Patient Empowerment Improved Perioperative Quality of Care in Cancer Patients Aged ≥ 65 Years - A Randomized Controlled Trial.

Maren Schmidt,Bruno Neuner,Rahel Eckardt,Jalid Sehouli,Christian G Stief,Claudia D Spies,Kathrin Scholtz,Klaus-Dieter Wernecke,Vera Von Dossow-Hanfstingl,Helge Bruns

doi:10.1371/journal.pone.0137824

Maren Schmidt, Bruno Neuner + Show 8 more

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https://doi.org/10.1371/journal.pone.0137824

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Abstract

PurposeThis randomized controlled, clinical prospective interventional trial was aimed at exploring the effect of patient empowerment on short- and long-term outcomes after major oncologic surgery in elderly cancer patients.MethodsThis trial was performed from February 2011 to January 2014 at two tertiary medical centers in Germany. The study included patients aged 65 years and older undergoing elective surgery for gastro-intestinal, genitourinary, and thoracic cancer. The patients were randomly assigned to the intervention group, i.e. patient empowerment through information booklet and diary keeping, or to the control group, which received standard care. Randomization was done by block randomization in blocks of four in order of enrollment. The primary outcome were 1,postoperative length of hospital stay (LOS) and 2. long-term global health-related quality of life (HRQoL) one year postoperatively. HRQoL was assessed using the EORTC QLQ C30 questionnaire. Secondary outcomes encompassed postoperative stress and complications. Further objectives were the identification of predictors of LOS, and HRQoL at 12 months.ResultsOverall 652 patients were included. The mean age was 72 ± 4.9 years, and the majority of patients were male (68.6%, n = 447). The ^median of postoperative length of stay was 9 days (IQR 7–14 day). There were no significant differences between the intervention and the control groups in postoperative LOS (p = 0.99) or global HRQoL after one year (women: p = 0.54, men: p = 0.94). While overall complications and major complications occurred in 74% and 24% of the cases, respectively, frequency and severity of complications did not differ significantly between the groups. Patients in the intervention group reported significantly less postoperative pain (p = 0.03) than the control group. Independent predictors for LOS were identified as severity of surgery, length of anesthesia, major postoperative complications, nutritional state, and pre-operative physical functional capacity measured by the Timed Up and Go-test by multiple robust regressions.ConclusionPatient empowerment through information booklet and diary keeping did not shorten the postoperative LOS in elderly onco-surgical patients, but improved quality of care regarding postoperative pain. Postoperative length of stay is influenced by pre-operative nutritional state, pre-operative functional impairment, severity of surgery, and length of anesthesia.Trial RegistrationClinicaltrials.gov. Identifier NCT01278537

Highlights

Cancer is among the leading cause of morbidity and death worldwide]
There were no significant differences between the intervention and the control groups in postoperative length of hospital stay (LOS) (p = 0.99) or global healthrelated quality of life (HRQoL) after one year
Independent predictors for LOS were identified as severity of surgery, length of anesthesia, major postoperative complications, nutritional state, and pre-operative physical functional capacity measured by the Timed Up and Go-test by multiple robust regressions

Summary

Introduction

Cancer is among the leading cause of morbidity and death worldwide]. The incidence of (solid) cancer increases substantially with age [1]. With the increase of life expectancy in the developed countries, the incidence of cancer, and respectively volume of cancer surgery in patients older than 65 years, increases steadily. In Europe, it has been estimated that this age group accounts for approximately 58% of all cancers, and 69% of cancer deaths [1]. As the “state of the art” therapy for most solid tumors, must be performed in elderly patients, a major risk group with the highest perioperative mortality rate, ranging from 7% to 15% [2,3], prone to prolonged hospital stay [4,5]. Postoperative morbidity and mortality is associated with an immense socio-economic burden, making prevention of postoperative complications, improved quality of care, and reduced length of in-hospital stay a permanent interest of research [6]

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