Feasibility Of Exercise Programs Research Articles

Perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.

219 Background: Older adults with cancer have unique needs, particularly in the perioperative setting, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. Our systematic review sought to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials (RCT) focusing on patient-centered interventions that enrolled adults >60 years old with cancer, excluding studies with pharmacologic, procedural, and radiographic interventions. Results: We included 11 RCTs with 2,177 patients. Patients’ age ranged from 60-95, and median number of patients per study was 147 (range: 44-690). Most studies included patients with colorectal cancer (81.8% [9/11]), all involving non-emergent elective surgeries. Half the studies (54.5% [6/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2% [3/11]), nutrition optimization (9.1% [1/11]), and patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications, quality of life, feasibility of exercise programs, delirium incidence, inspiratory muscle endurance, hospital length of stay, and consistency of nutritional management. All studies had postoperative complications as a primary or secondary outcome. In studies with exercise-based interventions, all but one (83.3% [5/6]) found reduction in postoperative complications, and one showed improvement in quality of life (16.7% [1/6]). Studies focusing on geriatric assessment did not achieve significant differences in outcomes. We found implementation challenges that influenced several studies, including high drop-out rates and intervention fidelity. Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. RCTs to date seem to primarily focus on exercise interventions and geriatric assessment-guided strategies. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

Investigating perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.

e13765 Background: Older adults with cancer have unique needs, particularly in perioperative settings, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. We conducted a systematic review to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials that enrolled adults >60 years old with cancer, excluding studies on pharmacologic or procedural interventions. Results: We identified 1,036 studies and 922 abstracts through our initial search. Title and abstract review resulted in 20 manuscripts. After full-text review, 9 were removed as their study design, patient population, or intervention did not align with inclusion criteria. Our final review included 11 studies (90.9% [10/11] were conducted outside of the US and 45.6% [5/11] were published within the past 2 years). Patients’ age ranged from 60-95 and median number of patients per study was 147 (range: 44-690). Studies were primarily on patients with colorectal cancer (81.8% [9/11]), with all involving non-emergent elective surgeries. Most studies (63.6% [7/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (18.2% [2/11]), nutrition optimization (9.1% [1/11]), or patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications (36.4% [4/11]), feasibility of exercise programs (27.3% [3/11]), quality of life (18.2% [2/11]), delirium incidence (9.1% [1/11]), or hospital length of stay (9.1% [1/11]). All studies had postoperative complications as a primary or secondary outcome. Overall, 54.5% (6/11) found a positive primary outcome including: postoperative complications (18.2% [2/11]), implementation of exercise program (18.2% [2/11]), quality of life (9.1% [1/11]), or nutrition (9.1% [1/11]). Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating further work is required to address the unique perioperative needs of the geriatric oncology population.