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P. Rajesh
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MA 08 - Supportive Care and Communication (ID 669)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:E. Esposito-Nguyen, John McPhelim
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 511 + 512
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MA 08.09 - Postoperative Mobilisation and Rehabilitation Requirements for Lung Cancer Patients Undergoing Minimally Invasive Surgery (ID 10064)
11:00 - 12:30 | Author(s): P. Rajesh
- Abstract
- Presentation
Background:
Video-assisted thoracoscopic surgery (VATS) is now increasingly performed and recommended in early-stage NSCLC resection. Early postoperative mobilisation, rehabilitation and physiotherapy can improve subsequent reduction in lung volumes, aid clearance of secretions and independent mobility, although there is much variation in how lung cancer patients are currently managed in this respect. The objective of this study was to observe capability for early mobility and frequency of issues potentially amenable to physiotherapy rehabilitation following VATS lobectomy for lung cancer. Any preoperative factors associated with increased rehabilitation needs were also identified, thus enabling early recognition of lung cancer patients needing rehabilitation.
Method:
A prospective observational study was performed including all consecutive cancer patients undergoing VATS lobectomy in a regional centre over 4 years (2012-2016). Standard postoperative care included early mobilisation where patients were sat out by nursing staff from postoperative day 1 (POD1) and assisted to mobilise as able. Physiotherapy assessment of all patients on POD1 determined presence of issues potentially amenable to rehabilitation, and this was commenced as deemed necessary. Outcome measures included development of postoperative pulmonary complication (PPC), hospital and high dependency unit (HDU) length of stay (LOS) and intensive therapy unit admission (ITU).
Result:
285 lung cancer patients were observed; 76 (27%) patients did not requiring specialised rehabilitation or physiotherapy, and engaged with nursing staff successfully in early mobility and becoming independently mobile. These patients had a significantly lower hospital and HDU length of stay (p<0.001), reflecting uncomplicated recovery. The remaining 209 patients (73%) received physiotherapy rehabilitation to assist/improve reduced mobility. Of these patients 23 (8%) also received chest physiotherapy for sputum clearance and 65 (23%) for lung volume loss. amongst those requiring this therapy were all patients who developed PPC, and all those admitted to the ITU. Despite surgery being non-invasive the frequency of development of PPC was higher than that for other VATS surgery at 7%, and this was associated with poorer outcomes. Logistic regression identified that COPD, BMI, preoperative mobility and age were associated with increased postoperative rehabilitation needs for mobility or respiratory issues (p=0.013).
Conclusion:
We recommend that all lung cancer patients receive early mobilisation and routine postoperative rehabilitation following this surgery ensuring issues amenable to physiotherapy and the need for rehabilitation is detected early. Associated preoperative baseline factors included COPD, poor preoperative mobility, and increasing BMI and age; such patients may benefit from preoperative rehabilitation as well as routine physiotherapy for better postoperative outcome.
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P1.10 - Nursing/Palliative Care/Ethics (ID 696)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.10-002 - Outcome of Pilot RCT in Lung Cancer Surgery Patients Receiving Either Preop Carbohydrate & Postop Nutritional Drinks or Water (ID 8405)
09:30 - 16:00 | Author(s): P. Rajesh
- Abstract
Background:
In recent thoracic surgical studies, malnutrition and/or weight loss are important risk factors for complications after surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in complications or malnutrition. Enhanced Recovery After Surgery (ERAS) programmes in non-lung surgery include pre-surgery optimisation with carbohydrate loading drinks and post-surgery nutritional supplements. These interventions have proven highly effective in reducing post-operative complications. No trials have been performed in thoracic surgery to assess the impact.
Method:
Single centre mixed method open label Randomised Controlled Trial (RCT) was conducted to assess the feasibility of carrying out a large multicentre RCT in patients undergoing lung resection. A nutritional intervention regime of preoperative carbohydrate-loading drinks 4x200mls evening before surgery and 2X200mls the morning of surgery, and early postoperative nutritional protein supplement drinks twice a week for 2 weeks was compared to the control group receiving an equivalent volume of water. Trial feasibility measures were collected as primary outcome. Postoperative pulmonary complications were measured using the Melbourne group scale along with additional surgical complications. Visual analogue scores of symptoms, Quality of Recovery score 40, quality of life (EQ-5D-5L) and satisfaction questionnaires were collected at baseline, in hospital, 3-4 weeks and 3 month post-surgery along with hand grip and peak flow. Qualitative semi structured interviews post-surgery were undertaken to assess patient experience of the trial and interventions.
Result:
Feasibility criteria’s were met and the study completed recruitment 5 months ahead of target. All elective lung cancer surgery patients were screened of which 41% (n=64) were randomised over 6 month period. The 2 groups were well balanced and tools used to measure outcome robust. 97% of patients were compliant with nutritional drinks scheduled pre-surgery, 89% of 3 month questionnaires were returned completed. Importantly, qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires used captured their experience of recovery from surgery well.
Conclusion:
Current international guidelines for enhanced recovery following thoracic surgery cannot recommend pre or post-operative nutrition because of lack of evidence. We have shown an intervention and a trial design of pre-op carbohydrate-loading and post-surgery supplementation is highly acceptable to patients’ with good compliance to both intervention and trial measures. A large multi-centre clinical trial is required to test clinical efficacy in improving outcomes after surgery.
