With the conjunction of increased life expectancy and the increasing incidence of cancer with aging, older patient represent an increasing proportion of cancer patients. Increasing age is also associated with increased risk of co-morbidities as well as a decline of functional reserve of multiple organ systems, eventually leading in the context of the disease-and/or the treatment-related stress to functional deconditioning or organ failure. Surgery or complex medico-surgical procedures - that associate chemotherapy and/or radiotherapy and surgery, can be considered as one proof-of principle of such risks, since major cancer surgery the older population is at higher risk of morbi-mortality and unplanned hospitalization for geriatric events In order to reduce complications after surgery, prehabilitation has often been considered, and 71% of the surgeons would accept a 4 weeks delay before surgery to improve patients' outcomes if shown to be beneficial. However, the actual level of evidence depends on the interventions: high for pre-operative nutrition, but low for physical exercise, due to heterogeneous programs with often bad adherence. In addition, geriatric validated interventions, in order to prevent iatrogenic event, may be added in a multi-interventional model of intervention.
PROADAPT pilot study is a standardized geriatric intervention constructed on a multi-professional and multi-disciplinary basis after a systematic analysis of published data. This intervention was designed to be implemented pragmatically in the centers according local habits in several distinct hospital contexts in different tumor contexts. It consists in: 1. before surgery: a prehabilitation of the patients including a nutritional, physical and educational preparation; 2. during the hospitalization for surgery: an optimisation of their treatments through a pharmaceutical conciliation, educational interventions, standardization of surgical procedures and enhanced rehabilitation after surgery; 3. bridging and post-discharge interventions for hospital-to-home transition.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
148
Nutritional care is based on: * A personalized evaluation of nutritional balance and nutritional needs of the patient * A weekly follow-up of weight and nutritional intake Total-body rehabilitation is based on: * 2 to 3 times a week: strength exercise * 2 to 3 times a week: endurance exercise, 20 to 45 min each sequence * 2 times a week: respiratory physiotherapy Pharmaceutical conciliation and optimization according STOPP/START criteria During peri-operative time, the nurse contacts the surgical team for transmission of patient's personal data, physical medication conciliation results During rehabilitation time and hospital-home transition time, the nurse contacts the rehabilitation team for transmission of patient's personal data and care course, physical (nutritional, functional and/or comorbidities), medication conciliation results.
Centre Hospitalier de Chambéry
Chambéry, France
Centre hospitalier de Givors
Givors, France
Centre Hospitalier Edouard Herriot
Lyon, France
Hôpital Croix Rousse
Lyon, France
Centre hospitalier d'Annecy Genevois
Metz-Tessy, France
Centre Hospitalier Lyon Sud, Service d'Oncologie Médicale
Pierre-Bénite, France
Centre Hospitalier Lyon Sud, Service de Gériatrie
Pierre-Bénite, France
Centre hospitalier Universitaire de Saint Etienne
Saint-Etienne, France
Hôpital Nord-Ouest
Villefranche-sur-Saône, France
Clinique mutualiste Médipole
Villeurbanne, France
Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study
Preoperative physical activity including strength and endurance exercise assessed by physical exercises accomplished under the supervision of a physiotherapist. Number of patients with at least 1 intervention achieved in the domain.
Time frame: 12 months
Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study
Nutrition guidelines before and after physical activity assessed by questionnaires. Number of patients with at least 1 intervention achieved in the domain.
Time frame: 12 months
Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study
Patient education and coaching assessed by questionnaires and visits. Number of patients with at least 1 intervention achieved in the domain
Time frame: 12 months
Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study
Achievement of standardized intervention procedures, according to the checklist established in consensus with surgeons. Number of patients with at least 1 intervention achieved in the domain
Time frame: 12 months
Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study
Rehabilitation assessed by questionnaires. Number of patients with at least 1 intervention achieved in the domain
Time frame: 12 months
Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study
Accomplishment of pharmaceutical medication conciliation and treatment optimization. Number of patients with at least 1 intervention achieved in the domain
Time frame: 12 months
Implementation of at least one item of PROADAPT standardized geriatric intervention of the program PROADAPT pilot study
Bridging interventions for hospital-to-home transition. Number of patients with at least 1 intervention achieved in the domain
Time frame: 12 months
Post operative morbidity
Post operative morbidity according Clavien-Dindo classification
Time frame: 30 and 90 days
Post-operative morbidity
Post-operative morbidity according to NCI CTC v4.4
Time frame: 90 days
Therapeutic strategy
Treatment plan completion rate: Number of patients for whom the treatment plan was completed.
Time frame: 12 months
Progression-free Survival
Time frame: 12 months
Post-treatment complication
Post-treatment complication grade≥3 according the National Cancer Institute Common Toxicity Criteria version 4 (NCI-CTC-v4)
Time frame: 12 months
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