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B. Naidu
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MA 08 - Supportive Care and Communication (ID 669)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:E. Esposito-Nguyen, John McPhelim
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 511 + 512
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MA 08.09 - Postoperative Mobilisation and Rehabilitation Requirements for Lung Cancer Patients Undergoing Minimally Invasive Surgery (ID 10064)
12:00 - 12:05 | Author(s): B. Naidu
- Abstract
- Presentation
Background:
Video-assisted thoracoscopic surgery (VATS) is now increasingly performed and recommended in early-stage NSCLC resection. Early postoperative mobilisation, rehabilitation and physiotherapy can improve subsequent reduction in lung volumes, aid clearance of secretions and independent mobility, although there is much variation in how lung cancer patients are currently managed in this respect. The objective of this study was to observe capability for early mobility and frequency of issues potentially amenable to physiotherapy rehabilitation following VATS lobectomy for lung cancer. Any preoperative factors associated with increased rehabilitation needs were also identified, thus enabling early recognition of lung cancer patients needing rehabilitation.
Method:
A prospective observational study was performed including all consecutive cancer patients undergoing VATS lobectomy in a regional centre over 4 years (2012-2016). Standard postoperative care included early mobilisation where patients were sat out by nursing staff from postoperative day 1 (POD1) and assisted to mobilise as able. Physiotherapy assessment of all patients on POD1 determined presence of issues potentially amenable to rehabilitation, and this was commenced as deemed necessary. Outcome measures included development of postoperative pulmonary complication (PPC), hospital and high dependency unit (HDU) length of stay (LOS) and intensive therapy unit admission (ITU).
Result:
285 lung cancer patients were observed; 76 (27%) patients did not requiring specialised rehabilitation or physiotherapy, and engaged with nursing staff successfully in early mobility and becoming independently mobile. These patients had a significantly lower hospital and HDU length of stay (p<0.001), reflecting uncomplicated recovery. The remaining 209 patients (73%) received physiotherapy rehabilitation to assist/improve reduced mobility. Of these patients 23 (8%) also received chest physiotherapy for sputum clearance and 65 (23%) for lung volume loss. amongst those requiring this therapy were all patients who developed PPC, and all those admitted to the ITU. Despite surgery being non-invasive the frequency of development of PPC was higher than that for other VATS surgery at 7%, and this was associated with poorer outcomes. Logistic regression identified that COPD, BMI, preoperative mobility and age were associated with increased postoperative rehabilitation needs for mobility or respiratory issues (p=0.013).
Conclusion:
We recommend that all lung cancer patients receive early mobilisation and routine postoperative rehabilitation following this surgery ensuring issues amenable to physiotherapy and the need for rehabilitation is detected early. Associated preoperative baseline factors included COPD, poor preoperative mobility, and increasing BMI and age; such patients may benefit from preoperative rehabilitation as well as routine physiotherapy for better postoperative outcome.
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P1.10 - Nursing/Palliative Care/Ethics (ID 696)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.10-002 - Outcome of Pilot RCT in Lung Cancer Surgery Patients Receiving Either Preop Carbohydrate & Postop Nutritional Drinks or Water (ID 8405)
09:30 - 09:30 | Author(s): B. Naidu
- Abstract
Background:
In recent thoracic surgical studies, malnutrition and/or weight loss are important risk factors for complications after surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in complications or malnutrition. Enhanced Recovery After Surgery (ERAS) programmes in non-lung surgery include pre-surgery optimisation with carbohydrate loading drinks and post-surgery nutritional supplements. These interventions have proven highly effective in reducing post-operative complications. No trials have been performed in thoracic surgery to assess the impact.
Method:
Single centre mixed method open label Randomised Controlled Trial (RCT) was conducted to assess the feasibility of carrying out a large multicentre RCT in patients undergoing lung resection. A nutritional intervention regime of preoperative carbohydrate-loading drinks 4x200mls evening before surgery and 2X200mls the morning of surgery, and early postoperative nutritional protein supplement drinks twice a week for 2 weeks was compared to the control group receiving an equivalent volume of water. Trial feasibility measures were collected as primary outcome. Postoperative pulmonary complications were measured using the Melbourne group scale along with additional surgical complications. Visual analogue scores of symptoms, Quality of Recovery score 40, quality of life (EQ-5D-5L) and satisfaction questionnaires were collected at baseline, in hospital, 3-4 weeks and 3 month post-surgery along with hand grip and peak flow. Qualitative semi structured interviews post-surgery were undertaken to assess patient experience of the trial and interventions.
Result:
Feasibility criteria’s were met and the study completed recruitment 5 months ahead of target. All elective lung cancer surgery patients were screened of which 41% (n=64) were randomised over 6 month period. The 2 groups were well balanced and tools used to measure outcome robust. 97% of patients were compliant with nutritional drinks scheduled pre-surgery, 89% of 3 month questionnaires were returned completed. Importantly, qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires used captured their experience of recovery from surgery well.
Conclusion:
Current international guidelines for enhanced recovery following thoracic surgery cannot recommend pre or post-operative nutrition because of lack of evidence. We have shown an intervention and a trial design of pre-op carbohydrate-loading and post-surgery supplementation is highly acceptable to patients’ with good compliance to both intervention and trial measures. A large multi-centre clinical trial is required to test clinical efficacy in improving outcomes after surgery.
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P3.10 - Nursing/Palliative Care/Ethics (ID 726)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.10-005 - National UK Thoracic Surgery PPI Group Identify Key Questions in Routine Clinical Care for Further Research (ID 10483)
09:30 - 09:30 | Author(s): B. Naidu
- Abstract
Background:
Patient and public involvement helps us understand and improve healthcare and treatments. A national UK group incorporating patient and carers who have had experience of thoracic surgery was developed in 2016. Involving this group could enhance thoracic surgery research. The aim of this study was to determine from the patient and carer perspective what could be improved with the thoracic surgery pathway to increase satisfaction and care thus enhancing clinical outcomes.
Method:
15 patients and carers from the national Thoracic surgery PPI group were sent a questionnaire via post. This consisted of 10 open ended questions regarding the service, education and advice they received before and after their lung surgery. They were also asked to comment on their experience as an inpatient, at the point of discharge and provide any suggestions for improvement. The questions were semi structured which allowed flexibility to follow up responses. Each questionnaire was analysed using phenomenological approach in order to gather a deep understanding of the patients and carer’s experiences through an inductive method.
Result:
Three themes were gathered from this audit; ambiguity regarding information; continuous need for reassurance, reflection, interpretation, and finally psychological impact. Overwhelmingly patients felt they needed additional advice and information to cope with the physical and more importantly mental changes which affected their daily lives following thoracic surgery.
Conclusion:
It is evident that patient and public involvement in developing ideas for further research in thoracic surgery is invaluable. Their insight and experience can assist healthcare professionals make appropriate improvements to the service for the benefit of future patients. From this audit it is apparent that receiving sufficient information and advice is vital to patient to managing the surgical journey and enhance recovery, interventions to support patients mental health would be of benefit to the patients. In order to achieve further in depth and detailed understanding of patient experiences post thoracic surgery, qualitative methods such as focus groups or interviews should be conducted with a larger sample size.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-024 - Feasibility of the Fit4Surgery App - Can It Replace Conventional Pulmonary Rehabilitation in the Surgical Population? (ID 10159)
09:30 - 09:30 | Author(s): B. Naidu
- Abstract
Background:
Perioperative exercise and physiotherapy is increasingly recognised as beneficial for preparation and recovery in patients undergoing lung cancer surgery. Time and resource constraints may be a barrier to referral for rehabilitation prior to lung cancer surgery. We aimed to establish if provision of an exercise app to use at home would enable patients to exercise more frequently than attendance at classes and determine what the patient experience of using the app was.
Method:
We developed an app for an Apple iPad which utilised a Bluetooth connection to a pulse oximeter to provide patients with realtime feedback on their pulse rate and oxygen saturations during exercise. The app guides patients in doing pulmonary rehabilitaton exercises, which can be made more intense or gentler depending on baseline fitness. We conducted a prospective cohort study to test use of the app by patients at home before and after lung cancer resection. Incremental shuttle walk tests were performed before and after using the app to investigate the difference in preoperative functional capacity. Patients were asked to complete semi structured telephone interviews to comment on their experience of the app. Transcripts of interviews were analysed using content analysis to categorise and highlight the important messages from patients.
Result:
During the 14 month study 37 patients were recruited. A variety of patients participated; the age range was 33 to 84 years and FEV1 range was 45% to 124% predicted. The average number of sessions completed on the app was 4, double the amount if they were attending pulmonary rehabilitation classes prior to lung cancer surgery. All patients except one improved their incremental shuttle walk distance before surgery. Interviews yielded five key messages about the app; patients had a range of motivations for taking part in the study, it was simple to use, patients had a positive experience using it, they had tips for improving it and they thought it had had an impact upon their fitness levels. All the patients found the app convenient to help them perform exercises outside of hospital.
Conclusion:
Patients welcomed the app and immediate provision of the app eliminated any delay in accessing support to exercise. Patients were able to perform more sessions of exercise by using it at home as opposed to hospital based exercises classes. It was feasible to use the app in all types of patients attending for surgery and a multi-centre study is indicated to assess the impact upon postoperative outcomes.
