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Chapman L, Ren T, Solka J, Bazzi AR, Borsari B, Mello MJ, Fernandez AC. Reducing Alcohol Use Before and After Surgery: Qualitative Study of Two Treatment Approaches. JMIR Perioper Med 2023; 6:e42532. [PMID: 37494103 PMCID: PMC10413235 DOI: 10.2196/42532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/14/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
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.
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Affiliation(s)
- Lyndsay Chapman
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Tom Ren
- College of Medicine, Central Michigan University, Mount Pleasant, MI, United States
| | - Jake Solka
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Brian Borsari
- Mental Health Service, San Francisco VA Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michael J Mello
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, United States
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
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Lauridsen SV, Thomsen T, Jensen JB, Kallemose T, Schmidt Behrend M, Steffensen K, Poulsen AM, Jacobsen A, Walther L, Isaksson A, Thind P, Tønnesen H. Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy-the STOP-OP Study: A Randomised Clinical Trial. Eur Urol Focus 2022; 8:1650-1658. [PMID: 35241394 DOI: 10.1016/j.euf.2022.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; WHO-CC, Clinical Health Promotion Centre, Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.
| | - Thordis Thomsen
- Department of Anaesthesiology, Herlev and Gentofte Hospital, Copenhagen University Hospitals, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | | | - Alicia Martin Poulsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - André Jacobsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Urology, Herlev Hospital, Herlev, Denmark
| | - Lisa Walther
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, University Hospital, Lund University, Lund, Sweden
| | - Anders Isaksson
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, University Hospital, Lund University, Lund, Sweden
| | - Peter Thind
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Tønnesen
- WHO-CC, Clinical Health Promotion Centre, Parker Institute, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark; Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Skåne, Sweden
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Tønnesen H, Lydom LN, Joensen UN, Egerod I, Pappot H, Lauridsen SV. STRONG for Surgery & Strong for Life - against all odds: intensive prehabilitation including smoking, nutrition, alcohol and physical activity for risk reduction in cancer surgery - a protocol for an RCT with nested interview study (STRONG-Cancer). Trials 2022; 23:333. [PMID: 35449008 PMCID: PMC9027477 DOI: 10.1186/s13063-022-06272-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/02/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Hanne Tønnesen
- Clinical Health Promotion Centre, The Parker Institute, Bispebjerg-Frederiksberg Hospital, Part of Copenhagen University Hospitals, 2000, Frederiksberg, Denmark.
| | - Line Noes Lydom
- Clinical Health Promotion Centre, The Parker Institute, Bispebjerg-Frederiksberg Hospital, Part of Copenhagen University Hospitals, 2000, Frederiksberg, Denmark
| | - Ulla Nordström Joensen
- Department of Urology 2112, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Susanne Vahr Lauridsen
- Clinical Health Promotion Centre, The Parker Institute, Bispebjerg-Frederiksberg Hospital, Part of Copenhagen University Hospitals, 2000, Frederiksberg, Denmark.,Department of Urology 2112, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
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Jensen BT, Thomsen T, Mohamed N, Paterson C, Goltz H, Retinger NL, Witt VR, Lauridsen SV. Efficacy of Pre and Rehabilitation in Radical Cystectomy on Health Related Quality of Life and Physical Function, A Systematic Review. Asia Pac J Oncol Nurs 2022; 9:100046. [PMID: 35662875 PMCID: PMC9160473 DOI: 10.1016/j.apjon.2022.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 01/01/2023] Open
Abstract
Objective Methods Results Conclusions There is no significant association between pre and/ or rehabilitation interventions and global HRQoL. Physical prehabilitation interventions can improve physical function before radical cystectomy. Enteral nutrition reduces risk such as sarcopenia, frailty and increase benefits to the patient. Pre- and postoperative stoma education is effective and impacts significantly on self-efficacy. Cognitive interventions focusing on depression and anxiety should be addressed in future research.
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Affiliation(s)
| | - Thordis Thomsen
- Department of Anesthesia, Copenhagen University Hospital, Herlev, Denmark
| | - Nihal Mohamed
- Mount Sinai, Ichan Scool of Medicine, Department of Urology, USA
| | | | | | | | | | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark
- WHO-CC Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Denmark
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Wang J, Guo W, Cui X, Shen Y, Guo Y, Cai Y, Liu X, Fang M, Gu B, Yuan J, Xie Y, Xie K, Zhou H, Chen X. Smoking is a risk factor for postoperative ileus after radical resection in male patients. Medicine (Baltimore) 2021; 100:e27465. [PMID: 34678877 PMCID: PMC8542170 DOI: 10.1097/md.0000000000027465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Jiangling Wang
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Wenjing Guo
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Xiaoying Cui
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Yajian Shen
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Ye Guo
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Yunfang Cai
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Xinyi Liu
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Man Fang
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Bin Gu
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Junbo Yuan
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Yuyizi Xie
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Kangjie Xie
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Huidan Zhou
- Department of Anesthesiology and Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, No. 1 Banshan East Road, Gongshu District, Hangzhou, Zhejiang, China
| | - Xinzhong Chen
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, No. 1 Xueshi Road, Xihu District, Hangzhou, Zhejiang, China
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Brophy L, Birkhimer D, DeVilliers A, Davis L, Meade K, Pervo V. Oncologic Surgical Care Using an Enhanced Recovery Approach. AACN Adv Crit Care 2021; 32:286-296. [PMID: 34490448 DOI: 10.4037/aacnacc2021151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Enhanced recovery programs are multimodal, evidence-based perioperative programs designed to improve a patient's functional recovery after surgery. Enhanced recovery programs promote standardized, multidisciplinary care throughout the perioperative course to improve patient outcomes, rather than focusing on surgical technique. It is important for nurses working in acute and critical care to be aware of the paradigm shift created by the trend toward the enhanced recovery approach. By learning more about facets of the approach, the nurse will be better prepared to adopt whatever aspects of enhanced recovery their institution implements for the surgical oncology population. An overview is provided of the potential components of enhanced recovery.
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Affiliation(s)
- Lynne Brophy
- Lynne Brophy is Breast Oncology Clinical Nurse Specialist, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard M. Solve Research Institute, Administration-Room 2040, 1145 Olentangy River Road, Columbus, OH 43212
| | - Danette Birkhimer
- Danette Birkhimer is Oncology Clinical Nurse Specialist, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard M. Solve Research Institute, Columbus, Ohio
| | - Allison DeVilliers
- Allison DeVilliers is Oncology Clinical Nurse Specialist, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard M. Solve Research Institute, Columbus, Ohio
| | - Loletia Davis
- Loletia Davis is Oncology Clinical Nurse Specialist, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard M. Solve Research Institute, Columbus, Ohio
| | - Karen Meade
- Karen Meade is Oncology Clinical Nurse Specialist, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard M. Solve Research Institute, Columbus, Ohio
| | - Valerie Pervo
- Valerie Pervo is Clinical Outcomes Manager, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard M. Solve Research Institute, Columbus, Ohio
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Prediction of Bladder Cancer Treatment Side Effects Using an Ontology-Based Reasoning for Enhanced Patient Health Safety. INFORMATICS 2021. [DOI: 10.3390/informatics8030055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
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 oncologist’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.
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Streck JM, Hyland KA, Regan S, Muzikansky A, Rigotti NA, Ponzani CJ, Perez GK, Kalkhoran S, Ostroff JS, Park ER. Examining the effects of problematic alcohol use on cigarette abstinence in recently diagnosed cancer patients enrolled in a cessation trial: A secondary analysis. Addict Behav 2021; 115:106794. [PMID: 33385757 DOI: 10.1016/j.addbeh.2020.106794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/16/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022]
Abstract
AIMS Among people with cancer, dual alcohol and tobacco use increases risk for morbidity and mortality. Most smoking cessation clinical trials with this patient population have excluded individuals with problematic alcohol use. This investigation examined whether problematic alcohol use affects smoking cessation in cancer patients. METHODS Mixed-methods secondary analysis of data from the Smokefree Support Study, a randomized-controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Problematic alcohol use was assessed at enrollment using the Cut-Down-Annoyed-Guilty-Eye-Opener (CAGE), weekly frequency of alcohol use and binge drinking measures. Alcohol use was categorized as: no current alcohol use, moderate and problematic use. The primary outcome was biochemically-confirmed cigarette abstinence at 6-months. A subset of patients (n = 72) completed qualitative exit-interviews. RESULTS Among all participants, biochemically-confirmed cigarette abstinence rates were 25% (n = 32), 28% (n = 27), and 36% (n = 20) for participants reporting no current alcohol use, moderate use, and problematic use, respectively (p = 0.33). In logistic regression analysis, neither problematic alcohol use (AOR = 0.96, 95% CI = 0.35-2.67, p = .94) nor the problematic use by study arm interaction (AOR = 2.22, 95% CI = 0.59-8.39, p = .24) were associated with biochemically-confirmed 6-month abstinence. Qualitatively, participants reported that drinking alcohol triggers urges to smoke. CONCLUSION Newly diagnosed cancer patients reporting problematic alcohol use were not less likely to quit smoking than those without. Additional research is needed to investigate whether problematic alcohol users may benefit from smoking and alcohol behavior change interventions at the time of cancer diagnosis.
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Abstract
OBJECTIVE Cigarette smoking and alcohol drinking are preventable risk factors in surgery. It is unknown whether intervening on these two risk factors also have an effect on other lifestyles. Therefore, the primary aim of this study was to compare the effect of an intensive alcohol and smoking cessation intervention on other lifestyles (malnutrition, obesity, and physical inactivity) with treatment as usual, among patients scheduled for radical cystectomy. The secondary aim was to evaluate associations between successful quitting and changes in other lifestyles. DATA SOURCES Data on 94 patients with bladder cancer undergoing radical cystectomy originated from the STOP-OP study, a randomized intervention trial that enrolled patients from four Danish hospitals. Patients were enrolled between November 2014 and July 2017. CONCLUSION We found no significant differences regarding the three lifestyle factors; risk of malnutrition, obesity, and physical inactivity between patients in the intervention and standard care at the end of the intervention at 6 weeks, 3 months, 6 months, and 12 months. Also, there were no significant associations between successful quitters and non-quitters for alcohol and smoking and the other three lifestyles; risk of malnutrition, obesity, and physical inactivity. IMPLICATIONS FOR NURSING PRACTICE Findings from this study show that cancer surgery is a good opportunity to address lifestyle changes and that more research into the effect of multimodal interventions are needed. Guidelines on how to support patients to change lifestyle in relation to surgery should be part of nursing practice.
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Jensen BT, Lauridsen SV, Scheede-Bergdahl C. The Potential of Prehabilitation in Radical Cystectomy Pathways: Where Are We Now? Semin Oncol Nurs 2021; 37:151107. [PMID: 33446382 DOI: 10.1016/j.soncn.2020.151107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark and WHO-CC, Parker Institute Bispebjerg & Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
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Jensen BT, Lauridsen SV, Jensen JB. Optimal Delivery of Follow-Up Care After Radical Cystectomy for Bladder Cancer. Res Rep Urol 2020; 12:471-486. [PMID: 33117747 PMCID: PMC7569073 DOI: 10.2147/rru.s270240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark and WHO-CC, Clinical Health Promotion Centre, The Parker Institute Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Abstract
PURPOSE OF REVIEW Whether prehabilitation in radical cystectomy adds to the effort of reducing postoperative morbidity and impairments in the survivorship phase has until recently received limited attention. This narrative review aims to summarize the current evidence base on prehabilitaion interventions focusing on the efficacy of procedure-specific interventions and the influence on postoperative outcomes. RECENT FINDINGS Given the oncological risk, there is a relative short window to intervene and proactively optimize the patient before radical cystectomy. Preliminary results are however promising and a single-center randomized controlled trial (RCT) has shown that home-based short-term physical prehabilitation is feasible and effective and significantly improves early mobilization, time to perform activities of daily living and health-related quality of life (HRQoL). No significant impact on length of stay or complications was found. Limited evidence support preoperative nutritional interventions in cancer surgery, although evidence suggests improved outcome if malnourished individuals are adequately fed 7-10 days before surgery. No RCTs have evaluated the effect of smoking or alcohol cessation interventions on complications or HRQoL in radical cystectomy. Patient education interventions focusing on stoma care improve significantly self-efficacy in regards to independently change of stoma-appliance up to 1 year postoperatively. Currently, there is no evidence of early intervention considering psychological well being, sexual health or shared decision-making. SUMMARY Published data indicate that a group of preoperative multiprofessional interventions including physical exercises, supportive nutritional care and stoma education can postoperatively improve early mobilization, self-efficacy and HRQoL. No evidence for further reduction of length of stay or complications was found.
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Hovhannisyan K, Günther M, Raffing R, Wikström M, Adami J, Tønnesen H. Compliance with the Very Integrated Program (VIP) for Smoking Cessation, Nutrition, Physical Activity and Comorbidity Education Among Patients in Treatment for Alcohol and Drug Addiction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2285. [PMID: 31261620 PMCID: PMC6650928 DOI: 10.3390/ijerph16132285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 12/20/2022]
Abstract
Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.
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Affiliation(s)
- Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
| | - Michelle Günther
- Skånevård Kryh, Medicon Village, Region Skåne, 223 81 Lund, Sweden
| | - Rie Raffing
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark.
| | - Maria Wikström
- Student Health, Malmö University, Neptuniplan 7, 21118 Malmö, Sweden
| | - Johanna Adami
- President Office, Sophiahemmet University, Box 5605, 114 86 Stockholm, Sweden
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark
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14
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Contemporary Preoperative and Intraoperative Management of the Radical Cystectomy Patient. Urol Clin North Am 2018; 45:169-181. [DOI: 10.1016/j.ucl.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Lauridsen SV, Thomsen T, Kaldan G, Lydom LN, Tønnesen H. Smoking and alcohol cessation intervention in relation to radical cystectomy: a qualitative study of cancer patients' experiences. BMC Cancer 2017; 17:793. [PMID: 29178899 PMCID: PMC5702236 DOI: 10.1186/s12885-017-3792-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022] Open
Abstract
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 bladder cancer patients experience a perioperative smoking and alcohol cessation intervention in relation to radical cystectomy. METHODS A qualitative study was conducted in two urology out-patient clinics. We conducted semi-structured in-depth interviews with 11 purposively sampled persons who had received the smoking and alcohol cessation intervention. The analysis followed the steps contained in the thematic network analysis. RESULTS Two global themes emerged: "smoking and alcohol cessation was experienced as an integral part of bladder cancer surgery" and "returning to everyday life was a barrier for continued smoking cessation/alcohol reduction". Participants described that during hospitalization their focus shifted to the operation and they did not experience craving to smoke or drink alcohol. Concurrent with improved well-being or experiencing stressful situations, the risk of relapse increased when returning to everyday life. CONCLUSIONS The smoking and alcohol cessation intervention was well received by the participants. Cancer surgery served as a kind of refuge and was a useful cue for motivating patients to quit smoking and to reconsider the consequences of risky drinking. These results adds to the sparse evidence of what supports smoking and alcohol cessation in relation to bladder cancer patients undergoing major surgery and point to the need to educate healthcare professionals in offering smoking and alcohol cessation interventions in hospitals. The study also provides knowledge about the intervention in the STOP-OP study and will help guide the design of future smoking and alcohol cessation studies aimed at cancer patients undergoing surgery.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology 2112, Inge Lehmanns Vej 7, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Health & Medical Sciences, Copenhagen, Denmark
| | - Gudrun Kaldan
- Abdominal Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Line Noes Lydom
- Department of Urology 2112, Inge Lehmanns Vej 7, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Bispebjerg & Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark
- Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Sweden
- Health Science, University of Southern Denmark, Odense, Denmark
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