Implementing a Multimodal Prehabilitation Program to Radical Cystectomy in a Comprehensive Cancer Center: A Pilot Study to Assess Feasibility and Outcomes.

BACKGROUND: Radical cystectomy(RC) often leads to postoperative morbidity and complications. We conducted a pilot study on the effectiveness of multimodal prehabilitation, a preoperative conditioning method shown to be effective for colorectal surgery, in bladder cancer patients soon to undergo RC. We assessed patients' adherence to the prehabilitation regimen and changes in their physical condition. METHODS: Thirty-two bladder cancer patients at Memorial Sloan Kettering from February to August 2015 scheduled for RC were included in a standardized prehabilitation program. The 2-week program consisted of general physical exercises for the major muscle groups used for everyday activities, and sufficient protein intake. Patients received a program journal to document physical and nutritional achievements. Patients were physically tested using handgrip strength and bio-impedance at 2 weeks pre-surgery, day of surgery, and 6 weeks post-surgery. Additionally, a six-minute walk test (6MWT) 2 weeks before and 6 weeks after surgery were measured. RESULTS: Adherence to the exercises and nutritional recommendations respectively, was 62% (95% confidence interval [CI] 42-78%) for the exercise component and 81% (95% CI 62-93) for the nutritional component. The 6MWT results, showing physical capacity, significantly improved from baseline to 6-week follow-up, with an increase of 9.2% (95% CI 0.3-20.99; p=0.03). The handgrip strength, a proxy for nutritional status, improved 6.8% (95% CI 1.4-14.4; p=0.001) from baseline to admission, and maintained until 6-week follow-up (p=0.7). CONCLUSION: In a United States comprehensive cancer center, implementing a multimodal prehabilitation program is feasible in clinical practice and maintained. or even improved, physical functioning post-surgery compared to baseline.

Preoperative Nutritional Status and The Impact on Radical Cystectomy Recovery: An International Comparative Study.

In radical cystectomy, under-nutrition is common and has detrimental physiological and clinical effects, which can lead to increased complications and prolonged recovery. This article compares measurements and outcomes across continents in this patient population with advanced bladder cancer. The association of preoperative nutritional risk, nutritional status, and length of stay is equal across continents, and the results promote increased clinical awareness that women at severe risk should be identified preoperatively.