Optimization of Patients' Physical and Mental Status Prior to Colorectal Cancer Surgery
NCT ID: NCT04909567
Last Updated: 2023-03-10
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
518 participants
INTERVENTIONAL
2021-10-26
2025-09-01
Brief Summary
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At Danderyd Hospital, Stockholm, Sweden, we are starting up an optimization center where patients are offered optimizing measures while waiting for surgery. This form of structured treatment has not been studied before and we therefore want to investigate outcomes in a randomized study.
All patients with colorectal cancer who are being examined for surgery are offered participation in the study. Randomization of 518 patients in to either an intervention group where the patients; are optimized for concomitant diseases, treated for malnutrition and overconsumption of alcohol and tobacco, undergoes an exercise program and receives psychosocial support before surgery, or a control group where patients are prepared for surgery according to current routines. Primary outcome is the difference in severe complications between the groups. Secondary outcome is difference in length of stay as well as fitness and mental well-being before and 30 days after the operation.If optimization before surgery reduces complications and shortens length of stay, the model can also be used by other operating specialties. This may result in a great improvement for the healthcare in general.
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Detailed Description
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Intervention arm:
All patients in the intervention group will be treated in an "optimization center" which constitutes its own physical location at the hospital and functions as a day care unit staffed with doctors, contact nurses, physiotherapists, ERAS nurses and dietitians. An expert team of cardiologists, physiologists, renal physicians and endocrinologists are attached to the unit.
Day 1. (2-12 weeks before the operation). Multipel testing: Clinical status, ASA score, NSQIP score. Alcohol and Smoke score tests. Nutritional score. 6 minute walk test. Psychiatric score tests. If mortality risk \>5% according to NSQIP, low performance on walk test, chair stand test. ASA 3-4, HbA1c \>50 for non diabetics, \>60 for diabetics or (GFR \<45) = special attention from the expert team.
Day 2 until one week before surgery:
Home exercise 5 days / week. Organised (physiotherapist) exercise 2 days / week. Dietprogram with close follow-up. Psychosocial support. Smoking and alcohol cessation program
The week before surgery: The same tests as day 1. 30 days posted: The same tests as day 1.
Controlarm: The same tests as for the intervention group, day 1, the week before surgery and 30 days post. No interventions during the period.
The international ERAS database will be used to record data in the study. Consecutive registration of over 300 perioperative variables on each individual patient.
Examples of these variables are basic patient characteristics, preoperative variables such as information before surgery, laxation, nutrition, fluid intake, anemia and glucose optimization. Intraoperative variables such as body temperature, fluid supply, anesthesia method, bleeding, operation time and gastric tube. Postoperative variables such as catheter removal, nutrition, mobilization, nausea, paralytic ileus, specified complications, reoperations and length of stay after surgery. Compliance with the ERAS protocol will be registered.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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Intervention arm
Optimisation:
Diet, organised exercise, psychosocial support
Optimisation
Defined optimisation
Control arm
Current standard preparation before surgery
No interventions assigned to this group
Interventions
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Optimisation
Defined optimisation
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
18 Years
ALL
No
Sponsors
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Karolinska Institutet
OTHER
Responsible Party
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Ulf Oskar Gustafsson, MD, PhD
Associate Professor of Surgery
Principal Investigators
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Ulf Gustafsson, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
Karolinska Institutet
Josefin Karlsson, Nurse
Role: STUDY_CHAIR
Karolinska Institutet
Locations
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Ulf Oskar Gustafsson
Stockholm, , Sweden
Countries
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Central Contacts
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Facility Contacts
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Other Identifiers
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RCT: OPTIMIZATION: 2021:9
Identifier Type: -
Identifier Source: org_study_id
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