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Trial of Prehabilitation in Vulnerable Patients Undergoing Cystectomy for Bladder Cancer

Primary Purpose

Bladder Cancer

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Baseline Strength Test
Exercise
Sponsored by
University of Michigan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bladder Cancer

Eligibility Criteria

60 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Patients must have biopsy-proven bladder cancer.
  • Patients age ≥60, diagnosed with bladder cancer with planned cystectomy and urinary diversion, +/- neoadjuvant chemotherapy.
  • The patient must be able to communicate and understand/complete forms/instructions, and be able to provide informed written consent prior to enrollment. Patients may have the assistance of an interpreter or surrogate when completing forms/surveys as needed.
  • Karnofsky performance status ≥70 with the ability to walk unassisted.
  • Sedentary baseline lifestyle, with an average of <180 minutes/week of moderate-intensity aerobic activity.
  • Attending surgeon clearance to undergo a supervised exercise training program.

Exclusion Criteria:

  • Contraindication to exercise training, such as skeletal metastases, symptomatic coronary artery disease, severe anemia, or any condition limiting their ability to participate in an exercise training program.
  • Patients who require surgery sooner than 28 days from enrollment.

Sites / Locations

  • University of Michigan

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Prehabilitation

Arm Description

The progressive, pre-operative exercise training program includes 3 supervised exercise sessions per week for 4 weeks. The first week of training will include an acclimation period accomplished via a ramping protocol. Subjects will warm-up on a treadmill for 5-minutes. Subjects will then complete 1 set of 15 repetitions exercising 8 major muscle groups during week one; during week #2 they will complete 2 sets with a goal of at least 12 repetitions; if subjects reach 15 repetitions on the second set, the resistance will be increased by 10% at the next training session to ensure progression. After completion of the resistance training portion of each session, subjects will walk on a treadmill for 30 minutes at a low/moderate intensity followed by a 5 minutes cool-down period.

Outcomes

Primary Outcome Measures

Assess whether a pre-operative exercise training program (Prehabilitation) for elderly patients undergoing cystectomy for bladder cancer will lower their post-operative 90-day hospital readmission rate.
The study will compare the readmission rate of 70 recruited prehabilitation patients to the historic readmission rates from our institution and the published literature. Readmission will be defined as an admission to any acute care hospital after initial discharge from the immediate post-operative stay within 90 days of surgery. Visits to emergency rooms or urgent, unscheduled outpatient evaluations will be tracked, but will not count as a readmission. We will also track instances in which patients experience multiple re-admissions within 90 days of surgery, but for the purposes of this study, multiple re-admissions for an individual patient will only count as a single readmission event.

Secondary Outcome Measures

Determine the efficacy of prehabilitation on improving functional capacity and strength from baseline levels.
A submaximal exercise test and 6 minute walk test will be used to assess the maximal rate of oxygen utilization and functional capacity at baseline and at the conclusion of the intervention period. Muscular strength will be evaluated using volume loading.
Composite of measures assessing the effects of prehabilitation on peri-operative cystectomy complications, resource utilization, patient reported outcomes, and functional status.
Early (within 30 days of surgery) and late (between 31 and 90 days of surgery) complications, length of hospital stay, resource utilization (emergency room visits, need for sub-acute rehabilitation or nursing home stays, and the costs associated with this additional care) and post-operative outcomes, such as functional capacity and quality of life, will be evaluated and compared to historic data available in the published literature.
Evaluate safety for a prehabilitation program in elderly cystectomy patients.
The endpoint for safety is the prevalence of adverse events during study-related assessments and exercise training sessions.
Rates of attrition for a prehabilitation program in elderly cystectomy patients.
Study attrition will be the rate at which patients drop out of the study.
Rates of adherence for a prehabilitation program in elderly cystectomy patients.
Study adherence will be the percentage of prescribed exercise sessions each participant completes during the treatment period.
Rates of accrual for a prehabilitation program in elderly cystectomy patients.
Track the study recruitment rate and, once patients have been screened by the study team and approached to participate, note the reasons that patients who choose not to participate give for their refusal (personal preference, medical comorbidities/deconditioning, perceived program intensity, time commitment for the study protocol, travel distance or lack of consistent means of travel).

Full Information

First Posted
April 9, 2013
Last Updated
August 6, 2019
Sponsor
University of Michigan
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1. Study Identification

Unique Protocol Identification Number
NCT01840137
Brief Title
Trial of Prehabilitation in Vulnerable Patients Undergoing Cystectomy for Bladder Cancer
Official Title
Trial of Prehabilitation in Vulnerable Patients Undergoing Cystectomy for Bladder Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Completed
Study Start Date
June 2012 (Actual)
Primary Completion Date
April 2018 (Actual)
Study Completion Date
April 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Michigan

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The development of clinically relevant and scalable exercise interventions in older cystectomy patients may have an impact upon: Patients: Exercise interventions may improve patient outcomes, including quality of life and avoidance of skilled nursing facilities. Clinicians: Proving the safety and feasibility of targeted interventions in older surgical patients may facilitate the development of clinically relevant preoperative interventions suitable for wider study and implementation. Payers: Improved surgical outcomes among high risk surgical patients will be associated with significant cost savings. Researchers: Targeted and well controlled studies focusing on improving surgical outcomes through exercise may provide insight into relationships between patient factors, surgical stressors and outcomes. Ultimately, such work may lead to novel clinical approaches to optimize patients for surgery. The investigators will study the effects of preoperative exercise training on cystectomy patients, specifically targeting increasing functional capacity and muscular strength. Prior to conducting a more extensive, multi-center, randomized-controlled trial, the feasibility, safety, and initial efficacy of preoperative exercise in cystectomy patients must be determined. To address this issue, the investigators will complete a trial of rehabilitation in cystectomy patients at the University of Michigan.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bladder Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
53 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Prehabilitation
Arm Type
Experimental
Arm Description
The progressive, pre-operative exercise training program includes 3 supervised exercise sessions per week for 4 weeks. The first week of training will include an acclimation period accomplished via a ramping protocol. Subjects will warm-up on a treadmill for 5-minutes. Subjects will then complete 1 set of 15 repetitions exercising 8 major muscle groups during week one; during week #2 they will complete 2 sets with a goal of at least 12 repetitions; if subjects reach 15 repetitions on the second set, the resistance will be increased by 10% at the next training session to ensure progression. After completion of the resistance training portion of each session, subjects will walk on a treadmill for 30 minutes at a low/moderate intensity followed by a 5 minutes cool-down period.
Intervention Type
Other
Intervention Name(s)
Baseline Strength Test
Intervention Description
A symptom limited submaximal cardiopulmonary exercise test to estimate the subject's exercise capacity.
Intervention Type
Other
Intervention Name(s)
Exercise
Intervention Description
Treadmill and muscle exercises.
Primary Outcome Measure Information:
Title
Assess whether a pre-operative exercise training program (Prehabilitation) for elderly patients undergoing cystectomy for bladder cancer will lower their post-operative 90-day hospital readmission rate.
Description
The study will compare the readmission rate of 70 recruited prehabilitation patients to the historic readmission rates from our institution and the published literature. Readmission will be defined as an admission to any acute care hospital after initial discharge from the immediate post-operative stay within 90 days of surgery. Visits to emergency rooms or urgent, unscheduled outpatient evaluations will be tracked, but will not count as a readmission. We will also track instances in which patients experience multiple re-admissions within 90 days of surgery, but for the purposes of this study, multiple re-admissions for an individual patient will only count as a single readmission event.
Time Frame
3 Years
Secondary Outcome Measure Information:
Title
Determine the efficacy of prehabilitation on improving functional capacity and strength from baseline levels.
Description
A submaximal exercise test and 6 minute walk test will be used to assess the maximal rate of oxygen utilization and functional capacity at baseline and at the conclusion of the intervention period. Muscular strength will be evaluated using volume loading.
Time Frame
3 Years
Title
Composite of measures assessing the effects of prehabilitation on peri-operative cystectomy complications, resource utilization, patient reported outcomes, and functional status.
Description
Early (within 30 days of surgery) and late (between 31 and 90 days of surgery) complications, length of hospital stay, resource utilization (emergency room visits, need for sub-acute rehabilitation or nursing home stays, and the costs associated with this additional care) and post-operative outcomes, such as functional capacity and quality of life, will be evaluated and compared to historic data available in the published literature.
Time Frame
3 years
Title
Evaluate safety for a prehabilitation program in elderly cystectomy patients.
Description
The endpoint for safety is the prevalence of adverse events during study-related assessments and exercise training sessions.
Time Frame
3 Years
Title
Rates of attrition for a prehabilitation program in elderly cystectomy patients.
Description
Study attrition will be the rate at which patients drop out of the study.
Time Frame
3 Years
Title
Rates of adherence for a prehabilitation program in elderly cystectomy patients.
Description
Study adherence will be the percentage of prescribed exercise sessions each participant completes during the treatment period.
Time Frame
3 Years
Title
Rates of accrual for a prehabilitation program in elderly cystectomy patients.
Description
Track the study recruitment rate and, once patients have been screened by the study team and approached to participate, note the reasons that patients who choose not to participate give for their refusal (personal preference, medical comorbidities/deconditioning, perceived program intensity, time commitment for the study protocol, travel distance or lack of consistent means of travel).
Time Frame
3 Years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Patients must have biopsy-proven bladder cancer. Patients age ≥60, diagnosed with bladder cancer with planned cystectomy and urinary diversion, +/- neoadjuvant chemotherapy. The patient must be able to communicate and understand/complete forms/instructions, and be able to provide informed written consent prior to enrollment. Patients may have the assistance of an interpreter or surrogate when completing forms/surveys as needed. Karnofsky performance status ≥70 with the ability to walk unassisted. Sedentary baseline lifestyle, with an average of <180 minutes/week of moderate-intensity aerobic activity. Attending surgeon clearance to undergo a supervised exercise training program. Exclusion Criteria: Contraindication to exercise training, such as skeletal metastases, symptomatic coronary artery disease, severe anemia, or any condition limiting their ability to participate in an exercise training program. Patients who require surgery sooner than 28 days from enrollment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffrey S. Montgomery, MD
Organizational Affiliation
University of Michigan
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Michigan
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States

12. IPD Sharing Statement

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Trial of Prehabilitation in Vulnerable Patients Undergoing Cystectomy for Bladder Cancer

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