Anaesthesia
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Peri-operative allogeneic red blood cell transfusion is hypothesised to increase the risk of cancer recurrence following cancer surgery. However, previous data supporting this association are limited by residual confounding. We conducted an umbrella review (i.e. a systematic review of systematic reviews) to synthesise and evaluate the evidence between red blood cell transfusion and cancer recurrence. ⋯ Currently available evidence describes an association between peri-operative red blood cell transfusion and cancer recurrence, but this is mostly of low to critically low quality, with minimal control for residual confounding. Further research, at low risk of bias, is required to provide definitive evidence and inform practice.
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Review
The inequalities and challenges of prehabilitation before cancer surgery: a narrative review.
Prehabilitation seeks to enhance functional capacity and preparedness before surgery with the aim of improving outcomes; it is generally based on exercise, diet and psychological interventions. While there is obvious appeal to this approach in terms of patient experience and resource use, the interventions are complex and the evidence base for prehabilitation before cancer surgery is heterogeneous. Prehabilitation requires patient understanding and motivation as well as commitment of resources. Programmes are challenging to design and implement, and can generate 'intervention-based inequalities' based on the capacity of patients to engage. We present a narrative review on the inequalities and challenges of prehabilitation before cancer surgery. ⋯ Prehabilitation must be implemented carefully to avoid widening inequalities. More research is needed, both in terms of the impact of interventions and to understand how prehabilitation should account for the social determinants of health.
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Review
Optimisation of the patient having oncological surgical through prehabilitation: a narrative review.
Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery. ⋯ Prehabilitation has the potential to improve surgical outcomes for patients undergoing cancer surgery. Further evidence is needed to understand how and what we provide to patients as optimal exercise, nutrition and psychological interventions as part of their surgical care, and how we improve long-term lifestyle using behaviour change methodology. Digital technology offers the opportunity for scaling and greater personalisation of prehabilitation but needs to be deliberately fashioned to ensure equitable access.
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Radiotherapy is currently used in approximately one-third of children with cancer. Treatments are typically received as weekday outpatient appointments over 3-6 weeks. The treatment is painless but requires a still, co-operative patient who can lie alone in set positions, facilitated by the use of immobilisation devices, for up to 1 h. ⋯ The requirement for anaesthesia for paediatric radiotherapy is typically confined to younger children. Patients may be unwell, with several specific considerations related to their cancer diagnosis and the impact of various treatments including surgery and chemotherapy, in addition to the radiotherapy. A multidisciplinary team approach to all aspects of care is imperative in this group of high-risk patients.
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Peri-operative medicine is becoming increasingly relevant in the context of managing frail patients with cancer. This paper outlines how demographic shifts in populations are affecting cancer incidence and frailty rates, the relevance this holds to the management of cancer care, and the outcome measures that should be used to gauge best clinical practice to ensure patient-centred care. ⋯ There is need for a greater emphasis on quality-of-life measures alongside mortality and patient-reported outcome measures. We argue that holistic care approaches should play a greater role in enabling the measurement of outcome states beyond simply dead or alive.