Sebio-Garcia Raquel, Celada-Castro Cristina, Arguis Maria J, Sisó Marina, Torné Aureli, Tena Beatriz, Díaz-Feijoo Berta, Martinez-Palli Graciela
Department of Rehabilitation, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
Gynecology Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
Int J Gynecol Cancer. 2024 Oct 7. doi: 10.1136/ijgc-2024-005686.
Prehabilitation, defined as the preparatory intervention to increase patient preparedness in the lead-up to surgery, has shown a decrease in post-operative complications in various types of surgery. However, there is limited evidence in advanced ovarian cancer surgery. This study aimed to evaluate the benefits of multimodal prehabilitation in advanced ovarian cancer patients in terms of improving physical functioning, body composition, and psychological well-being during the pre-operative period.
This single-center, ambispective study included patients with advanced ovarian cancer eligible for primary or interval cytoreductive surgery. Participants attended a multimodal prehabilitation program comprising medical optimization, supervised exercise training, nutritional counseling and supplementation, and psychological support. Functional capacity, nutritional status, and psychological well-being were assessed before the start of the program and before surgery.
62 patients were referred for the multimodal prehabilitation program from July 2019 to May 2023. Median adherence to the training program reached 75% (IQR 58-87%). 35 patients (59%) were evaluated pre-operatively. Patients attended a median of 8 (IQR 6-12) supervised exercise training sessions with no differences between those who underwent primary or interval cytoreductive surgery (p=0.80). A significant improvement was observed in functional capacity according to the 6 min walk test (mean 33.1 m, 95% CI 10.5 to 55.5) as well as in the 30 s sit-to-stand test (+3.3 repetitions, 95% CI 1.8 to 4.8), with both being above the minimal clinically important difference of 14 m and two repetitions, respectively. Patients also reported a significant decrease in depression, anxiety, and total scores of the Hospital Anxiety and Depression Scale.
Multimodal prehabilitation in patients with advanced ovarian cancer undergoing cytoreductive surgery improves pre-operative physical functioning and decreases emotional distress. Further controlled studies with a larger sample size are warranted to corroborate improvement in functional capacity, body composition, and psychological well-being through prehabilitation programs.
术前康复，定义为在手术前增加患者准备程度的预备性干预措施，已显示在各类手术中可降低术后并发症。然而，在晚期卵巢癌手术方面证据有限。本研究旨在评估多模式术前康复对晚期卵巢癌患者在术前改善身体功能、身体成分和心理健康方面的益处。
这项单中心、前瞻性研究纳入了符合初次或间隔期肿瘤细胞减灭术条件的晚期卵巢癌患者。参与者参加了一个多模式术前康复计划，包括医疗优化、监督下的运动训练、营养咨询与补充以及心理支持。在计划开始前和手术前评估功能能力、营养状况和心理健康。
2019年7月至2023年5月期间，62例患者被转介至多模式术前康复计划。对训练计划的中位依从率达到75%（四分位间距58 - 87%）。35例患者（59%）接受了术前评估。患者平均参加了8次（四分位间距6 - 12次）监督下的运动训练课程，接受初次或间隔期肿瘤细胞减灭术的患者之间无差异（p = 0.80）。根据6分钟步行试验，功能能力有显著改善（平均33.1米，95%置信区间10.5至55.5），30秒坐立试验也有显著改善（增加3.3次重复，95%置信区间1.8至4.8），两者均分别高于最小临床重要差异14米和2次重复。患者还报告抑郁、焦虑以及医院焦虑抑郁量表总分显著降低。
接受肿瘤细胞减灭术的晚期卵巢癌患者进行多模式术前康复可改善术前身体功能并减轻情绪困扰。需要进一步开展更大样本量的对照研究，以证实术前康复计划在功能能力、身体成分和心理健康方面的改善效果。
