Exercise prehabilitation program for patients under neoadjuvant treatment for rectal cancer: A pilot study.

CONTEXT: Prehabilitation is emerging as a method of preparing patients physically and mentally for the often disabling effects of cancer treatment. AIMS: This study aims to assess the feasibility and to explore the potential effects of a prehabilitation program consisting of educational physical exercise sessions in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy treatment (NCRT). SETTINGS AND DESIGN: This was a pilot study with 12 patients (3 males and 9 females, age 61 ± 7 years). SUBJECTS AND METHODS: The program included six educational sessions of exercise during NCRT. Adherence to the intervention; quality of life (QoL); anxiety and depression; body mass index; physical fitness (peak oxygen uptake (VO2peak), handgrip and dynamic leg strength); and physical activity (PA) levels were measured. STATISTICAL ANALYSIS USED: Data are reported as the mean ± standard deviation or medians and interquartile ranges for questionnaire-derived data. Secondary outcome measures were compared using the nonparametric Wilcoxon test. The threshold P value for significance was calculated after correction for multiple comparisons using the Bonferroni method. RESULTS: Adherence to the program was 64 of 72 possible exercise education sessions completed, i.e., 89%. We detected a trend toward a significant improvement in VO2peak after the intervention (P = 0.015), together with reduced scores for both depression (P = 0.017) and the QoL domain "emotional function" (P = 0.027). Mean levels of moderate to vigorous PA tended to increase after the exercise program (P = 0.091). CONCLUSIONS: Exercise might be an effective prehabilitation strategy for surgery during the period of NCRT.

Threats for sustainability of multidisciplinary working: Attitudes and perceptions of cancer care providers.

BACKGROUND: To develop methods for cancer teams to work effectively, it is first necessary to understand how multidisciplinary teams work together as part of an organization. Implementation and adoption of new clinical practices such as team working is a challenging task. It is known that implementation of multidisciplinary working depends on a complex, multilevel interaction of team, and organizational factors. However, little is known about the threats to the sustainability of functioning multidisciplinary teams. MATERIALS AND METHODS: A questionnaire was mailed to 125 multidisciplinary team meetings (MTMs) attendees. Five focus groups were gathered in order to discuss threats and strengths of cancer team-working. Discussions at the meetings were transcribed verbatim and analyzed for emergent themes using standard qualitative research methodology. RESULTS: About 31 physicians and MTMs attendees participated in the focus groups. They perceive that meetings are very useful for making a good decision over patients. Lack of dedicated time and lack of support by the institution were the most recurrent themes which could be considered as threats for sustainability of cancer conferences. Leadership and decision-making process should be refined. CONCLUSIONS: Physicians see enormous value in MTMs but the lack of support from the organization could compromise the future effective working. This research highlights the need to explore local strengths and threats for sustainability of periodic cancer team working.