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  • br Discussion Prehabilitation is a

    2019-04-17


    Discussion “Prehabilitation” is a program to enhance functional capacity and psychological health to enable patients to withstand an upcoming stressor, e.g. surgery. It is intended to reduce treatment-related morbidity and/or mortality, to decrease length of hospital stay and/or re-admission, and to increase available treatment options. Prehabilitation should be considered as a meaningful regimen preoperatively to enhance functional capacity of patients during the period when they are waiting for scheduled surgery, searching for a second opinion, or psychologically unable to readily deal with the primary cancer treatment, especially for those with poor physical capacity. Fast-track rehabilitation was developed by Kehlet and Basse et al during the mid-1990 s. It is a recovery enhancing rehabilitation in an attempt to alleviate stress response, reduce complications, facilitate postoperative mobilization, speed up recovery and shorten the hospital stay, all without compromising patient safety. Early postoperative mobilization is one of the essential parts of fast-track rehabilitation. For example, the protocol for early mobilization developed by Lee et al consisted of getting the patient to sit in the chair over an hour on the day of surgery; then progressing to sit in the chair over 3 h and to walk in the ward for more than 400 m on postoperative day one; and finally, continuing to walk for more than 600 m on postoperative day two. The meta-analysis reported by Li et al has initially shown that laparoscopic fast-track rehabilitation is safe and efficacious for CRC patients. Exercise and physical activity interventions are beneficial to increase survivors\' physical activity levels and submaximal aerobic fitness, and enrich their quality of life. Physical activity performed before or after cancer diagnosis is thought to be related to a reduced recurrence and mortality risk among CRC survivors. Insulin resistance, SB202190 growth factor binding protein-1 (IGFBP-1), cytokines, leptin and adiponectin have been proposed as factors Complementation assay may influence the prognosis of colorectal cancer. Leptin may act as a potent mitogen and antiapoptotic cytokine in colon cancer and facilitate the invasion of cancer cells. In contrast, adiponectin has antiproliferative effects and is a direct angiogenesis inhibitor. CRC patients were found to have higher serum leptin, lower serum adiponectin, and greater leptin/adiponectin (L/A) ratio than the controls. Leptin and adiponectin are theorized to be involved in the pathogenesis of gastrointestinal cancer, and L/A ratio is considered as an independent predictor for CRC survival. In addition, lower level of IGFBP-1 were found to be associated with increased mortality. Increasing physical activity may potentially have an effect on level of the predictive biomarkers for the outcome of colorectal cancer. If there is no contraindication for the CRC patients to pursue exercise, they should be encouraged to engage in more exercise, just to increase or at least maintain their physical activity level. A great majority of studies employ aerobic exercise, using ergometry, stationary bicycling, walking programs, muscle strength training, REST exercise and elastic band exercise. Exercise programs can be conducted as either center-based or home-based. Physical activity participation includes household and yard work activities, occupational activity, walking or cycling for transport, walking at home and at work, and leisure time physical activity as well as sedentary activity. For patients who felt too tired or “weak” to mobilize soon after surgery or during chemotherapy, the ten exercises recommended by The Christie NHS Foundation Trust are appropriate. The patients\' physical activity level can be assessed by either self-administered questionnaire or monitored by physical therapists, well-trained nurse specialists or case managers through telephone-delivered intervention, which has been shown to be feasible, convenient, flexible, wide-reaching and potentially low cost.