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Hospitalization, for cancer patients, exposes to a risk of undernutrition which has the effect of significantly increasing infections, pressure ulcers, muscle wasting, loss of autonomy, impaired function and delayed healing.
All of these factors contribute to increase the length of stay in hospital, thus lengthening the spiral of undernutrition, which has serious consequences for the patient welbeing, health establishments and public health.
Undernutrition has been the subject of many studies over the last twenty years, that outline that an adequate nutritional management exerts a direct effect on the reduction of comorbidities and duration of hospitalization.
However, there are periods, in the preoperative course of care, where nutritional and phisical care are not realized in the current clinical practice whereas they could be done, for example, between the diagnosis and the consultation of anesthesia, between the anesthesia consultation and the surgical procedure and the end of hospitalization of the patient.
Current management is usually limited to the period of hospitalization which tends to be reduced. This situation is reinforced by the absence of relays at home, dietary consultations being not reimbursed by French health insurance.
Moreover, a preliminary survey, conducted in 2012 during the pre-operative outpatient anesthesia consultation, shows that 26% of patients are already clinically malnourished, with 16.5 % of them who have lost more than 10% of their weight.
Then, the investigators hypothesize that the combination of perioperative nutrition and mobilization program coordinated andrealized by dieticians and physiotherapists, with the Nutrimus follow-up booklet, would improve the post-operative evolution of patients and reduce their postoperative comorbidities.
This management, initiated at the consultation of anesthesia, would include an accurate nutritional diagnosis, nutritional and physical support therapy to improve their nutritional and muscular status.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental group | Experimental | nutritional and functional management coordinated by dieticians and physiotherapists, with adapted nutritional and physical advice and support, realized with the use of Nutrimus booklet in order to facilitate coordination and delivration of cares proposed to the patients |
|
| Control group | Active Comparator | usual preoperative advice for patients who undergoing surgical procedure concerning nutritional cares and physical activity |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dietary advice | Other | Nutritional status assessment Explanation of standard nutritional advices with an written explanation sheet |
|
| Measure | Description | Time Frame |
|---|---|---|
| Variation of the Medical Outcome Study Short Form 36 score | Use of a scale for quality of life | Change in score at 30 days before surgery and 1 Day before hospital discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Sarcopenia index measurement | Measure from routine preoperative Computerized Tomography scan | 30 days before surgery |
| Satisfaction score of the Nutrimus tool | Use of a questionnaire |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| DRCI Strasbourg | Contact | 0388117438 | dpidrci@chru-strasbourg.fr |
| Name | Affiliation | Role |
|---|---|---|
| Alain PARDIGNAC | Strasbourg Universitary hospitals | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Service de Médecine Interne et Nutrition, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg | Recruiting | Strasbourg | 67098 | France |
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| Physiotherapist intervention | Other | Respiratory capacity Functional capacity |
|
| Dietary intervention | Other | Nutritional status assessment Presentation of the Nutrimus booklet by the coordinating dietitian Establishment or adaptation of a nutritional support (prescription of nutritional supplements if necessary). Delivery and explanation of the preoperative nutritional counseling support |
|
| Intensify physiotherapist intervention | Other | Respiratory capacity Functional capacity Tips adapted for physical activity and strengthening or maintenance of muscle mass Presentation of respiratory physiotherapy exercises to prevent postoperative bronchial congestion Nutrition and physical mobilization tips with the Nutrimus booklet |
|
| 6 months postoperative |
| Ease of use of the Nutrimus tool | Use of a questionnaire | 6 months postoperative |
| Measurement of the Medical Outcome Study Short Form 36 score | Use of a scale for quality of life | Change in score at 1 day before surgery, 1 day before the end of hospitalization, 1 Month, 3 Months and 6 Months post hospitalization |
| Evaluation of nutritional parameters | Use of a notebook | Change in values measures at 30 days to 10 days, 1 day before surgery, 1 day before the end of hospitalization, 1 Month, 3 Months and 6 Months post hospitalization |
| Evaluation of respiratory and functional capacities | Change in measures at 30 days to 10 days, 1 day before surgery, 1 day before the end of hospitalization, 1 Month, 3 Months and 6 Months post hospitalization |
| Pain assessment | Use of a visual analogue scale Measure of score from 0 to 10 | Change in score at 30 days to 10 days, 1 day before surgery, 1 day before the end of hospitalization, 1 Month, 3 Months and 6 Months post hospitalization |
| Length hospitalization | Length (in days) between hospital admission and discharge | Duration (in days) of patient's hospitalization |
| ID | Term |
|---|---|
| D044342 | Malnutrition |
| D005770 | Gastrointestinal Neoplasms |
| ID | Term |
|---|---|
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
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| ID | Term |
|---|---|
| D015596 | Nutrition Assessment |
| D004035 | Diet Therapy |
| ID | Term |
|---|---|
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D015991 | Epidemiologic Measurements |
| D011634 | Public Health |
| D004778 | Environment and Public Health |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
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