in the analysis, which included 1875 patients undergoing orthopaedic surgery, of whom 938 and 937 were in the ERAS and control groups, respectively. The analysis revealed that in patients undergoing orthopaedic surgery, implementation of ERAS in the perioperative period was associated with a significantly reduced the rate of wound infections (1.6% vs. 6.19%, risk ratio [RR]: 0.30, 95% confidence interval [CI]: 0.18-0.50, p < 0.001) and complication (5.12% vs. 21.88%, RR: 0.23, 95% CI: 0.17-0.32, p < 0.001) and can effectively shorten the hospital length of stay (standardised mean difference [SMD]: -2.50 days, 95% CI: -3.17 to -1.83 days, p < 0.001) compared with that of conventional care. The available evidence suggests that the implementation of ERAS in the perioperative period of patients undergoing orthopaedic surgery could effectively reduce the rate of wound infections and complications, shorten the hospital length of stay and promote the early recovery of patients.