妇科癌症患者的预康复 (PHOCUS)
计划推迟手术治疗的妇科癌症患者的预康复:一项前瞻性随机试验。
Prehabilitation 是指旨在在已知压力事件(例如预定手术)发生之前提高患者的恢复力和功能能力的干预措施。 这些干预措施通常包括身体活动以及心理和营养支持。 有大量证据表明多模式预康复对接受手术治疗的非妇科癌症患者有积极作用;然而,尚无妇科癌症患者的前瞻性数据。
PHOCUS 试验是一项前瞻性随机试验,旨在评估多模式预康复在妇科癌症患者中的作用。 64 名患者将在 36 个月内以 1:1 的比例随机分配到单个机构中,进入 ARM A:控制组,将提供基本信息和护理支持标准; ARM B:接受由身体活动、心理和营养支持组成的多模式预康复的活跃手臂。 将通过一系列非侵入性测试以标准间隔(试验期间三次)对所有患者进行评估,评估身体机能、术后发病率、营养状况、压力和焦虑水平以及生活质量。
研究概览
详细说明
该试验的目的是评估强化多模式预康复方案对接受妇科癌症手术治疗的患者术前功能能力、术后发病率和生活质量的影响。
计划推迟手术治疗的两组患者将有资格参加试验:i) 转诊接受新辅助化疗和间隔减瘤手术的晚期卵巢癌患者; ii) I-II 期子宫内膜癌患者被归类为虚弱(根据经过验证的改良虚弱指数),他们将接受三个月的激素治疗,然后进行手术治疗。
研究类型
注册 (估计的)
阶段
- 第三阶段
联系人和位置
学习联系方式
- 姓名:Jana Stribrna
- 电话号码:+420 224 967 432
- 邮箱:jana.stribrna@vfn.cz
研究联系人备份
- 姓名:Stefan Lednicky, MD.
- 邮箱:stefan.lednicky@vfn.cz
学习地点
-
-
-
Prague、捷克语、12000
- 招聘中
- Gynecologic Oncology Center in Prague
-
接触:
- David Cibula, M.D.
- 电话号码:+420603547055
- 邮箱:dc@davidcibula.cz
-
接触:
- Jana Stribrna
- 电话号码:+420224967432
- 邮箱:jana.stribrna@vfn.cz
-
-
参与标准
资格标准
适合学习的年龄
接受健康志愿者
描述
纳入标准
两组患者将有资格参加试验:
i) 转诊进行 NACT 的上皮性卵巢癌患者: a) FIGO III 期或 IV 期疾病; b) 患者不适合初次减瘤手术; c) 患者是标准护理联合化疗的合适人选; d) 患者适合间歇性减瘤 外科手术
ii) I 或 II 期子宫内膜癌患者根据经过验证的改良虚弱指数分类为虚弱:a) FIGO I 或 II 期; b) 患者被归类为虚弱; c) 患者适合接受激素治疗。
排除标准
- 第二恶性肿瘤(治疗中)
- 患者不适合任何手术延迟
- 患者身体无法满足预康复干预计划或无法行走
学习计划
研究是如何设计的?
设计细节
- 主要用途:支持治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
无干预:A
将为患者提供基本信息和标准护理支持。
|
|
|
实验性的:乙
将提供积极的预康复,包括 i) 由身体和康复医学 (PRM) 专家提供的三种与身体活动相关的干预措施; iii) 与医生或营养专家就营养状况进行 3 次 30 分钟的咨询; ii) 与心理学家的三节课。
|
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
功能容量变化
大体时间:9-12周
|
六分钟步行测试 (6MWT)
|
9-12周
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
术后并发症
大体时间:9-12周
|
根据 Clavien-Dindo 和综合并发症指数对术中和术后早期并发症进行分类,直至术后第 30 天。
术后 30 天后发生的不良事件将根据 NCI 不良事件通用术语标准 5.0 版进行评估
|
9-12周
|
|
术后住院时间(天)
大体时间:9-12周
|
9-12周
|
|
|
遵守培训计划
大体时间:9-12周
|
每天的步数和每周的阻力练习次数。
|
9-12周
|
|
营养支持计划对身体成分的影响(脂肪重量和瘦体重,单位为 kg)
大体时间:9-12周
|
9-12周
|
|
|
营养支持计划对静息能量消耗的影响(以千卡/千克为单位)。
大体时间:9-12周
|
9-12周
|
|
|
营养支持计划对血浆和红细胞磷脂脂肪酸组成的影响(以 mol% 计)。
大体时间:9-12周
|
9-12周
|
|
|
与健康相关的生活质量
大体时间:9-12周
|
两个研究 ARM 的 QoL 分析将基于 EORTC 验证问卷进行:QLQ-C30 和 OV28(针对卵巢癌患者)/EN24(针对子宫内膜癌患者。 QLQ-C30 由 EORTC 开发,这种自我报告的问卷评估临床试验中癌症患者的健康相关生活质量。 该调查问卷包括五个功能量表(身体、日常活动、认知、情绪和社交)、三个症状量表(疲劳、疼痛、恶心和呕吐)、一个健康/生活质量总体量表,以及一些评估常见问题的附加要素症状(包括呼吸困难、食欲不振、失眠、便秘和腹泻),以及疾病对经济的影响。 EORTC QLQ-OV28/EN24 与 EORTC QLQ-C30 结合使用,并提供与卵巢癌/子宫内膜癌具体相关的另外 25 个项目的信息。 |
9-12周
|
|
心理健康:抑郁症
大体时间:9-12周
|
贝克抑郁量表:一个包含 21 个项目的自我报告评级量表,用于测量抑郁症的特征态度和症状。
|
9-12周
|
|
心理健康:焦虑
大体时间:9-12周
|
状态-特质焦虑量表:一种心理量表,由 40 个自我报告项目组成,采用 4 分李克特量表。
STAI 测量两种类型的焦虑——状态焦虑和特质焦虑。
|
9-12周
|
|
心理健康:非特定的感知压力
大体时间:9-12周
|
感知压力量表:用于测量非特定感知压力的心理工具(情境压力、减压干预措施的有效性以及心理压力与精神和身体疾病之间的关联程度)。
|
9-12周
|
|
心理健康:特定感知压力
大体时间:9-12周
|
压力概况:问卷评估生活九个方面的压力严重程度:社交习惯、社会关系、生活事件、性问题、睡眠、精神症状、老年、月经压力和“压力与心脏”。
|
9-12周
|
合作者和调查者
合作者
调查人员
- 首席研究员:David Cibula, prof.、Charles University, Czech Republic
出版物和有用的链接
一般刊物
- Barberan-Garcia A, Ubre M, Roca J, Lacy AM, Burgos F, Risco R, Momblan D, Balust J, Blanco I, Martinez-Palli G. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. 2018 Jan;267(1):50-56. doi: 10.1097/SLA.0000000000002293.
- Minnella EM, Awasthi R, Loiselle SE, Agnihotram RV, Ferri LE, Carli F. Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial. JAMA Surg. 2018 Dec 1;153(12):1081-1089. doi: 10.1001/jamasurg.2018.1645.
- Mayo NE, Feldman L, Scott S, Zavorsky G, Kim DJ, Charlebois P, Stein B, Carli F. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery. 2011 Sep;150(3):505-14. doi: 10.1016/j.surg.2011.07.045.
- Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Wongyingsinn M, Gamsa A, Kim DJ, Vassiliou MC, Feldman LS. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc. 2013 Apr;27(4):1072-82. doi: 10.1007/s00464-012-2560-5. Epub 2012 Oct 9.
- Minnella EM, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol. 2017 Feb;56(2):295-300. doi: 10.1080/0284186X.2016.1268268. Epub 2017 Jan 12.
- Silver JK. Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. Semin Oncol Nurs. 2015 Feb;31(1):13-30. doi: 10.1016/j.soncn.2014.11.003. Epub 2014 Dec 3.
- Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012 Nov 14;11:CD008879. doi: 10.1002/14651858.CD008879.pub2.
- Benzo R, Wigle D, Novotny P, Wetzstein M, Nichols F, Shen RK, Cassivi S, Deschamps C. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Lung Cancer. 2011 Dec;74(3):441-5. doi: 10.1016/j.lungcan.2011.05.011. Epub 2011 Jun 12.
- Biglia N, Zanfagnin V, Daniele A, Robba E, Bounous VE. Lower Body Lymphedema in Patients with Gynecologic Cancer. Anticancer Res. 2017 Aug;37(8):4005-4015. doi: 10.21873/anticanres.11785.
- Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014 Nov;121(5):937-47. doi: 10.1097/ALN.0000000000000393.
- Gillis C, Buhler K, Bresee L, Carli F, Gramlich L, Culos-Reed N, Sajobi TT, Fenton TR. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology. 2018 Aug;155(2):391-410.e4. doi: 10.1053/j.gastro.2018.05.012. Epub 2018 May 8.
- McKenna NP, Bews KA, Al-Refaie WB, Colibaseanu DT, Pemberton JH, Cima RR, Habermann EB. Assessing Malnutrition Before Major Oncologic Surgery: One Size Does Not Fit All. J Am Coll Surg. 2020 Apr;230(4):451-460. doi: 10.1016/j.jamcollsurg.2019.12.034. Epub 2020 Feb 26.
- Blackwell JEM, Doleman B, Boereboom CL, Morton A, Williams S, Atherton P, Smith K, Williams JP, Phillips BE, Lund JN. High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial. Prostate Cancer Prostatic Dis. 2020 Dec;23(4):696-704. doi: 10.1038/s41391-020-0219-1. Epub 2020 Mar 10.
- Cook PC, Leit ME. Issues in the pediatric athlete. Orthop Clin North Am. 1995 Jul;26(3):453-64.
- Althoff FC, Neb H, Herrmann E, Trentino KM, Vernich L, Fullenbach C, Freedman J, Waters JH, Farmer S, Leahy MF, Zacharowski K, Meybohm P, Choorapoikayil S. Multimodal Patient Blood Management Program Based on a Three-pillar Strategy: A Systematic Review and Meta-analysis. Ann Surg. 2019 May;269(5):794-804. doi: 10.1097/SLA.0000000000003095.
- Peteroy ET, Pirrello PE, Adams N. The relationship between two Wiggins Content Scales and length of hospitalization. J Clin Psychol. 1982 Apr;38(2):344-6. doi: 10.1002/1097-4679(198204)38:23.0.co;2-z.
- Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. Prehabilitation in cancer care: patients' ability to prepare for major abdominal surgery. Scand J Caring Sci. 2021 Mar;35(1):143-155. doi: 10.1111/scs.12828. Epub 2020 Feb 11.
- Burke SM, Brunet J, Sabiston CM, Jack S, Grocott MP, West MA. Patients' perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise. Support Care Cancer. 2013 Dec;21(12):3345-53. doi: 10.1007/s00520-013-1908-2. Epub 2013 Aug 3.
- Carli F, Brown R, Kennepohl S. Prehabilitation to enhance postoperative recovery for an octogenarian following robotic-assisted hysterectomy with endometrial cancer. Can J Anaesth. 2012 Aug;59(8):779-84. doi: 10.1007/s12630-012-9734-4. Epub 2012 May 26.
- Cianci S, Tarascio M, Rosati A, Caruso S, Uccella S, Cosentino F, Scaletta G, Gueli Alletti S, Scambia G. Sexual function and quality of life of patients affected by ovarian cancer. Minerva Med. 2019 Aug;110(4):320-329. doi: 10.23736/S0026-4806.19.06080-4. Epub 2019 May 6.
- Cortes-Guiral D, Mohamed F, Glehen O, Passot G. Prehabilitation of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Eur J Surg Oncol. 2021 Jan;47(1):60-64. doi: 10.1016/j.ejso.2020.01.032. Epub 2020 Jan 30.
- Daroszewski C, Stasiewicz M, Jazwinska-Tarnawska E, Rachwalik A, Mura E, Luboch-Kowal J, Drys A, Bogucki ZA, Brzecka A. Quality of Life in Patients with Advanced Non-Small-Cell Lung Cancer Receiving Palliative Chemotherapy. Adv Exp Med Biol. 2019;1160:11-18. doi: 10.1007/5584_2019_346.
- Driver JA, Viswanathan AN. Frailty measure is more predictive of outcomes after curative therapy for endometrial cancer than traditional risk factors in women 60 and older. Gynecol Oncol. 2017 Jun;145(3):526-530. doi: 10.1016/j.ygyno.2017.03.010. Epub 2017 Mar 28.
- Ekici U, Ferhatoglu MF. Perioperative and Postoperative Effects of Preoperative Low-Calorie Restrictive Diets on Patients Undergoing Laparoscopic Sleeve Gastrectomy. J Gastrointest Surg. 2020 Feb;24(2):313-319. doi: 10.1007/s11605-019-04157-5. Epub 2019 Feb 20.
- Goode PS. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU Int. 2012 Oct;110(7):1010-1. doi: 10.1111/j.1464-410X.2012.11451.x. Epub 2012 Aug 22. No abstract available.
- Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol. 2012 May;125(2):477-82. doi: 10.1016/j.ygyno.2012.01.003. Epub 2012 Jan 11.
- Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ, Young J. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015 Jun;26(6):1091-1101. doi: 10.1093/annonc/mdu540. Epub 2014 Nov 17.
- Cho BC, Serini J, Zorrilla-Vaca A, Scott MJ, Gehrie EA, Frank SM, Grant MC. Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis. Anesth Analg. 2019 May;128(5):981-992. doi: 10.1213/ANE.0000000000004005.
- Kei T, Mistry N, Curley G, Pavenski K, Shehata N, Tanzini RM, Gauthier MF, Thorpe K, Schweizer TA, Ward S, Mazer CD, Hare GMT. Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis. Can J Anaesth. 2019 Jun;66(6):716-731. doi: 10.1007/s12630-019-01351-6. Epub 2019 Mar 28.
- Li MH, Bolshinsky V, Ismail H, Burbury K, Ho KM, Amin B, Heriot A, Riedel B. A cross-sectional survey of Australian anesthetists' and surgeons' perceptions of preoperative risk stratification and prehabilitation. Can J Anaesth. 2019 Apr;66(4):388-405. doi: 10.1007/s12630-019-01297-9. Epub 2019 Jan 28.
- Marshall KM, Loeliger J, Nolte L, Kelaart A, Kiss NK. Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr. 2019 Apr;38(2):644-651. doi: 10.1016/j.clnu.2018.04.007. Epub 2018 May 2.
- Mazzola M, Bertoglio C, Boniardi M, Magistro C, De Martini P, Carnevali P, Morini L, Ferrari G. Frailty in major oncologic surgery of upper gastrointestinal tract: How to improve postoperative outcomes. Eur J Surg Oncol. 2017 Aug;43(8):1566-1571. doi: 10.1016/j.ejso.2017.06.006. Epub 2017 Jun 23.
- Ohkura Y, Ichikura K, Shindoh J, Ueno M, Udagawa H, Matsushima E. Relationship between psychological distress and health-related quality of life at each point of the treatment of esophageal cancer. Esophagus. 2020 Jul;17(3):312-322. doi: 10.1007/s10388-019-00710-y. Epub 2020 Jan 2.
- Onstad MA, Schmandt RE, Lu KH. Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. J Clin Oncol. 2016 Dec 10;34(35):4225-4230. doi: 10.1200/JCO.2016.69.4638. Epub 2016 Nov 7.
- Pal N, Broaddus RR, Urbauer DL, Balakrishnan N, Milbourne A, Schmeler KM, Meyer LA, Soliman PT, Lu KH, Ramirez PT, Ramondetta L, Bodurka DC, Westin SN. Treatment of Low-Risk Endometrial Cancer and Complex Atypical Hyperplasia With the Levonorgestrel-Releasing Intrauterine Device. Obstet Gynecol. 2018 Jan;131(1):109-116. doi: 10.1097/AOG.0000000000002390.
- Papadia A, Ragni N, Salom EM. The impact of obesity on surgery in gynecological oncology: a review. Int J Gynecol Cancer. 2006 Mar-Apr;16(2):944-52. doi: 10.1111/j.1525-1438.2006.00577.x.
- Rabischong B, Larrain D, Canis M, Le Bouedec G, Pomel C, Jardon K, Kwiatkowski F, Bourdel N, Achard JL, Dauplat J, Mage G. Long-term follow-up after laparoscopic management of endometrial cancer in the obese: a fifteen-year cohort study. J Minim Invasive Gynecol. 2011 Sep-Oct;18(5):589-96. doi: 10.1016/j.jmig.2011.05.015. Epub 2011 Jun 29.
- Ramirez PT, Frumovitz M, Bodurka DC, Sun CC, Levenback C. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. Gynecol Oncol. 2004 Oct;95(1):133-8. doi: 10.1016/j.ygyno.2004.06.045.
- Schier R, Levett D, Riedel B. Prehabilitation: The next challenge for anaesthesia teams. Eur J Anaesthesiol. 2020 Apr;37(4):259-262. doi: 10.1097/EJA.0000000000001167. No abstract available.
- Wei J, Zhang W, Feng L, Gao W. Comparison of fertility-sparing treatments in patients with early endometrial cancer and atypical complex hyperplasia: A meta-analysis and systematic review. Medicine (Baltimore). 2017 Sep;96(37):e8034. doi: 10.1097/MD.0000000000008034.
- West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, Grocott MP, Jack S. 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 Feb;114(2):244-51. doi: 10.1093/bja/aeu318. Epub 2014 Oct 1.
- Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013 Mar 2;381(9868):752-62. doi: 10.1016/S0140-6736(12)62167-9. Epub 2013 Feb 8.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他相关的 MeSH 术语
其他研究编号
- PHOCUS_38/20
药物和器械信息、研究文件
研究美国 FDA 监管的药品
研究美国 FDA 监管的设备产品
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.