Preparing for colorectal surgery: a qualitative study of experiences and preferences of patients in Western Canada.

OBJECTIVES: The burden and costs of abdominal surgery for chronic conditions are on the rise, but could be reduced through self-management support. However, structured support to prepare for colorectal surgery is not routinely offered to patients in Canada. This study aimed to describe experiences and explore preferences for multimodal prehabilitation among colorectal surgery patients. METHODS: A qualitative descriptive study using three focus groups (FG) was held with 19 patients who had a surgical date for abdominal surgery (April 2017-April 2018) and lived close (≤ 50 km radius) to a tertiary hospital in Western Canada (including a Surgical Lead for the British Columbia Enhanced Recovery After Surgery (ERAS) Collaborative). FGs were audio-taped and verbatim transcribed with coding and pile-and-sort methods performed by two independent reviewers, confirmed by a third reviewer, in NVivo v9 software; followed by thematic analysis and narrative synthesis. RESULTS: Four themes emerged: support, informed decision-making, personalization of care, and mental/emotional health, which patients felt was particularly important but rarely addressed. Patient preferences for prehabilitation programming emphasised regular support from a single professional source, simple health messages, convenient access, and flexibility. CONCLUSIONS: There is an unmet need for structured preoperative support to better prepare patients for colorectal surgery. Future multimodal prehabilitation should be flexible and presented with non-medical information so patients can make informed decisions about their preoperative care and surgical outcomes. Healthcare providers have an important role in encouraging healthy lifestyle changes before colorectal surgery, though clearer communication and accurate advice on self-care, particularly mental health, are needed for improving patient outcomes.

Impact of exercise on chemotherapy completion rate: A systematic review of the evidence and recommendations for future exercise oncology research.

Receipt of full chemotherapy dose is associated with improved treatment efficacy and survival following a diagnosis of cancer. Exercise has emerged as a supportive care intervention that may improve chemotherapy completion rate by managing dose-limiting toxicities. We conducted a systematic review to evaluate the impact of exercise interventions on outcomes of chemotherapy completion rate in adult cancer patients. Relevant literature was retrieved from CINAHL, Medline (Ovid) and EMBASE based on subject headings and keywords pertaining to cancer, exercise and antineoplastic agents. Eligible articles were randomized control trials (RCTs) that prescribed aerobic or resistance exercise and included end-points relating to chemotherapy completion rate. Overall, eight RCTs were included in the final analysis. Only two RCTs (25%) that enrolled women with early-stage breast cancer reported a significant beneficial effect of exercise on chemotherapy completion rate, including higher mean relative dose intensity and fewer chemotherapy dose adjustments, relative to usual care. The remaining six studies reported no difference with exercise. Altogether, despite the growing number of exercise oncology trials to-date, information pertaining to the effect of exercise on chemotherapy completion rate is limited. Current data suggest exercise does not worsen chemotherapy tolerability. However, full interpretation of these findings is limited by the small number of trials. Future research involving rigorous study design is needed to confirm whether exercise can influence chemotherapy treatments.