- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT03936764
Effect of Two Different Preoperative Training Densities in Patients With Non-small-cell Lung Cancer Before Lung Resection Surgery (Preo-Dens)
Pulmonary resection surgery is currently the recommended curative treatment for early stages of non-small cell lung cancer. The implementation of preoperative respiratory rehabilitation programs has shown beneficial results on pulmonary function, functional level, cardiorespiratory conditioning and the occurrence and severity of postoperative complications in this population of patients. Despite these benefits, the most recent meta-analyzes highlight the fact that training modalities (duration, frequencies, intensity) are very heterogeneous. It is then difficult to structure a program only on the basis of data from the literature.
In a cohort analysis of 50 patients trained from 2014 to 2017, our team reported a significantly greater improvement in physiological parameters in patients who performed 15 or more preoperative training sessions. This number of 15 outpatient sessions is therefore considered a minimum training goal in our current practice.
The difficulty of the oncological context is to find the compromise between the necessary diligence to initiate the cancer surgical treatment and the necessary time to obtain the benefits of the preoperative rehabilitation. Previous study reports the difficulty of setting up a four-week training program, perceived as delaying surgery. In order to prevent any risk of prolonging the surgical management time, rehabilitation teams routinely offer short programs with high training frequencies of up to five to six sessions per week. It seems important to note that preoperative rehabilitation is normally considered in patients for whom there is a risk of moderate to high postoperative complications according to the European and North American recommendations. Thus these patients generally benefit from a longer period of assessment than patients whose risk is considered low in terms of their cardio-respiratory and muscular function.
The median duration between the physiological evaluation of patients considered "at risk" before pulmonary resection surgery is 44 (Q1-Q3 29-76) days at Rouen University Hospital, with no significant differences observed between patients who have benefited or not from preoperative rehabilitation. Some teams have even pointed out that there is no difference in survival prognosis in the short or long term between patients who have had an operative delay of more or less 60 or 90 days respectively, which shows the compatibility with the set up a dedicated training course.
As mentioned earlier, the concept of delay has led to extremely dense training for a functionally and cardio-respiratory fragile target population as evidenced by pejorative VO2peak. The density of the training, failing to generate significant physiological stimulation, may increase fatigue or limit adherence to training, especially if it requires movement, and is added to a therapeutic planning including many consultations and further examinations. To date, no study has evaluated the density of preoperative supervised training on pre-surgical benefits.
The objective of this work is to compare the effectiveness of a program of 15 training sessions on VO2peak according to two different densities, namely five times a week over three weeks, or three times a week over five weeks.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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Normandie
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Bois-Guillaume, Normandie, Francia, 76230
- ADIR Association
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Age> 18 years old;
- Beneficiary of a social security scheme;
- Non-Small Cell Lung Cancer or suspicion of bronchial neoplasia;
- Addressed to respiratory rehabilitation in a preoperative setting with a moderate to high risk estimate (VO2peak < 20 ml/kg/min);
- Intervention date not established when included in the program or ≥ 5 wk.
Exclusion Criteria:
- Patient under guardianship;
- Pregnant or lactating woman;
- Cardiological contraindication to training;
- Neoadjuvant radio-chemotherapy;
- Refusal to carry out a training program in a rehabilitation center;
- Orthopedic, neurological, vascular or neuromuscular pathology limiting training;
- Exacerbation or deterioration of the general condition requiring stopping the preoperative re-training program;
- Modification of the therapeutic project at a multidisciplinary consultation meeting requiring the cessation of rehabilitation or participation in the study.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Cuidados de apoyo
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Único
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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Otro: Group 1
5 Preoperative Pulmonary Rehabilitation sessions / week during 3 weeks.
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Each prehabilitation session will last approximately 90 minutes and will include:
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Otro: Group 2
3 Preoperative Pulmonary Rehabilitation sessions / week during 5 weeks.
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Each prehabilitation session will last approximately 90 minutes and will include:
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
peak dioxyen consumption (VO2peak)
Periodo de tiempo: before the preoperative training program
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VO2peak (in ml/kg/min) measured during and incremental Cardio-Pulmonary Exercise Testing (CPET)
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before the preoperative training program
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peak dioxyen consumption (VO2peak)
Periodo de tiempo: through preoperative training program completion (15 sessions)
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VO2peak (in ml/kg/min) measured during and incremental Cardio-Pulmonary Exercise Testing (CPET)
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through preoperative training program completion (15 sessions)
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
peak work-rate (WRpeak)
Periodo de tiempo: before the preoperative training program
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maximum power reached during the Cardio-Pulmonary Exercise Testing (CPET)
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before the preoperative training program
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peak work-rate (WRpeak)
Periodo de tiempo: through preoperative training program completion (15 sessions)
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maximum power reached during the Cardio-Pulmonary Exercise Testing (CPET)
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through preoperative training program completion (15 sessions)
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oxygen consumption at ventilatory threshold (VO2vt)
Periodo de tiempo: before the preoperative training program
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oxygen consumption at ventilatory threshold recorded during the Cardio-Pulmonary Exercise Testing (CPET)
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before the preoperative training program
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oxygen consumption at ventilatory threshold (VO2vt)
Periodo de tiempo: through preoperative training program completion (15 sessions)
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oxygen consumption at ventilatory threshold recorded during the Cardio-Pulmonary Exercise Testing (CPET)
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through preoperative training program completion (15 sessions)
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work-rate at ventilatory threshold (WRvt)
Periodo de tiempo: before the preoperative training program
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work-rate at ventilatory threshold recorded during the Cardio-Pulmonary Exercise Testing (CPET)
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before the preoperative training program
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work-rate at ventilatory threshold (WRvt)
Periodo de tiempo: through preoperative training program completion (15 sessions)
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work-rate at ventilatory threshold recorded during the Cardio-Pulmonary Exercise Testing (CPET)
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through preoperative training program completion (15 sessions)
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ventilatory efficiency (VE/VCO2 slope)
Periodo de tiempo: before the preoperative training program
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linear regression of the ratio between the increase in minute ventilation and the expired carbon dioxide flow (VE/VCO2 slope)
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before the preoperative training program
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ventilatory efficiency (VE/VCO2 slope)
Periodo de tiempo: through preoperative training program completion (15 sessions)
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linear regression of the ratio between the increase in minute ventilation and the expired carbon dioxide flow (VE/VCO2 slope)
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through preoperative training program completion (15 sessions)
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body mass index (BMI)
Periodo de tiempo: before the preoperative training program
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weight in kilograms divided by the square of height in meters
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before the preoperative training program
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body mass index (BMI)
Periodo de tiempo: through preoperative training program completion (15 sessions)
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weight in kilograms divided by the square of height in meters
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through preoperative training program completion (15 sessions)
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fat-free mass
Periodo de tiempo: before the preoperative training program
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impedancemetry (Bodystat® 1500MDD, (5/50 kHz), Bodystat, Douglas, Isle of Man, UK).
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before the preoperative training program
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fat-free mass
Periodo de tiempo: through preoperative training program completion (15 sessions)
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impedancemetry (Bodystat® 1500MDD, (5/50 kHz), Bodystat, Douglas, Isle of Man, UK).
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through preoperative training program completion (15 sessions)
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quadriceps peak torque
Periodo de tiempo: before the preoperative training program
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quadriceps peak torque (in Nm) assessed by dynamometry (MicroFET2®, Hogan Health Industries, Inc., UT)
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before the preoperative training program
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quadriceps peak torque
Periodo de tiempo: through preoperative training program completion (15 sessions)
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quadriceps peak torque (in Nm) assessed by dynamometry (MicroFET2®, Hogan Health Industries, Inc., UT)
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through preoperative training program completion (15 sessions)
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maximum inspiratory pressure (MIP)
Periodo de tiempo: before the preoperative training program
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Maximum negative oral pressure generated by the patient during inspiration (in cmH2O)
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before the preoperative training program
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maximum inspiratory pressure (MIP)
Periodo de tiempo: through preoperative training program completion (15 sessions)
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Maximum negative oral pressure generated by the patient during inspiration (in cmH2O)
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through preoperative training program completion (15 sessions)
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Health related quality of life (HRQoL) questionnaire
Periodo de tiempo: before the preoperative training program
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Full name of the scale : "European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire and modular supplement for Lung Cancer patients" (EORTC QLQ-C30 / LC13) The EORTC QLQ-C30, is a 30 questions questionnaire developed by the European Organization for Research and Treatment of Cancer, to assess the QoL of cancer patients. It has been translated and validated into over 100 languages and is used in more than 3,000 studies worldwide. For patients with Lung Cancer, a 13 questions modular supplement, the LC-13, is validated. The HRQoL is therefore evaluated by a set of 43 questions gathering all aspects that could be impacted. A raw score is calculated for each dimension and summary score, then standardized from 0 to 100 points. The additional module for Lung Cancer (LC-13) provides a complementary dimension with specific items related to the tumor site. (see Fayers et. al., The EORTC QLQ-C30 Scoring Manual (3rd Edition) 2001. |
before the preoperative training program
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Health related quality of life (HRQoL) questionnaire
Periodo de tiempo: through preoperative training program completion (15 sessions)
|
Full name of the scale : "European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire and modular supplement for Lung Cancer patients" (EORTC QLQ-C30 / LC13) The EORTC QLQ-C30, is a 30 questions questionnaire developed by the European Organization for Research and Treatment of Cancer, to assess the QoL of cancer patients. It has been translated and validated into over 100 languages and is used in more than 3,000 studies worldwide. For patients with Lung Cancer, a 13 questions modular supplement, the LC-13, is validated. The HRQoL is therefore evaluated by a set of 43 questions gathering all aspects that could be impacted. A raw score is calculated for each dimension and summary score, then standardized from 0 to 100 points. The additional module for Lung Cancer (LC-13) provides a complementary dimension with specific items related to the tumor site. (see Fayers et. al., The EORTC QLQ-C30 Scoring Manual (3rd Edition) 2001. |
through preoperative training program completion (15 sessions)
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Adherence to sessions
Periodo de tiempo: through preoperative training program completion (15 sessions)
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number of sessions performed on number of sessions planned
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through preoperative training program completion (15 sessions)
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Postoperative Complications
Periodo de tiempo: At 30 days post-intervention
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number and type of complication during the 30 days post lung resection.
Each complication severity is evaluated with the Clavien-Dindo scale.
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At 30 days post-intervention
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Colaboradores e Investigadores
Patrocinador
Publicaciones y enlaces útiles
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Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- Preo-Dens
- ID-RCB : 2018-A03301-54 (Identificador de registro: 2018-A03301-54)
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
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