Brain Prehabilitation for Oncologic Surgery

Neil Daksla, Victoria Nguyen, Zhaosheng Jin, Sergio D Bergese, Neil Daksla, Victoria Nguyen, Zhaosheng Jin, Sergio D Bergese

Abstract

Purpose of review: This review aims to summarize the current research on postoperative cognitive complications, such as delirium and cognitive dysfunction. This includes discussion on preoperative preventive strategies, such as physical and nutritional prehabilitation as well as up-to-date information on neuroprehabilitation.

Recent findings: Current recommendations for prevention of postoperative delirium have focused on multicomponent interventions. The optimal composition of surgical prehabilitation programs targeting exercise and nutrition has not yet been established. The Neurobics Trial shows that cognitive prehabilitation improves cognitive reserve and may be a useful addition to multimodal surgical prehabilitation. Perioperative management of oncologic patients is often associated with a myriad of challenges, such as the management of tumor-related pathologies, adverse events from neoadjuvant therapy, and chronic metabolic and immunological changes associated with malignancy. In addition, oncologic patients are at increased risk of developing frailty, which adversely affects postoperative recovery and further cancer treatment. As a result, oncologic patients are at considerable risk of developing postoperative cognitive complications, such as delirium and cognitive dysfunction. In this review, we discuss the effect of prehabilitation on postoperative cognitive outcomes.

Keywords: Cancer; Cognitive prehabilitation; Frailty; Postoperative cognitive dysfunction; Postoperative delirium; Surgical prehabilitation.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

References

    1. Witlox J, Eurelings L, de Jonghe J, Kalisvaart K, Eikelenboom P, van Gool W. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–451.
    1. Siddiqi N, House A, Holmes J. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35(4):350–364.
    1. Hshieh T, Saczynski J, Gou R, Marcantonio E, Jones R, Schmitt E, Cooper Z, Ayres D, Wright J, Travison TG, Inouye SK. Trajectory of functional recovery after postoperative delirium in elective surgery. Ann Surg. 2017;265(4):647–653.
    1. Leslie D, Marcantonio E, Zhang Y, Leo-Summers L, Inouye S. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32.
    1. Vasilevskis E, Han J, Hughes C, Ely E. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012;26(3):277–287.
    1. Inouye S, Bogardus S, Charpentier P, Leo-Summers L, Acampora D, Holford T, Cooney L. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–676.
    1. Gracie T, Caufield-Noll C, Wang N, Sieber F. The association of preoperative frailty and postoperative delirium: a meta-analysis. Anesth Analg. 2021;133(2):314–323.
    1. Susano M, Grasfield R, Friese M, Rosner B, Crosby G, Bader A, Kang JD, Smith TR, Lu Y, Groff MW, Chi JH, Grodstein F, Culley DJ. Brief preoperative screening for frailty and cognitive impairment predicts delirium after spine surgery. Anesthesiology. 2020;133(6):1184–1191.
    1. Handforth C, Clegg A, Young C, Simpkins S, Seymour M, Selby P, Young J. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015;26(6):1091–1101.
    1. Carli F, Silver J, Feldman L, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B. Surgical prehabilitation in patients with cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Phys Med Rehabil Clin N Am. 2017;28(1):49–64.
    1. Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, Jones RN. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367(1):30–39.
    1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–922.
    1. Hughes CG, Boncyk CS, Culley DJ, Fleisher LA, Leung JM, McDonagh DL, Gan TJ, McEvoy MD, Miller TE. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg. 2020;130(6):1572–1590.
    1. Mahanna-Gabrielli E, Zhang K, Sieber FE, Lin HM, Liu X, Sewell M, Deiner SG, Boockvar KS. Frailty is associated with postoperative delirium but not with postoperative cognitive decline in older noncardiac surgery patients. Anesth Analg. 2020;130(6):1516–1523.
    1. Greaves D, Psaltis PJ, Davis DHJ, Ross TJ, Ghezzi ES, Lampit A, Smith AE, Keage HAD. Risk factors for delirium and cognitive decline following coronary artery bypass grafting surgery: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9(22):e017275.
    1. Androsova G, Krause R, Winterer G, Schneider R. Biomarkers of postoperative delirium and cognitive dysfunction. Front Aging Neurosci. 2015;7:112.
    1. Schmitt EM, Saczynski JS, Kosar CM, Jones RN, Alsop DC, Fong TG, Metzger E, Cooper Z, Marcantonio ER, Travison T, Inouye SK. The successful aging after elective surgery (SAGES) study: cohort description and data quality procedures. J Am Geriatr Soc. 2015;63(12):2463–2471.
    1. Daiello LA, Racine AM, Yun Gou R, Marcantonio ER, Xie Z, Kunze LJ, Vlassakov KV, Inouye SK, Jones RN, Alsop D, Travison T, Arnold S, Cooper Z, Dickerson B, Fong T, Metzger E, Pascual-Leone A, Schmitt EM, Shafi M, Cavallari M, Dai W, Dillon ST, McElhaney J, Guttmann C, Hshieh T, Kuchel G, Libermann T, Ngo L, Press D, Saczynski J, Vasunilashorn S, O’Connor M, Kimchi E, Strauss J, Wong B, Belkin M, Ayres D, Callery M, Pomposelli F, Wright J, Schermerhorn M, Abrantes T, Albuquerque A, Bertrand S, Brown A, Callahan A, D’Aquila M, Dowal S, Fox M, Gallagher J, Anna Gersten R, Hodara A, Helfand B, Inloes J, Kettell J, Kuczmarska A, Nee J, Nemeth E, Ochsner L, Palihnich K, Parisi K, Puelle M, Rastegar S, Vella M, Xu G, Bryan M, Guess J, Enghorn D, Gross A, Gou Y, Habtemariam D, Isaza I, Kosar C, Rockett C, Tommet D, Gruen T, Ross M, Tasker K, Gee J, Kolanowski A, Pisani M, de Rooij S, Rogers S, Studenski S, Stern Y, Whittemore A, Gottlieb G, Orav J, Sperling R. Postoperative delirium and postoperative cognitive dysfunction: overlap and divergence. Anesthesiology. 2019;131(3):477–491.
    1. Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiac surgery. Anesth Analg. 2018;127(2):496–505.
    1. Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, Marcantonio ER. Measurement of postoperative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand. 2010;54(6):663–677.
    1. Franck M, Nerlich K, Neuner B, Schlattmann P, Brockhaus WR, Spies CD, Radtke FM. No convincing association between post-operative delirium and post-operative cognitive dysfunction: a secondary analysis. Acta Anaesthesiol Scand. 2016;60(10):1404–1414.
    1. Rockwood K, Song X, MacKnight C, Bergman H, Hogan D, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173(5):489–495.
    1. Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):146–156.
    1. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–608.
    1. Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? J Geriatr Oncol. 2017;8(1):8–15.
    1. Rolfson D, Majumdar S, Tsuyuki R, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail scale. Age Ageing. 2006;35(5):526–529.
    1. Petruzzelli M, Wagner EF. Mechanisms of metabolic dysfunction in cancer-associated cachexia. Genes Dev. 2016;30(5):489–501.
    1. Baijal P, Periyakoil V. Understanding frailty in cancer patients. Cancer J. 2014;20(5):358–366.
    1. Boakye D, Rillmann B, Walter V, Jansen L, Hoffmeister M, Brenner H. Impact of comorbidity and frailty on prognosis in colorectal cancer patients: a systematic review and meta-analysis. Cancer Treat Rev. 2018;64(30):9.
    1. Ding L, Lu J, Zhu H, Zhu S, Xu X, Hua H, Chen L, Zhao K, Xu Q. Effects of preoperative frailty on outcomes following surgery among patients with digestive system tumors: a systematic review and meta-analysis. Eur J Surg Oncol. 2021;47(12):3040–3048.
    1. Kwon M, Kim SA, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. An introduction to a head and neck cancer-specific frailty index and its clinical implications in elderly patients: a prospective observational study focusing on respiratory and swallowing functions. Oncologist. 2016;21(9):1091–1098.
    1. Collet M, Caballero J, Sonneville R, Bozza F, Nydahl P, Schandl A, Wøien H, Citerio G, van den Boogaard M, Hästbacka J, Haenggi M, Colpaert K, Rose L, Barbateskovic M, Lange T, Jensen A, Krog MB, Egerod I, Nibro HL, Wetterslev J, Perner A. Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study. Intensive Care Med. 2018;44(7):1081–1089.
    1. Maneeton B, Maneeton N, Srisurapanont M, Chittawatanarat K. Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial. Drug Des Devel Ther. 2013;7:657–667.
    1. Yoon H, Park K, Choi W, Choi S, Park J, Kim J, JH S. Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium. BMC Psychiatry. 2013;13:240.
    1. Boettger S, Jenewein J, Breitbart W. Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: a comparison of efficacy, safety, and side effects. Palliative & Supportive Care. 2015;13(4):1079–1085.
    1. Neufeld K, Yue J, Robinson T, Inouye S, Needham D. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and Meta-analysis. J Am Geriatr Soc. 2016;64(4):705–714.
    1. Nikooie R, Neufeld K, Oh E, Wilson L, Zhang A, Robinson K, DM N. Antipsychotics for treating delirium in hospitalized adults: a systematic review. Ann Intern Med. 2019;171(7):485–495.
    1. Wang Y, Yue J, Xie D, Carter P, Li Q, Gartaganis S, J C, SK I. Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults: a randomized clinical trial. JAMA Intern Med. 2020;180(1):17–25.
    1. Chen C, Li H, Liang J, Lai I, Purnomo J, Yang Y, Lin B, Huang J, Yang C, Tien Y, Chen C, Lin M, Huang G, Inouye SK. Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery: a cluster randomized clinical trial. JAMA Surger. 2017;152(9):827–834.
    1. Siddiqi N, Harrison J, Clegg A, Teale E, Young J, Taylor J, SA S. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;3:CD005563.
    1. Peden C, Miller T, Deiner S, Eckenhoff R, Fleisher L. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team. Brit J Asnaesthesia. 2021;126(2):423–432.
    1. Eamer G, Taheri A, Chen S, Daviduck Q, Chambers T, Shi X, RG K. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database Syst Rev. 2018;1(1):CD012485.
    1. Partridge J, Harari D, Martin F, Peacock J, Bell R, Mohammed A, JK D. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg. 2017;104(6):679–687.
    1. Shields L, Henderson V, Caslake R. Comprehensive geriatric assessment for prevention of delirium after hip fracture: a systematic review of randomized controlled trials. J Am Geriatr Soc. 2017;65(7):1559–1565.
    1. Minnella E, Awasthi R, Loiselle S, Agnihotram R, Ferri L, Carli F. Effect of exercise and nutrition Prehabilitation on functional capacity in Esophagogastric Cancer surgery: a randomized clinical trial. JAMA Surg. 2018;153(12):1081–1089.
    1. Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, J M, F W. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery. 2016;160(5):1189–1201.
    1. Gillis C, Buhler K, Bresee L, Carli F, Gramlich L, Culos-Reed N, TT S, TR F. Effects of nutritional Prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and Meta-analysis. Gastroenterology. 2018;155(2):391–410.
    1. Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, R V. Psychological prehabilitation before Cancer surgery: a systematic review. Ann Surg Oncol. 2015;22(13):4117–4123.
    1. Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg. 2017;39:156–162.
    1. Thomas G, Tahir M, Bongers B, Kallen V, Slooter G, van Meeteren N. Prehabilitation before major intra-abdominal cancer surgery: a systematic review of randomised controlled trials. Eur J Anaesthesiol. 2019;36(12):933–945.
    1. Denny DL, Trotter T, Lindseth G. Preoperative nutritional status and risk for subsyndromal delirium in older adults following joint replacement surgery. Orthop Nurs. 2020;39(6):384–392.
    1. Mazzola P, Ward L, Zazzetta S, Broggini V, Anzuini A, Valcarcel B, Brathwaite JS, Pasinetti GM, Bellelli G, Annoni G. Association between preoperative malnutrition and postoperative delirium after hip fracture surgery in older adults. J Am Geriatr Soc. 2017;65(6):1222–1228.
    1. Liu H, Dai M, Guan H, Gao X, Zhou Y, Sun X, Zhou J, Hu X, Li X, Song Y, Han Y, Cao J. Preoperative prognostic nutritional index value is related to postoperative delirium in elderly patients after noncardiac surgery: a retrospective cohort study. Risk Manag Healthc Policy. 2021;14:1–8.
    1. Lee SS, Lo Y, Verghese J. Physical activity and risk of postoperative delirium. J Am Geriatr Soc. 2019;67(11):2260–2266.
    1. Janssen T, Steyerberg E, Langenberg J, de Lepper C, Wielders D, Seerden T, de Lange DC, Wijsman JH, Ho GH, Gobardhan PD, van Alphen R, van der Laan L. Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: an uncontrolled before-and-after study. PLoS One. 2019;14(6):e0218152.
    1. Rossi PG, Carnavale BF, Farche ACS, Ansai JH, de Andrade LP, Takahashi ACM. Effects of physical exercise on the cognition of older adults with frailty syndrome: a systematic review and meta-analysis of randomized trials. Arch Gerontol Geriatr. 2021;93:104322.
    1. Deemer K, Zjadewicz K, Fiest K, Oviatt S, Parsons M, Myhre B, Posadas-Calleja J. Effect of early cognitive interventions on delirium in critically ill patients: a systematic review. Can J Anaesth. 2020;67(8):1016–1034.
    1. Woods B, Aguirre E, Spector A, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2012;2:CD005562.
    1. Rebok G, Ball K, Guey L, Jones R, Kim H, King J, Marsiske M, Morris JN, Tennstedt SL, Unverzagt FW, Willis SL. ACTIVE study group. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc. 2014;62(1):16–24.
    1. Tow A, Holtzer R, Wang C, Sharan A, Kim S, Gladstein A, Y B, J V. Cognitive reserve and postoperative delirium in older adults. J Am Geriatr Soc. 2016;64(6):1341–1346.
    1. Rivera-Rivera P, Rios-Lago M, Sanchez-Casarrubios S, Salazar O, Yus M, González-Hidalgo M, Sanz A, Avecillas-Chasin J, Alvarez-Linera J, Pascual-Leone A, Oliviero A, Barcia JA. Cortical plasticity catalyzed by prehabilitation enables extensive resection of brain tumors in eloquent areas. J Neurosurg. 2017;126(4):1323–1333.
    1. Kawano T, Eguchi S, Iwata H, Tamura T, Kumagai N, Yokoyama M. Impact of preoperative environmental enrichment on prevention of development of cognitive impairment following abdominal surgery in a rat model. Anesthesiology. 2015;123(1):160–170.
    1. Humeidan M, Reyes J, Mavarez-Martinez A, Roeth C, Nguyen C, Sheridan E, Zuleta-Alarcon A, Otey A, Abdel-Rasoul M, Bergese SD. Effect of cognitive prehabilitation on the incidence of postoperative delirium among older adults undergoing major noncardiac surgery: the neurobics randomized clinical trial. JAMA Surgery. 2021;156(2):148–156.
    1. Vlisides P, Das A, Thompson A, Kunkler B, Zierau M, Cantley M, AM M, B G. Home-based cognitive prehabilitation in older surgical patients: a feasibility study. J Neurosurg Anesthesiol. 2019;31(2):212–217.
    1. Santa Mina D, van Rooijen S, Minnella E, Alibhai S, Brahmbhatt P, Dalton S, Gillis C, Grocott MPW, Howell D, Randall IM, Sabiston CM, Silver JK, Slooter G, West M, Jack S, Carli F. Multiphasic prehabilitation across the cancer continuum: a narrative review and conceptual framework. Front Oncol. 2021;10:598425.
    1. West M, Loughney L, Lythgoe D, Barben C, Sripadam R, Kemp G, MP G, S J. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015;114(2):244–251.

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