BACKGROUND: Apart from clinical experience and theoretical considerations, there is a lack of evidence that the level of adherence to in-hospital mobilization protocols is related to functional recovery in patients after resection for lung cancer. The objectives of the study were to determine (1) the relationship between adherence to the in-hospital mobilization protocol and physical fitness at hospital discharge and (2) the value of physical fitness measures at discharge in predicting physical functioning 6 weeks and 3 months postoperatively.METHODS: This observational study included 62 patients who underwent surgical resection for lung cancer. Adherence to the in-hospital mobilization protocol was abstracted from patients' records. Physical fitness measures before the operation and at hospital discharge included handgrip strength, 30-second sit-to-stand test, and 6-minute walk test (6MWT). Self-reported physical functioning was assessed preoperatively and 6 weeks and 3 months postoperatively, using the Medical Outcome Study 36-Item Short Form (SF-36) Physical Function subscale (RAND Corp, Santa Monica, CA). Linear regression analyses were used to estimate the relationships of interest, adjusting for potential confounders.RESULTS: Level of adherence to the mobilization protocol was significantly and independently related to handgrip strength, sit-to-stand test, and 6MWT at discharge. Handgrip strength and 6MWT at discharge significantly predicted SF-36 Physical Function at 6 weeks and 3 months postoperatively. The sit-to-stand test only predicted SF-36 Physical Function at 6 weeks.CONCLUSIONS: Suboptimal postoperative mobilization after surgical resection for lung cancer negatively affects physical fitness at discharge. Our results underline the importance of adherence to early postoperative mobilization protocols. Measuring physical fitness at discharge may be useful to inform clinicians on elective referral of patients for postdischarge rehabilitation.
BACKGROUND: Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge.OBJECTIVE: This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery.METHODS: A mixed methods study was conducted in which 41 patients with cancer scheduled for lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy were included. Preoperatively, patients received an ankle-worn accelerometer and the corresponding mobile health app to familiarize themselves with its use. The use was continued for up to 6 weeks after surgery. Feasibility criteria related to the study procedures, the System Usability Scale, and user experiences were established. In addition, 6 patients were selected to participate in semistructured interviews.RESULTS: The percentage of patients willing to participate in the study (68/90, 76%) and the final participation rate (57/90, 63%) were considered good. The retention rate was acceptable (41/57, 72%), whereas the rate of missing accelerometer data was relatively high (31%). The mean System Usability Scale score was good (77.3). Interviewed patients mentioned that the accelerometer and app were easy to use, motivated them to be more physically active, and provided postdischarge support. The technical shortcomings and comfort of the ankle straps should be improved.CONCLUSIONS: Self-monitoring of PA after discharge appears to be feasible based on good system usability and predominantly positive user experiences in patients with cancer after lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy. Solving technical problems and improving the comfort of the ankle strap may reduce the number of dropouts and missing data in clinical use and follow-up studies.
Background: Improving physical activity, especially in combination with optimizing protein intake, after surgery has a potential positive effect on recovery of physical functioning in patients after gastrointestinal and lung cancer surgery. The aim of this randomized controlled trial is to evaluate the efficacy of a blended intervention to improve physical activity and protein intake after hospital discharge on recovery of physical functioning in these patients. Methods: In this multicenter single-blinded randomized controlled trial, 161 adult patients scheduled for elective gastrointestinal or lung cancer surgery will be randomly assigned to the intervention or control group. The purpose of the Optimal Physical Recovery After Hospitalization (OPRAH) intervention is to encourage self-management of patients in their functional recovery, by using a smartphone application and corresponding accelerometer in combination with coaching by a physiotherapist and dietician during three months after hospital discharge. Study outcomes will be measured prior to surgery (baseline) and one, four, eight, and twelve weeks and six months after hospital discharge. The primary outcome is recovery in physical functioning six months after surgery, and the most important secondary outcome is physical activity. Other outcomes include lean body mass, muscle mass, protein intake, symptoms, physical performance, self-reported limitations in activities and participation, self-efficacy, hospital readmissions and adverse events. Discussion: The results of this study will demonstrate whether a blended intervention to support patients increasing their level of physical activity and protein intake after hospital discharge improves recovery in physical functioning in patients after gastrointestinal and lung cancer surgery. Trial registration: The trial has been registered at the International Clinical Trials Registry Platform at 14–10-2021 with registration number NL9793. Trial registration data are presented in Table 1.
Every year in the Netherlands around 10.000 people are diagnosed with non-small cell lung cancer, commonly at advanced stages. In 1 to 2% of patients, a chromosomal translocation of the ROS1 gene drives oncogenesis. Since a few years, ROS1+ cancer can be treated effectively by targeted therapy with the tyrosine kinase inhibitor (TKI) crizotinib, which binds to the ROS1 protein, impairs the kinase activity and thereby inhibits tumor growth. Despite the successful treatment with crizotinib, most patients eventually show disease progression due to development of resistance. The available TKI-drugs for ROS1+ lung cancer make it possible to sequentially change medication as the disease progresses, but this is largely a ‘trial and error’ approach. Patients and their doctors ask for better prediction which TKI will work best after resistance occurs. The ROS1 patient foundation ‘Stichting Merels Wereld’ raises awareness and brings researchers together to close the knowledge gap on ROS1-driven oncogenesis and increase the options for treatment. As ROS1+ lung cancer is rare, research into resistance mechanisms and the availability of cell line models are limited. Medical Life Sciences & Diagnostics can help to improve treatment by developing new models which mimic the situation in resistant tumor cells. In the current proposal we will develop novel TKI-resistant cell lines that allow screening for improved personalized treatment with TKIs. Knowledge of specific mutations occurring after resistance will help to predict more accurately what the next step in patient treatment could be. This project is part of a long-term collaboration between the ROS1 patient foundation ‘Stichting Merels Wereld’, the departments of Pulmonary Oncology and Pathology of the UMCG and the Institute for Life Science & Technology of the Hanzehogeschool. The company Vivomicx will join our consortium, adding expertise on drug screening in complex cell systems.
De Nederlandse onafhankelijke bierbrouwers, die zijn aangesloten bij branchevereniging CRAFT, hebben een groeiend te kort aan hop. Achteruitgang van het teeltareaal en slechte zomers zorgen ervoor dat er te weinig hop beschikbaar is. Hop is een belangrijke smaakcomponent in het brouwen van speciaalbier, waar deze bierbrouwers in gespecialiseerd zijn en waar steeds meer vraag naar is. De teelt van hop is echter uit Nederland verdwenen waardoor de brouwers afhankelijk zijn van hop uit het buitenland. De bierbrouwers zijn daarom op zoek naar een Hollandse hop, met een authentieke smaak, die lokaal geteeld kan worden, voor het brouwen van hun speciaalbieren. In deze aanvraag willen we nieuwe teeltmethoden ontwikkelen om hoogkwalitatieve hop in Nederland te telen. Daarnaast gaan we voor de veredeling van een Hollandse hop variëteit op zoek naar hopplanten in herbaria en in het wild, die als kruisingsouders kunnen dienen. Van deze planten gaan we DNA-profielen maken en vergelijken met de DNA-profielen van huidige variëteiten om de genetische overeenkomsten en verschillen tussen de planten in kaart te brengen. Tevens gaan we de smaak-profielen van de verwilderde en huidige hop variëteiten bepalen om authentieke smaakcompenten op te sporen. De nieuwste technieken op het gebied van DNA sequensing en chemische analyse van inhoudsstoffen zullen ingezet worden om deze gegevens te verzamelen. Daarnaast zullen moleculaire merkers ontwikkeld worden die gebruikt worden bij merker-gestuurde veredeling. De verzamelde gegevens over de genetische achtergrond (fylogenie) en smaakcomponenten zullen als basis dienen voor de keuze van het beste oudermateriaal om te starten met de moleculaire veredeling van een nieuwe Hollandse hop variëteit die een authentieke smaak heeft, lokaal in Nederland geteeld wordt, en gebruikt wordt voor het maken van lokaal speciaalbier.
Everybody has conscious and unconscious experiences during their holidays. They usually impact your life to a limited degree, but sometimes you have an experience as a result of which you will have a new outlook on life from that moment onwards: a life-changing experience.There are travelers who consciously seek a place in which they can have this type of experiences. Think, for instance of a wellness resort in Bali, in which you learn to eat healthy food and monitor your work-life balance. When returning from this holiday, you are likely to change course and take the plunge.You could also have an unconscious (spontaneous) experience during your holiday. An experience of which you did not know you would ever have it. You are being triggered, and when arriving home, you are going to take action to change things for the better. You may have visited an orphanage or a nature reserve during a round trip for which you are going to set up a fund-raising appeal after your holidays.This PhD research will seek answers to the following questions:• Can a life-changing experience be designed?• To what degree can a life-changing experience lead to a sustainable behavioural change? Partner: University of Surrey
