Effect of total-body prehabilitation on postoperative outcomes: A systematic review and meta-analysis

Objective To systematically review the evidence of pre-operative exercise, known as ‘prehabilitation’, on peri- and postoperative outcomesin adult surgical populations.Design Systematic review and meta-analysis.Data sources CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011.Methods Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-bodyexercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Riskof bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysisdue to the heterogeneity of measures and methodologies for assessing other outcomes.Results In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small(median = 54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found thattotal-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improvinghealth-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitationreduced postoperative length of stay with a small to moderate effect size (Hedges’ g = −0.39, P = 0.033). Intervention-related adverse eventswere reported in two of 669 exercising participants.Conclusion The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physicalbenefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.© 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.DSM is funded by the Princess Margaret Foundation viathe Prostate Centre for post-doctoral research, not specific tothis study

Long-Term Health Care Costs for Prostate Cancer Patients on Androgen Deprivation Therapy

Background: Comparing relative costs for androgen deprivation therapy (ADT) protocols in prostate cancer (PCa) requires an examination of all health care resources, not only those specific to PCa. The objective of the present study was to use administrative data to estimate total health care costs in a population-based cohort of PCa patients. Methods: Patients in Ontario with PCa who started 90 days or more of ADT at age 66 years or older during 1995–2005 were selected from cancer registry and health care administrative databases. We classified patients (n = 21,818) by regimen (medical castration, orchiectomy, anti-androgen monotherapy, medical castration with anti-androgen, orchiectomy with anti-androgen) and indication (neoadjuvant, adjuvant, metastatic disease, biochemical recurrence, primary nonmetastatic). Using nonparametric regression methods, with inverse probability weighting to adjust for censoring, and bootstrapping, we computed mean 1-year, 5-year, and 10-year longitudinal total direct medical costs (2009 Canadian dollars). Results: Mean first-year costs were highest for metastatic disease, ranging from $24,400 for orchiectomy to$32,120 for anti-androgen monotherapy. Mean first-year costs for all other indications were less than $20,000. Mean 5-year and 10-year costs were lowest for neoadjuvant treatment: approximately$43,000 and $81,000 respectively, with differences of less than$4,000 between regimens. Annual costs were highest in the first year of ADT. Orchiectomy was the least costly regimen for most time periods, but was limited to primary and metastatic indications. Outpatient drugs, including pharmacologic ADT, accounted for 17%–65% of total first-year costs. Conclusions: Compared with combined therapies, the ADT monotherapies, particularly orchiectomy when clinically feasible, are more economical. Our methods exemplified the use of algorithms to elucidate clinical information from administrative data. Our approach can be adapted for other cancers to expand the range of studies using Canadian administrative data

Meeting the Needs of the Aging Population: The Canadian Network on Aging and Cancer—Report on the First Network Meeting, 27 April 2016

The aging of the Canadian population represents the major risk factor for a projected increase in cancer incidence in the coming decades. However, the evidence base to guide management of older adults with cancer remains extremely limited. It is thus imperative that we develop a national research agenda and establish a national collaborative network to devise joint studies that will help to accelerate the development of high-quality research, education, and clinical care and thus better address the needs of older Canadians with cancer. To begin this process, the inaugural meeting of the Canadian Network on Aging and Cancer was held in Toronto, 27 April 2016. The meeting was attended by 51 invited researchers and clinicians from across Canada, as well as by international leaders in geriatric oncology from the United States and France. The objectives of the meeting were to (1) review the present landscape of education, clinical care, and research in the area of cancer and aging in Canada; (2) identify issues of high research priority in Canada within the field of cancer and aging; (3) identify current barriers to geriatric oncology research in Canada and develop potential solutions; (4) develop a Canadian collaborative multidisciplinary research network between investigators to improve health outcomes for older adults with cancer; (5) learn from successful international efforts to stimulate the geriatric oncology research agenda in Canada. In the present report, we describe the education, clinical care, and research priorities that were identified at the meeting