Faculty of Health, University of Canberra, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia.
Faculty of Health, University of Canberra, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, ACT, Australia; ACT Synergy Nursing and Midwifery Research Centre, Canberra Hospital, ACT, Australia.
Semin Oncol Nurs. 2020 Oct;36(5):151072. doi: 10.1016/j.soncn.2020.151072. Epub 2020 Sep 30.
BACKGROUND: Muscle invasive bladder cancer (MIBC) is commonly treated with radical cystectomy. Patients who require radical cystectomy are often frail, unwell, have multiple comorbidities, and can experience unmet supportive care needs. Due to these complexities, patients requiring radical cystectomy are often considered high risk for anesthetics, and therefore improving their physical and psychological well-being is crucial prior to radical surgery. Prehabilitation is the practice of enhancing a patient's functional and psychological capacity before surgery, with the aim of improving postoperative outcomes. This narrative review aims to identify and evaluate the role of physical exercise, nutritional intervention, and person-centered holistic approaches to prehabilitation in people affected by MIBC treated by radical cystectomy. DATA SOURCES: Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google scholar until June 2020. CONCLUSION: Evidence to support specific prehabilitation clinical recommendations in people affected by MIBC is emerging. Prehabilitation including exercise prescription, nutritional intervention, and person-centered holistic support is an important part of the clinical pathway for people affected by MIBC. Individualized prehabilitation programs across the multidisciplinary team should be considered to provide specific individual recommendations to avoid "one size fits all". Given the limited research in this clinical area, future high-quality multi-center prospective trials are urgently needed. IMPLICATIONS FOR NURSING PRACTICE: People affected by MIBC can experience a range of unmet supportive care needs in routine clinical care delivery at the time of diagnosis and into survivorship. Evidence is emerging around the role of multidisciplinary interventions in the form of exercise, nutritional input, and holistic supportive care to improve physical and psychological well-being prior to major surgery. Specialist nurses are ideally placed to ensure that individual holistic care needs are addressed, and appropriate care and support is provided. Nurses can trigger timely referrals to members of the multidisciplinary team to coordinate an integrated person-centered approach to prehabilitation service provision to address the unmet needs of people undergoing treatment for MIBC.
背景：肌层浸润性膀胱癌（MIBC）通常采用根治性膀胱切除术进行治疗。需要接受根治性膀胱切除术的患者通常身体虚弱、不适，合并多种疾病，并且可能存在未满足的支持性护理需求。由于这些复杂性，需要接受根治性膀胱切除术的患者通常被认为存在麻醉高风险，因此在进行根治性手术前，改善他们的生理和心理健康至关重要。术前康复是指在手术前增强患者的功能和心理能力，旨在改善术后结果。本叙述性综述旨在确定和评估身体锻炼、营养干预以及以患者为中心的整体方法在接受根治性膀胱切除术治疗的 MIBC 患者中的术前康复作用。
数据来源：使用 Google Scholar 搜索了 CINAHL、MEDLINE、PsychINFO、Scopus 和灰色文献在内的电子数据库，检索时间截至 2020 年 6 月。
结论：支持 MIBC 患者特定术前康复临床建议的证据正在出现。包括运动处方、营养干预和以患者为中心的整体支持在内的术前康复是 MIBC 患者临床路径的重要组成部分。应该考虑跨多学科团队的个体化术前康复计划，为避免“一刀切”提供具体的个体化建议。鉴于该临床领域的研究有限，迫切需要进行未来的高质量多中心前瞻性试验。
对护理实践的影响：MIBC 患者在诊断时和进入生存阶段，在常规临床护理中可能会经历一系列未满足的支持性护理需求。越来越多的证据表明，多学科干预措施以运动、营养输入和整体支持性护理的形式发挥作用，可在接受重大手术前改善生理和心理健康。专科护士最适合确保满足个体的整体护理需求，并提供适当的护理和支持。护士可以及时转介给多学科团队成员，协调以患者为中心的综合术前康复服务提供方式，以满足正在接受 MIBC 治疗的患者的未满足需求。
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