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Moorthy K, Halliday LJ, Noor N, Peters CJ, Wynter-Blyth V, Urch CE. Feasibility of Implementation and the Impact of a Digital Prehabilitation Service in Patients Undergoing Treatment for Oesophago-Gastric Cancer. Curr Oncol 2023; 30:1673-1682. [PMID: 36826089 PMCID: PMC9955831 DOI: 10.3390/curroncol30020128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Home-based and supervised prehabilitation programmes are shown to have a positive impact on outcomes in patients with oesophago-gastric (OG) cancer. The primary aim of this study was to establish the feasibility of delivering a digital prehabilitation service. METHODS Patients undergoing treatment for OG cancer with curative intent were recruited into the study. During the COVID-19 pandemic, patients were offered a digital prehabilitation service. Following the lifting of COVID-19 restrictions, patients were also offered both a hybrid clinic-based in-person service and a digital service. Implementation and clinical metrics from the two prehabilitation models were compared. RESULTS 31 of 41 patients accepted the digital service (75%). Of the people who started the digital programme, 3 dropped out (10%). Compliance with the weekly touchpoints was 86%, and the median length of programme was 12 weeks. Twenty-six patients enrolled in the in-person service. Two patients dropped out (10%). Average compliance to weekly touchpoints was 71%, and the median length of programme was 10 weeks. In the digital group, sit to stand (STS) increased from 14.5 (IQR 10.5-15.5) to 16 (IQR 16-22); p = 0.02. Median heart rate recovery (HRR) increased from 10.5 (IQR 7.5-14) to 15.5 (IQR 11-20) bpm; p = 0.24. There was a significant drop in distress (median 3 (IQR 0-5) to 1 (IQR 0-2); p = 0.04) and a small drop in anxiety (median 3 (0-5) to 2 (0-3); p = 0.22). There was no difference in the postoperative complication rate and length of hospital stay between the two groups. DISCUSSION This study has shown that digital prehabilitation can be delivered effectively to patients with OG cancer, with high engagement and retention rates. We observed improvements in some physical and psychological parameters with the digital service, with comparable clinical outcomes to the in-person service.
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Affiliation(s)
- Krishna Moorthy
- Department of Surgery and Cancer, Imperial College, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Onkohealth Ltd., Edgware HA8 7EB, UK
- Correspondence:
| | - Laura J. Halliday
- Department of Surgery and Cancer, Imperial College, London W2 1NY, UK
| | - Nigel Noor
- Department of Surgery and Cancer, Imperial College, London W2 1NY, UK
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Christodoulidis G, Halliday LJ, Samara A, Bhuva N, Park WHE, Moorthy K. Personalized Prehabilitation Improves Tolerance to Chemotherapy in Patients with Oesophageal Cancer. Curr Oncol 2023; 30:1538-1545. [PMID: 36826079 PMCID: PMC9955115 DOI: 10.3390/curroncol30020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/04/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Prehabilitation programmes aim to optimise patients before and after cancer treatment including surgery. Previous studies in surgical patients demonstrate that prehabilitation improves pre-operative fitness and overcomes the negative impact of neoadjuvant chemotherapy on fitness. The aim of this study was to assess the impact of prehabilitation on the tolerance of neoadjuvant chemotherapy in patients with oesophageal cancer. METHODS Patients with oesophageal or gastroesophageal junction (GOJ) cancer from two oncology centres were retrospectively included in the present comparative cohort study; one provided a multimodal prehabilitation programme and one did not offer any prehabilitation. Tolerance of chemotherapy, defined as completion of the full chemotherapy regime as per protocol, was compared between the two groups. RESULTS In terms of participants, 92 patients were included in this study, 47 patients in the prehabilitation cohort and 45 in the control cohort. Compared with the control group, the prehabilitation group demonstrated an improved rate of chemotherapy completion (p = 0.029). In multivariate analysis, participation in prehabilitation was significantly associated with an improved rate of chemotherapy completion. CONCLUSION The findings of this exploratory study suggest that prehabilitation is associated with better tolerance for chemotherapy. Further research is needed to establish the long-term impact of prehabilitation on oncological outcomes.
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Affiliation(s)
| | - Laura J. Halliday
- Department of Surgery and Cancer, Imperial College London, London W2 1NS, UK
| | - Athina Samara
- General Surgery Department, University Hospital of Larisa, 41110 Larisa, Greece
| | - Neel Bhuva
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood HA6 2RN, UK
| | | | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College London, London W2 1NS, UK
- Imperial College Healthcare NHS Trust, London W2 1NS, UK
- Correspondence: ; Tel.: +44-203-312-1427; Fax: +44-0203-312-1810
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Halliday LJ, Boshier PR, Doganay E, Wynter-Blyth V, Buckley JP, Moorthy K. The effects of prehabilitation on body composition in patients undergoing multimodal therapy for esophageal cancer. Dis Esophagus 2022; 36:6632930. [PMID: 35795994 PMCID: PMC9885737 DOI: 10.1093/dote/doac046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/22/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
Prehabilitation aims to optimize a patient's functional capacity in preparation for surgery. Esophageal cancer patients have a high incidence of sarcopenia and commonly undergo neoadjuvant therapy, which is associated with loss of muscle mass. This study examines the effects of prehabilitation on body composition during neoadjuvant therapy in esophageal cancer patients. In this cohort study, changes in body composition were compared between esophageal cancer patients who participated in prehabilitation during neoadjuvant therapy and controls who did not receive prehabilitation. Assessment of body composition was performed from CT images acquired at the time of diagnosis and after neoadjuvant therapy. Fifty-one prehabilitation patients and 28 control patients were identified. There was a significantly greater fall in skeletal muscle index (SMI) in the control group compared with the prehabilitation patients (Δ SMI mean difference = -2.2 cm2/m2, 95% CI -4.3 to -0.1, p=0.038). Within the prehabilitation cohort, there was a smaller decline in SMI in patients with ≥75% adherence to exercise in comparison to those with lower adherence (Δ SMI mean difference = -3.2, 95% CI -6.0 to -0.5, P = 0.023). A greater decrease in visceral adipose tissue (VAT) was seen with increasing volumes of exercise completed during prehabilitation (P = 0.046). Loss of VAT during neoadjuvant therapy was associated with a lower risk of post-operative complications (P = 0.017). By limiting the fall in SMI and promoting VAT loss, prehabilitation may have multiple beneficial effects in patients with esophageal cancer. Multi-center, randomized studies are needed to further explore these findings.
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Affiliation(s)
- Laura J Halliday
- Address correspondence to: Miss Laura Halliday, Academic Surgical Unit, 10th Floor, QEQM Building, St Mary’s Hospital, London W2 1NY. Tel: 0203 312 1427 Fax: 0203 312 1810.
| | - Piers R Boshier
- Department of Surgery and Cancer, Imperial College London, UK
| | - Emre Doganay
- Department of Surgery and Cancer, Imperial College London, UK
| | - Venetia Wynter-Blyth
- Oesophago-Gastric Cancer Surgery Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - John P Buckley
- Centre for Active Living, University Centre Shrewsbury/University of Chester, Shrewsbury, UK
| | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College London, UK
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Halliday LJ, Doganay E, Wynter-Blyth V, Osborn H, Buckley J, Moorthy K. Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients. J Gastrointest Surg 2021; 25:890-899. [PMID: 32314231 PMCID: PMC8007503 DOI: 10.1007/s11605-020-04561-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/29/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prehabilitation is thought to reduce post-operative respiratory complications by optimising fitness before surgery. This prospective, single-centre study aimed to establish the effect of pre-operative exercise on cardiorespiratory fitness in oesophageal cancer patients and characterise the effect of adherence and weekly physical activity on response to prehabilitation. METHODS Patients received a personalised, home-based pre-operative exercise programme and self-reported their adherence each week. Cardiorespiratory fitness (pVO2max and O2 pulse) was assessed at diagnosis, following completion of neoadjuvant chemotherapy (NAC) and immediately before surgery. Study outcomes included changes in fitness and post-operative pneumonia. RESULTS Sixty-seven patients with oesophageal cancer underwent prehabilitation followed by surgery between January 2016 and December 2018. Fitness was preserved during NAC and then increased prior to surgery (pV02max Δ = +2.6 ml min-1, 95% CI 1.2-4.0 p = 0.001; O2 pulse Δ = +1.4 ml beat-1 95% CI 0.5-2.3 p = 0.001). Patients with higher baseline fitness completed more physical activity. Regression analyses found adherence was associated with improvement in fitness immediately before surgery (p = 0.048), and the amount of physical activity completed was associated with the risk of post-operative pneumonia (p = 0.035). CONCLUSION Pre-operative exercise can maintain cardiorespiratory fitness during NAC and facilitate an increase in fitness before surgery. Greater exercise volumes were associated with a lower risk of post-operative pneumonia, highlighting the importance progressing exercise programmes throughout prehabilitation. Patients with high baseline fitness completed more physical activity and may require less supervision to reach their exercise goals. Further research is needed to explore stratified approaches to prehabilitation.
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Affiliation(s)
- Laura J Halliday
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Emre Doganay
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Venetia Wynter-Blyth
- Oesophago-Gastric Cancer Surgery Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hayley Osborn
- Oesophago-Gastric Cancer Surgery Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - John Buckley
- Centre for Active Living, University Centre Shrewsbury/University of Chester, Shrewsbury, Chester, UK
| | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College London, London, UK
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Halliday LJ, Doganay E, Wynter-Blyth VA, Hanna GB, Moorthy K. The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison. J Gastrointest Surg 2021; 25:2733-2741. [PMID: 33269459 PMCID: PMC8602132 DOI: 10.1007/s11605-020-04881-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive. METHODS Between January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics. RESULTS Seventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8-17 days; control = median 13 days, IQR 11-20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications. CONCLUSION Prehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services.
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Affiliation(s)
- Laura J. Halliday
- grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emre Doganay
- grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, London, UK
| | - Venetia A. Wynter-Blyth
- grid.417895.60000 0001 0693 2181Oesophago-gastric cancer surgery unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - George B. Hanna
- grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, London, UK
| | - Krishna Moorthy
- grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, London, UK
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Halliday LJ, Doran SLF, Sgromo B, Viswanath YKS, Tucker O, Patel B, Jambulingam PS, Dawas K, Mercer S, Baker C, Mughal M, Hanna GB, Moorthy K. Variation in esophageal anastomosis technique-the role of collaborative learning. Dis Esophagus 2020; 33:5610077. [PMID: 31665408 DOI: 10.1093/dote/doz072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Centralization of care has improved outcomes in esophagogastric (EG) cancer surgery. However, specialist surgical centers often work within clinical silos, with little transfer of knowledge and experience. Although variation exists in multiple dimensions of perioperative care, the differences in operative technique are rarely studied. An esophageal anastomosis workshop was held to identify areas of common and differing practice within the operative technique. Surgeons showed videos of their anastomosis technique by open and minimally invasive surgery. Each video was followed by a discussion. Surgeons from 10 different EG cancer centers attended. Eight key technical differences and learning points were identified and discussed: the optimum diameter of the gastric conduit; avoiding ischemia in the gastric conduit; minimizing esophageal trauma; the use of an esophageal mucosal collar; omental wrapping; intraoperative leak testing; ideal diameter of the circular stapler and the growing use of linear stapled anastomoses. The workshop received positive feedback from participants and on 2 years follow-up, 40% stated that they believed that the learning of tips and techniques during the workshop has contributed to lowering their anastomotic leak rate. Many differences exist in surgical technique. The reasons for, and crucially the significance of, these differences must be discussed and examined. Workshops provide a forum for peer-to-peer collaborative learning to reflect on one's own practice and improve surgical technique. These changes can, in turn, generate incremental improvements in patient care and postoperative outcomes.
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Affiliation(s)
- L J Halliday
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - S L F Doran
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - B Sgromo
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Y K S Viswanath
- Department of Surgery, James Cook University Hospital, Middlesborough, UK
| | - O Tucker
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - B Patel
- Upper GI Surgery Unit, The Royal London Hospital, London, UK
| | - P S Jambulingam
- Department of Upper GI Surgery, Luton and Dunstable Hospital, Luton, UK
| | - K Dawas
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - S Mercer
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - C Baker
- Upper GI Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Mughal
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - K Moorthy
- Department of Surgery and Cancer, Imperial College London, London, UK
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Whibley J, Peters CJ, Halliday LJ, Chaudry AM, Allum WH. Poor performance in incremental shuttle walk and cardiopulmonary exercise testing predicts poor overall survival for patients undergoing esophago-gastric resection. Eur J Surg Oncol 2018; 44:594-599. [PMID: 29459017 DOI: 10.1016/j.ejso.2018.01.242] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/27/2017] [Accepted: 01/30/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Esophageal and gastric cancer have a poor prognosis and surgical intervention is associated with considerable morbidity, highlighting the need for careful preoperative assessment. The Incremental Shuttle Walk Test (ISWT) and Cardiopulmonary exercise testing (CPET) can assess preoperative fitness. This study aims to investigate their correlation with both postoperative respiratory complications and overall survival. PATIENTS AND METHODS Patients were identified who underwent esophageal or gastric resections for cancer between 2010 and 2014 and had ISWT and/or CPET assessments. Tumor differentiation, stage, postoperative respiratory complications, and outcome were documented and then correlated with the results of the preoperative fitness assessments. RESULTS Neither the ISWT result, anaerobic threshold (AT) nor VO2 Max correlated well with perioperative complications. However, ISWT (p < 0.001), AT (p < 0.001) and VO2 Max (p < 0.001) all correlated strongly with overall survival. No patient with a score of less than 350 m on ISWT survived beyond 3 years. In a subset of patients with ISWT results both pre and post chemotherapy (n = 49), those that had an improvement in result had a 19% incidence of post-operative respiratory complications compared to 45% where the result did not change or declined, though due to small numbers this only approached significance (p = 0.08). CONCLUSION ISWT and CPET can be useful preoperative tools to predict overall survival for patients undergoing esophago-gastric resection. Furthermore, patients that improve their functional status during chemotherapy seem to do better than those where it remains static or declines.
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Affiliation(s)
- Jessica Whibley
- Department of Physiotherapy, The Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK.
| | - Christopher J Peters
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Laura J Halliday
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Asif M Chaudry
- Academic Department of Surgery, The Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK.
| | - William H Allum
- Academic Department of Surgery, The Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK.
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Abstract
The feasibility and safety of enhanced recovery protocols (ERP) have been demonstrated in a large number of surgical specialties. Several studies have shown improved post-operative outcomes and economic benefit from the use of ERPs in oesophageal cancer surgery. However, these improvements are not always translated more widely into clinical practice due to variation in protocols, poor compliance and failure to implement a robust implementation strategy. ERP implementation strategies should reflect the fact that these are complex interventions that are influenced by a wide range of social, organizational and cultural factors.
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Affiliation(s)
- Laura J Halliday
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Sophie L F Doran
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Krishna Moorthy
- Department of Cancer and Surgery, Imperial College London, London, UK
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Halliday LJ, Sharma AK. Multiple thoracic duct cysts: an unusual CT finding. J Surg Case Rep 2015; 2015:rjv056. [PMID: 25952956 PMCID: PMC4423054 DOI: 10.1093/jscr/rjv056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Thoracic duct cysts in the mediastinum are rare. We report the case of a 66-year-old gentleman who was found to have multiple small thoracic duct cysts during investigation of a retrosternal thyroid goitre. Multiple paraoesphageal swellings were seen on a computed tomographic scan in the upper posterior mediastinum. The largest was 2 cm and they were continuous with the thoracic duct. This is this first reported case of multiple thoracic duct cysts. Previous cases are of a single large swelling, the majority of which were surgically excised. Small asymptomatic cysts such as the case we present are suitable for conservative management.
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Affiliation(s)
| | - Anup K Sharma
- Department of General Surgery, St George's Hospital, London, UK
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Abstract
A bilobed testicle is an extremely rare congenital malformation, with only five cases published to date. We present the case of a 12-year-old boy with a bilobed testicle. With so few cases available, much of what is known about the management of this condition is based on cases of polyorchidism and the complications associated with this, including malignancy and torsion. Whilst surgery may play a role in some patients, uncomplicated cases can be managed conservatively. There is no long-term data on the outcome of conservative management but we propose this patient can be discharged if no further changes are identified after 18 months.
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Affiliation(s)
- Laura J Halliday
- Department of General Surgery, Medway Maritime Hospital, Gillingham, UK
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Mounchili A, Wichtel JJ, Dohoo IR, Keefe GP, Halliday LJ. Risk factors for milk off-flavours in dairy herds from Prince Edward Island, Canada. Prev Vet Med 2004; 64:133-45. [PMID: 15325768 DOI: 10.1016/j.prevetmed.2004.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Revised: 04/15/2004] [Accepted: 05/07/2004] [Indexed: 11/26/2022]
Abstract
A sudden increase in the incidence of milk off-flavours in bulk tank milk from Prince Edward Island (Canada) dairy farms in the late 1990s prompted an investigation of potential herd-level risk factors. A prospective case-control study was conducted from 2000 to 2002. Data on herd management were obtained by questionnaire and field investigation from all the 62 identified off-flavour positive farms (cases) and 62 loosely matched (for data-collection convenience) off-flavour negative farms (controls). Forty-three of the 62 cases (69%) of milk off-flavours identified during the study period were classified as "transmitted" (feed) off-flavours, and 9 (15%), 6 (10%), and 4 (6%) as "rancid", "oxidized" and "malty" off-flavours, respectively. Given this evidence and the relatively low incidence of other flavour defects in milk, only transmitted-flavour cases were considered in the analyses of risk factors. Poor air quality in the lactating cows' barn (OR = 40.8), using baled silage as the main forage (OR = 10.6), as well as feeding roughage before milking (OR = 253.3) or as a free choice (OR = 3.2) all were significantly (P < 0.05) associated with the incidence of transmitted flavours in bulk-tank milk. Clipping the hair on the cows' udder (OR = 0.07) and changing the bedding material more than once a day (OR = 0.12) were protective. The finding about feeding baled silage before milking has raised hypotheses about silage composition (in particular the off-flavour compounds or their precursors) and also about the process of silage making itself.
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Affiliation(s)
- A Mounchili
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3.
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