2013年2月23日土曜日

がん術前のプレハビリテーション:系統的レビュー

がん患者の術前の運動介入(プレハビリテーション)に関する系統的レビューを紹介します。

Favil Singh, et al. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surgical Oncology, Available online 19 February 2013, http://dx.doi.org/10.1016/j.suronc.2013.01.004

18論文(RCTだけでなく非RCTも含んでいます)の系統的レビュー論文で、主に肺がん患者が多かったです。ほとんどの研究で有酸素運動が行われていました。運動療法の種類は異なりますが、多くの研究で歩行能力や心肺機能が改善したという結果でした。

以上より、がん患者の術前の運動介入・Prehabilitationが有効な可能性があるという結論です。メタ分析ではないこと、非RCTも含んでいる、アウトカムがQOLや入院日数ではないことなど、限界もいくつかありますが、系統的レビューで有効かもというのはやや心強いです。

Abstract

Background

Recent reviews suggest that enhancing fitness and functional capacity prior to surgery can accelerate post-surgery recovery and reduce mortality. However, the effect of pre-surgical exercise interventions in cancer patients is not fully explained. The aim of this paper is to systematically review the available literature regarding pre-surgery exercise training interventions in cancer patients and examine their effects on physiological outcomes as well as quality of life (QOL) and length of hospital stay.

Methods

Relevant studies were identified through a search on MEDLINE, PreMEDLINE, AMED, MEDLINE Daily Update, CINAHL and SPORTDiscus. All randomized controlled trials (RCTs) and non-RCTs that had some form of physical exercise undertaken prior to surgery were included. Descriptive characteristics such as participant characteristics, study design, types of cancer, length of study, and primary outcomes were extracted. Methodological rigour was assessed using a modified Delphi List. Due to the heterogeneity and the dearth of pre-surgical studies, we were limited to a systematic review rather than a meta-analysis.

Results

Eighteen studies were included consisting of a total of 966 participants. Lung cancer studies were the predominant group represented. Most of the studies prescribed an aerobic intervention programs done prior to surgery. Mode, frequency, duration, and intensity of exercise intervention varied across the different cancer groups. The majority of studies showed preliminary positive change in clinical outcomes with significant improvements in the rate of incontinence, functional walking capacity and cardiorespiratory fitness.

Conclusion

Pre-surgical exercise may benefit cancer patients through positive effects on function and physical capacity. Surgical oncologists may consider pre-surgical exercise interventions as a potential adjuvant therapy to improve patients' outcomes.

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