Jensen, B.T., Jensen, J.B., Laustsen, S., Petersen, A.K., Søndergaard, I., & Borre, M. (2014). Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: Secondary reported outcome of a randomized controlled trial. Journal of Multidisciplinary Healthcare, 7, 301.

To evaluate whether pre- and postoperative physical exercise affect quality of life and symptoms in patients undergoing radical cystectomy

Patients were randomized to a standard care or intervention group. Standard care included preoperative nutritional screening counseling and the use of oral supplements as needed, patient education, and standard mobilization postoperatively by walking during each shift with supervision once daily. The intervention included all aspects of standard care plus a preoperative exercise program and a more comprehensive postoperative exercise program with related patient education 14 days prior to surgery. Prior to surgery, a phone call after one week was done to promote adherence to the program. Postsurgery, the intervention group had physical therapy sessions two times per day including progressive muscle strength and endurance training. The difference between groups at four months after the intervention were reported.

• N = 100
• MEAN AGE = 70 years (range = 46–91 years)
• MALES: 66%, FEMALES: 34%
• KEY DISEASE CHARACTERISTICS: All had surgery for urinary diversion
• OTHER KEY SAMPLE CHARACTERISTICS: 57% married and living with a partner

• SITE: Single-site  
• SETTING TYPE: Multiple settings  
• LOCATION: Denmark

• PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial

• European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)
• Charlson Comorbidity Index (CCI)
• Nutritional risk screening tool

Those in the intervention group reported reduced symptoms of constipation and flatulence. Compared to the intervention group, those in the standard care group reported reduced insomnia (p = 0.04) and a clinically relevant, but not statistically significant, reduction in fatigue. There were no other differences between groups in symptoms.

The perioperative multicomponent rehabilitation program studied here did not result in reduced fatigue or improvement in overall quality of life compared to those who received standard care.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Patient adherence to exercises preoperatively was not described.

A more intensive exercise and educational counseling program provided perioperatively did not result in better patient outcomes related to fatigue four months after surgery for this group of patients. The lack of information about patients’ adherence to both pre- and postoperative exercise recommendations is a limitation of this report. Additional research on the impact of perioperative rehabilitation therapies in various patient groups would be of benefit.