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Colorectal CancerPrehab_2NCT04595604

Long Term Effect of Trimodal Prehabilitation Compared to ERAS in Colorectal Cancer Surgery.

A study testing Trimodal rehabilitation + ERAS and ERAS + nutritional prehabilitation in people with Colorectal Cancer, run by St. Borbala Hospital at 2 sites in Hungary.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Elective surgery is the most effective treatment option for colorectal cancer, however it has been recognized to be associated with high morbidity and mortality risks. ERAS (Enhanced Recovery After Surgery) is a preoperative multimodality treatment package, which has been well investigated and proved to be effective… Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Colorectal Cancer
What is being tested?
Trimodal rehabilitation + ERAS and ERAS + nutritional prehabilitation
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
500 participants
Where
2 sitesHungary
Study dates
7 Sep 2020to 7 Jun 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • patient with histologically proven primary colorectal adenocarcinoma
  • any stage of colorectal cancer
  • elective operation
  • curative intention
  • informed consent signed by patient

Who cannot join

  • emergency operation
  • palliative operation
  • non-colorectal, second malignancy
  • pregnancy
  • patient not giving consent

Trial locations and contacts

2 sites in 1 country.

Hungary2 sites
  • Department of Surgery, St. Borbala Hospital

    Tatabánya, 2800

  • St. Borbala Hospital

    Tatabánya, 2800

Other trials in Hungary

About this study

Elective surgery is the most effective treatment option for colorectal cancer, however it has been recognized to be associated with high morbidity and mortality risks.

ERAS (Enhanced Recovery After Surgery) is a preoperative multimodality treatment package, which has been well investigated and proved to be effective in reducing early postoperative morbidity, mortality, length of hospital stay and hospital costs, as well. Still, a good proportion of patients are not suitable for ERAS program, mainly based on lack of compliance and the impaired physical function before surgery.

Read more

Trimodal Prehabilitation Program is a recently introduced preoperative preparation (training) program, which addresses improvement of physical, mental and nutritional status of the high risk elective surgery patients.

This study aims to investigate the benefit of all efforts of a 4-6-week preoperative preparation program (Prehabilitation) being added to an established ERAS protocol.

Additionally the effect of trimodal prehabilitation on gut microbiom diversity and its relation to clinical outcome will be analyzed.

Read the detailed description

Aim:

Colorectal cancer patients with a planned resection are tested if a complex, trimodal rehabilitation program can hold functional and morbidity benefit for them.

In the prospective, randomized (2:1) study control patient group will be the well established and tested ERAS (enhanced recovery after surgery) Program.

Study protocol in details:

First visit: Outpatient Department of Surgery

On both arms:

  • History taking (including family history and oncologic history);
  • Physical examination

Operation indication, type of procedure and date of procedure agreed; Organizing further investigations, anesthesia; Operative risk assessment ("ACS - surgical risk calculator"); Study patient identifier Nr generated; Nurse-led ERAS/Prehab clinic: randomization

On both arms:

  • Randomization (Prehabilitation Program / ERAS Program). 2:1
  • Nurse led clinic assessment ("study nurse"):

.i. CaseReportForm (CRF) filled in.

.ii. Patient data (personal data, demographics, history) .iii. Anthropometrics (BMI, MUST, Body fat % measurement). .iv. Mental hygienic status assessment (smoking, alcohol consumption, anxiety, depression, sleeping disorders).

.v. Cardiovascular status (resting HR, RR). .vi. Operative risk assessment (CR-Possum score). .vii. Preoperative counseling (operation type, preparation, pain management, discharge plan).

.viii. Preoperative nutritional planning (education, nutrient prescription). .ix. Alcohol intake and smoking cessation - information given. .x. Stoma education started. . xi. Consent signed, patient workbook handed over. .xii. Respiratory test referral. xiii. Fecal sample collected and stored at -86 C.

Physiotherapy, first visit

Both on control and interventional arms:

  • Respiratory function test recorded.
  • Physical status tested (6MWD) on a treadmill.

Just on Prehabilitation arm:

  • Respiratory training education.
  • Respiratory trainer device usage educated.
  • Daily activity (walking) planned.

Physiotherapy - second/third/fourth visit (weekly)

Just on Prehabilitation arm:

Previous week activity reviewed as to workbook. Physical assessment: 6MWD, FVC. Next week activity planned. Psychic preparation

Just on Prehabilitation arm:

  • Once a week half an hour group relaxation training - regardless of the stage of prehabilitation program.

Admission to the Surgical Ward a day before surgery

Both on control and interventional arm:

  • Preoperative assessment:

.i. Anthropometrics (BMI, body fat%). .ii. Cardiovascular stage (resting HR and RR), ECG. .iii. Respiratory function tests. .iv. Physical status (6MWD) .v. Mental status (Hospital Anxiety and Depression Scale (HADS)) assessment. vi. Fecal sample collected and stored at -86 C.

  • Preoperative preparation (as to ERAS protocol).
  • Postoperative care (ITU, pain management, mobilization, oral nutrition built up, drains early removal, complications recorded (Clavien-Dindo-classification)).
  • Stoma education.

Dietary education. On discharge: Quality of Life (QoL) SF36 - (36-Item Short Form Survey from the RAND Medical Outcomes Study).

Postoperative follow up:

Both on control and interventional arms:

  • Assessment (8th week post op.):

.i. Anthropometrics (BMI, Body fat %) .ii. Cardiovascular status (resting HR and RR). .iii. Respiratory function tests. .iv. Physical status (6MWD). .v. Fecal sample collected and stored at -86 C.

  • Long-term follow-up: 12, 24, 36, 48 and 60 months post operative assessment: Behavioral changes (alcohol abstinence, smoking cessation) Daily physical activity routine assessment. SF36 quality of life assessment Oncological outcome: local recurrence rate, distant recurrence rate, disease free survival, overall survival.
Being tested
Trimodal rehabilitation + ERAS, ERAS + nutritional prehabilitation
Keywords
ERAS, prehabilitation, fecal microbata
Medical subject headings
Colorectal Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Trimodal rehabilitation + ERASProcedure or surgery

    Also called Prehabilitation

    Prehabilitation will cover a range preoperative education and exercises (weekly) on diet, physical activity (daily walking), respiratory training (forced deep inspiration with spirometer device), as well as anxiolytic group psychotherapy.

  • ERAS + nutritional prehabilitationProcedure or surgery

    Also called Enhanced Recovery After Surgery

    Enhanced Recovery Program, including preoperative 4 weeks nutritional supplementation.

Study groups in NCT04595604
Study groupRoleWhat they receive
Trimodal prehabilitation + ERASExperimentalPatients receiving a formal preoperative preparation on: Physical status (walking, respiratory training) Nutrition (nutritional supplements) Mental status (weekly groups led by clinical psychologist on anxiety and depression management). Each patient will be treated in an ERAS program preoperatively.
Receives: Procedure: Trimodal rehabilitation + ERAS
ERAS + nutritional prehabilitationActive comparatorEach patient will be treated in an ERAS program preoperatively. No specific preoperative training will be involved apart from nutritional status assessment and nutritional supplements.
Receives: Procedure: ERAS + nutritional prehabilitation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Length of hospital stay

    Postoperative length of hospital stay in days.

    Measured: 45 days

  2. Number of days spent on ICU (Intensive care unit).

    Number of days observed on ICU right after operation.

    Measured: 45 days

  3. Morbidity (early) classified after Clavien-Dindo.

    7-day morbidity will be detailed assessed. Grade 3 or above morbidity rate will be assessed.

    Measured: 7 days (until 8th postoperative day) postoperative

  4. Morbidity (long term) classified after Clavien-Dindo.

    30-day morbidity will be detailed assessed. Grade 3 or above morbidity rate will be assessed.

    Measured: 30 days (until 31st postoperative day)

  5. 30-day mortality

    30-day mortality of each patient will be recorded.

    Measured: 30 days (until 31st postoperative day)

  6. 90-day mortality

    90-day mortality of each patient will be recorded.

    Measured: 90 days (until 91st postoperative day)

  7. Change in preoperative functional status - 6MWD by operation

    6MWD (6-minute walking distance test)

    Measured: Measured points: 4 weeks before surgery, on day of hospital admission

  8. Change in postoperative functional status - 6MWD by the end of rehabilitation

    6MWD (6-minute walking distance test)

    Measured: Measured points: 4 weeks before surgery, 8 weeks after operation

  9. Change in preoperative functional status - FVC by operation

    Measured points: 4 weeks before surgery, on day of hospital admission

    Measured: Measured points: 4 weeks before surgery, on day of hospital admission

  10. Change in preoperative functional status - FVC by the end of rehabilitation

    Measured points: 4 weeks before surgery, 8 weeks after operation

    Measured: Measured points: 4 weeks before surgery, 8 weeks after operation

Secondary outcomes (1)
  1. Change of alpha- and beta-diversity of fecal microbata

    Fecal microbara diversity will be measured at diagnosis, at the time of operation and 8 weeks after operation. We will assess diversity changes related to the intervention.

    Measured: Measured points: 4 weeks before surgery, on day of hospital admission and 8 weeks after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Oct 2020
  2. Study start7 Sep 2020
  3. Primary completion7 Aug 2022
  4. Study completion7 Jun 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients planned for elective, curative operations for colorectal cancer will be randomized into two groups: experimental group will take part in a dedicated 4-week multimodal preparation program followed by ERAS preoperative management, while control group will just participate in the ERAS program without specific physical and mental preparation. 2:1 randomization will be performed for interventional and control arm
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
500 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04595604
Sponsor's protocol ID
ERASvsPrehab_2
Acronym
Prehab_2
Status last verified
Feb 2024
First submitted
30 Sep 2020
Last updated
29 Nov 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes

Publications

  • Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev. 2023 May 10;5(5):CD013259. doi: 10.1002/14651858.CD013259.pub3.

    PubMed 37162250
  • Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev. 2022 May 19;5(5):CD013259. doi: 10.1002/14651858.CD013259.pub2.

    PubMed 35588252

Questions about this trial

What is this clinical trial studying?

A study testing Trimodal rehabilitation + ERAS and ERAS + nutritional prehabilitation in people with Colorectal Cancer, run by St. Borbala Hospital at 2 sites in Hungary.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Hungary. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Length of hospital stay (time frame: 45 days). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04595604, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Nov 2024.

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