Patient Empowerment Improved Perioperative Quality of Care in Cancer Patients Aged ≥ 65 Years – A Randomized Controlled Trial

Abstract

PurposeThis randomized controlled, clinical prospective interventional trial was aimed at exploring the effect of patient empowerment on short- and long-term outcomes after major oncologic surgery in elderly cancer patients.MethodsThis trial was performed from February 2011 to January 2014 at two tertiary medical centers in Germany. The study included patients aged 65 years and older undergoing elective surgery for gastro-intestinal, genitourinary, and thoracic cancer. The patients were randomly assigned to the intervention group, i.e. patient empowerment through information booklet and diary keeping, or to the control group, which received standard care. Randomization was done by block randomization in blocks of four in order of enrollment. The primary outcome were 1,postoperative length of hospital stay (LOS) and 2. long-term global health-related quality of life (HRQoL) one year postoperatively. HRQoL was assessed using the EORTC QLQ C30 questionnaire. Secondary outcomes encompassed postoperative stress and complications. Further objectives were the identification of predictors of LOS, and HRQoL at 12 months.ResultsOverall 652 patients were included. The mean age was 72 ± 4.9 years, and the majority of patients were male (68.6%, n = 447). The ^median of postoperative length of stay was 9 days (IQR 7–14 day). There were no significant differences between the intervention and the control groups in postoperative LOS (p = 0.99) or global HRQoL after one year (women: p = 0.54, men: p = 0.94). While overall complications and major complications occurred in 74% and 24% of the cases, respectively, frequency and severity of complications did not differ significantly between the groups. Patients in the intervention group reported significantly less postoperative pain (p = 0.03) than the control group. Independent predictors for LOS were identified as severity of surgery, length of anesthesia, major postoperative complications, nutritional state, and pre-operative physical functional capacity measured by the Timed Up and Go-test by multiple robust regressions.ConclusionPatient empowerment through information booklet and diary keeping did not shorten the postoperative LOS in elderly onco-surgical patients, but improved quality of care regarding postoperative pain. Postoperative length of stay is influenced by pre-operative nutritional state, pre-operative functional impairment, severity of surgery, and length of anesthesia.Trial RegistrationClinicaltrials.gov. Identifier NCT01278537

Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes

“…Most individual RCTs analysed fewer than 60% of the sample originally recruited in the study, excluding participants due to comorbidity or inability to undergo cardiopulmonary exercise testing. Participants were adults with colorectal (Carli et al, ; Cheville et al, ; Gillis et al, ; Moriya, ) lung (Barlési et al, ; Stefanelli et al, ), head and neck (Van Bokhorst‐de Van der Schuer et al, ), breast (Garssen et al, ), bladder (Jensen, Krintel Petersen, Jensen, Lausten, & Borre, ; Jensen, Petersen, Jensen, Laustsen, & Borre, ) and prostate (Bales et al, ; Burgio et al, ; Parker et al, ) cancer or included individuals with a range of cancers (Schmidt et al, ). Trial designs were primarily feasibility studies, and therefore, the studies were rarely powered to determine the efficacy of prehabilitation on post‐treatment recovery outcomes.…”

“…The primary endpoint was predominantly objective physical function prior to treatment with the secondary endpoints described at 1–6 months post‐intervention. Only four (25%) of the authors fully reported participant comorbidities at baseline (Burgio et al, ; Jensen et al, ; Schmidt et al, ; Van Bokhorst‐de Van der Schuer et al, ) while two actively excluded participants with comorbidities possibly due to the intensity of the exercise programme (Carli et al, ; Stefanelli et al, ).…”

Exploring health navigating design: momentary contentment in a cancer context

“…Already existing psycho-pedagogical tools to increase knowledge about the disease show that specific and clear disease information increases patient empowerment and participation. From participation grows knowledge (Alden, 2014; Kane, 2014; Schmidt et al, 2015). There are several studies as well as patient testimonies pointing to the importance of patient participation and self-action in both diagnostic and treatment processes (deBronkart, 2011; McDonald, Bryce, & Graber, 2013).…”

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

“…Several studies, such as ERAS [1] and PER-ATECS [2], have already shown that the field of anesthesiology plays a significant role in ensuring the successful treatment and recovery of these patients. Surgeons and anesthesiologists must be aware of strategies required to deal with this special subgroup.…”