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Cited by 64Frailty in Older AdultsCancer survivorship and careIntensive Care Unit Cognitive Disorders

Pilot study of a telehealth perioperative physical activity intervention for older adults with cancer and their caregivers

Open access
Lafaro, Kelly J., Raz, Dan J., Kim, Jae Y., Hite, Sherry, Ruel, Nora, Varatkar, Gouri, Erhunmwunsee, Loretta, Melstrom, Laleh +4 more·2020·Supportive Care in Cancer
DOI 10.1007/s00520-019-05230-0PMC PMC8805142
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Abstract

Background Older adults undergoing cancer surgery are at greater risk for poor postoperative outcomes. Caregivers also endure significant burden. Participation in perioperative physical activity may improve physical functioning and enhance overall well-being for both patients and caregivers. In this study, we assessed the feasibility of a personalized telehealth intervention to enhance physical activity for older (≥ 65 years) gastrointestinal (GI) and lung cancer surgery patients/caregivers.Methods Participants completed four telehealth sessions with physical therapy/occupational therapy (PT/OT) before surgery and up to 2 weeks post-discharge. Outcomes included preop geriatric assessment, functional measures, and validated measures for symptoms and psychological distress. Pre/post-intervention trends/trajectories for outcomes were explored.Results Thirty-four patient/caregiver dyads (16, GI; 18, lung) were included. Accrual rate was 76% over 8 months; retention rate was 88% over 2 months. Median for postop of a 6-min walk test, timed up and go, and short physical performance battery test scores improved from baseline to postop. Participant satisfaction scores were high.Conclusion Our conceptually based, personalized, multimodal, telehealth perioperative physical activity intervention for older patient/caregiver dyads is feasible and acceptable. It offers an opportunity to improve postoperative outcomes by promoting functional recovery through telehealth, behavior change, and self-monitoring approaches.Trial registration ClinicalTrials.gov Identifier: NCT03267524.

Integrity signals

Registry

Crossref · 10.1007/s00520-019-05230-0

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    During hospitalization, lung cancer patients had more daily steps than GI cancer patients, with medians of 1331 versus 164.

    “During hospitalization, lung cancer patients had higher number of daily steps than GI cancer patients (median of 1331 vs. 164).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The Vivofit 3 wristband pedometer worn on the non-dominant hand accurately measures daily steps in this population.
  • Findingnone given

    Participant satisfaction scores were high.

    “Participant satisfaction scores were high.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The accrual rate was 76% over 8 months.

    “Accrual rate was 76% over 8 months; retention rate was 88% over 2 months.”
    Quote in the paperNot a substantial claim
  • Findingown data

    For GI cancer patients, median symptom severity was 1.9/10 by 2-4 weeks after discharge, with p=0.003 compared with pre-op.

    “and 1.9/10 by 2–4 weeks post-discharge (p=0.003 compared to pre-op).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Both patients and caregivers reported high satisfaction with using a pedometer for self-monitoring daily steps, with a score of 3.3/4.0.

    “Both patients and caregivers reported high satisfaction with use of a pedometer for self-monitoring daily steps (3.3/4.0).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingown data

    Median daily steps were 6324 before surgery, fell to 1050 during hospitalization, and rose gradually to 2927 in the first 2 weeks after discharge.

    “Overall, the median number of preoperative daily steps was 6324; this number decreased to 1050 during hospitalization and gradually increased to 2927 in the first 2 weeks after discharge.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The Vivofit 3 wristband pedometer worn on the non-dominant hand accurately measures daily steps in this population.

  • May combine two claims.

    Findingown data

    The study included 34 patient/caregiver dyads, of which 16 were GI and 18 were lung.

    “34 patient/caregiver dyads (16 GI, 18 lung) were included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At 2-4 weeks after discharge, 6-minute walk test distance exceeded baseline for lung patients, 420 meters versus 426 meters, with p=0.8.

    “as well as lung patients (420 meters vs. 426 meters, p=0.8)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Intervention acceptability was high overall for both patients and caregivers, with mean satisfaction scores of 3.2/4.0 and 3.5/4.0, respectively.

    “Intervention acceptability (as measured by self-reported satisfaction mean scores[29–31]) were high overall for both patients and caregivers (3.2/4.0 and 3.5/4.0, respectively).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [29] Sun V, Raz DJ, Ruel N, Chang W, Erhunmwunsee L, Reckamp K, Tiep B, Ferrell B, McCorkle R, Kim JY (2017) A multimedia self-management intervention to prepare cancer patients and family caregivers for lung surgery and postoperative recovery. Clin Lung Cancer 18(3):e151–e1e9. https://doi.org/10.1016/j.cllc.2017.01.010 source

      Not checked in the free run.

    • cites [30] Sun V, Dumitra S, Ruel N, Lee B, Melstrom L, Melstrom K et al (2017) Wireless monitoring program of patient-centered outcomes and recovery before and after major abdominal cancer surgery. JAMA Surg 152(9):852–859. https://doi.org/10.1001/jamasurg.2017.1519 source

      Not checked in the free run.

    • cites [31] Reb A, Ruel N, Fakih M, Lai L, Salgia R, Ferrell B, Sampath S, Kim JY, Raz DJ, Sun V (2017) Empowering survivors after colorectal and lung cancer treatment: pilot study of a self-management survivorship care planning intervention. Eur J Oncol Nurs 29:125–134. https://doi.org/10.1016/j.ejon.2017.06.003 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Caregivers had higher distress levels than patients at all time points before 2 weeks after discharge, but their distress followed a similar trajectory of gradual improvement after surgery.

    “For caregivers, distress levels were higher than patients at all time points prior to 2 weeks post discharge, but followed a similar trajectory of gradual improvements after surgery.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In exploratory analysis, neither the 6-minute walk test change nor the timed up and go change was statistically significant.

    “Neither of the changes observed were statistically significant, based on our exploratory analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients had mild distress before surgery, moderate distress before discharge, and gradual improvement by 2-4 weeks after discharge.

    “Similar trajectories were observed for all patients, with mild distress levels reported pre-operatively; levels increased to moderate distress prior to discharge, with gradual improvements at 2–4 weeks post-discharge.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Median postoperative scores on the 6-minute walk test, timed up and go, and short physical performance battery improved from baseline to after surgery.

    “Median for postop 6 minute walk test, timed up and go, and short physical performance battery test scores improved from baseline to post op.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For lung cancer patients, median symptom severity was 2.3/10 at 2-4 weeks after discharge, with p=0.3 compared with pre-op.

    “By 2 to 4 weeks post-discharge, median symptom severity score was 2.3/10 (p=0.3 compared to pre-op).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Mean timed up and go scores gradually improved from baseline to post-discharge for lung patients, from 10.0 seconds to 9.1 seconds, with p=1.0.

    “Functional mobility, as measured by mean TUG scores, gradually improved from baseline to post-discharge for lung patients (10.0 seconds to 9.1 seconds, p=1.0).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Exploratory analysis showed significant improvements in mean SPPB score of more than 1 point from before surgery to 2-4 weeks after discharge for GI patients (10.5-7.5, p=0.001) and lung patients (10.2-8.2, p=0.01).

    “For lower extremity physical performance status, exploratory analysis revealed significant improvements in mean SPPB score of greater than 1 point from before surgery to 2–4 weeks post-discharge (GI:10.5–7.5, p= 0.001; lung 10.2–8.2, p=0.01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Patient adherence to pedometer use was 79% before surgery and 68% after discharge.

    “Preoperative patient adherence to pedometer use was 79%, and 68% post-discharge.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Minimally significant changes on the Short Physical Performance Battery range from 0.3 to 0.8 points.

    “Minimally significant changes for SPPB is 0.3 to 0.8 points [37, 38].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Pavasini R, Guralnik J, Brown JC, di Bari M, Cesari M, Landi F, Vaes B, Legrand D, Verghese J, Wang C, Stenholm S, Ferrucci L, Lai JC, Bartes AA, Espaulella J, Ferrer M, Lim JY, Ensrud KE, Cawthon P, Turusheva A, Frolova E, Rolland Y, Lauwers V, Corsonello A, Kirk GD, Ferrari R, Volpato S, Campo G (2016) Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med 14(1):215. https://doi.org/10.1186/s12916-016-0763-7 source

      Not checked in the free run.

    • cites [38] Kwon S, Perera S, Pahor M, Katula JA, King AC, Groessl EJ et al (2009) What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study). J Nutr Health Aging 13(6):538–544 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Self-management interventions improve physical and psychosocial health, health behaviors, and healthcare resource use in chronic illnesses and cancer.

    “randomized trials in chronic illnesses and cancer suggest that interventions that promote self-management are effective in improving physical and psychosocial health, health behaviors, and healthcare resource use (ER visits, at home nursing care, readmissions) [12, 13].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Merluzzi TV, Pustejovsky JE, Philip EJ, Sohl SJ, Berendsen M, Salsman JM (2019) Interventions to enhance self-efficacy in cancer patients: a meta-analysis of randomized controlled trials. Psycho-oncology 0(ja). https://doi.org/10.1002/pon.5148 source

      Not checked in the free run.

    • cites [13] Howell D, Harth T, Brown J, Bennett C, Boyko S (2017) Self-management education interventions for patients with cancer: a systematic review. Support Care Cancer 25(4):1323–1355. https://doi.org/10.1007/s00520-016-3500-z source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent Spanish study reported enhanced aerobic capacity and reduced postoperative complications with a 6-week in-person program.

    “A recent study from Spain reported enhanced aerobic capacity and reduced postoperative complications with a 6-week, in-person program [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Barberan-Garcia A, Ubre M, Roca J, Lacy AM, Burgos F, Risco R et al (2018) Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg 267(1):50–56. https://doi.org/10.1097/SLA.0000000000002293 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    The intervention offers an opportunity to improve postoperative outcomes by promoting functional recovery through telehealth, behavior change, and self-monitoring.

    “It offers an opportunity to improve post-operative outcomes by promoting functional recovery through telehealth, behavior change, and self-monitoring approaches.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several published trials, including prehabilitation trials, have reported benefits of perioperative physical activity on surgical outcomes.

    “The concept of perioperative physical activity is not new, and several published trials, including prehabilitation, reported benefits on surgical outcomes [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Treanor C, Kyaw T, Donnelly M (2018) An international review and meta-analysis of prehabilitation compared to usual care for cancer patients. J Cancer Surviv 12(1):64–73. https://doi.org/10.1007/s11764-017-0645-9 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Perioperative physical activity grounded in a self-management framework has the potential to reduce postoperative complications, limit functional decline, and improve well-being for patients and caregivers.

    “Thus, participation in perioperative physical activity that are based on the self-management framework has the potential to reduce postoperative complications, minimize functional decline, and improve well-being for both patients and caregivers [14].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Treanor C, Kyaw T, Donnelly M (2018) An international review and meta-analysis of prehabilitation compared to usual care for cancer patients. J Cancer Surviv 12(1):64–73. https://doi.org/10.1007/s11764-017-0645-9 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The analyses were exploratory, and the study cannot statistically determine whether the observed changes are related to the intervention.

    “The analyses were exploratory, and we are unable to statistically determine whether the changes are related to the intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The conceptually based, personalized, multimodal telehealth perioperative physical activity intervention is feasible and acceptable for older patient/caregiver dyads.

    “Our conceptually-based, personalized, multimodal, telehealth perioperative physical activity intervention for older patient/caregiver dyads is feasible and acceptable.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    A model with multiple preoperative sessions is challenging to implement in the United States because the time between initial surgical consultation and surgery is much shorter there.

    “Although promising, this model of multiple preoperative sessions is challenging to implement in the United States, where the time between initial surgical consult and day of surgery is much shorter.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In the United States, the interval between initial surgical consultation and surgery is much shorter than in the Spanish study, which makes multiple preoperative in-person sessions difficult to implement.

  • May combine two claims.

    Premisecitation

    Caregivers of cancer surgery patients experience significant distress and deterioration in their overall well-being.

    “Caregivers, including family and friends, endure significant distress as they witness their care recipient struggle with a cancer diagnosis and the decision to undergo surgery [8, 9].”
    • Also stated in: § Background · plain
      “Supporting a care recipient through surgery not only causes considerable disruptions in the caregiver’s personal life, but also leads to deteriorations to their overall well-being [10].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Frambes D, Given B, Lehto R, Sikorskii A, Wyatt G (2018) Informal caregivers of cancer patients: review of interventions, care activities, and outcomes. West J Nurs Res 40(7):1069–1097. https://doi.org/10.1177/0193945917699364 source

      Not checked in the free run.

    • cites [9] Ferrell B, Wittenberg E (2017) A review of family caregiving intervention trials in oncology. CA Cancer J Clin 67(4):318–325. https://doi.org/10.3322/caac.21396 source

      Not checked in the free run.

    • cites [10] Schwartz AJ, Riedel RF, LeBlanc TW, Desai D, Jenkins C, Mahoney E et al (2019) The experiences of older caregivers of cancer patients following hospital discharge. Support Care Cancer 27(2):609–616. https://doi.org/10.1007/s00520-018-4355-2 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Accrual and retention rates above 70% were acceptable, and participants generally reported satisfaction with the intervention.

    “Accrual and retention rates were acceptable (greater than 70%), and participants generally reported satisfaction with the intervention as indicated by quantitative data derived from the satisfaction tool.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Only about 7% of published randomized trials currently target older adults with cancer.

    “Currently, only about 7% of published randomized trials target older adults with cancer [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Bruns ER, van den Heuvel B, Buskens CJ, van Duijvendijk P, Festen S, Wassenaar EB, van der Zaag E, Bemelman WA, van Munster B (2016) The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Color Dis 18(8):O267–O277. https://doi.org/10.1111/codi.13429 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Including caregivers is increasingly important because of growing pressure to shorten postoperative length of stay.

    “Including the caregivers is increasingly important as there is increased pressure to decrease postoperative length of stay.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The small sample size was chosen to determine proof-of-concept, so the findings are preliminary and limited to feasibility and acceptability.

    “First, our small sample size was chosen with the intent to determine proof-of-concept; thus, findings are preliminary and limited to feasibility and acceptability.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Older adults may need a more personalized approach to physical activity.

    “Older adults may require a more personalized approach to physical activity [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Looijaard S, Slee-Valentijn MS, Otten RHJ, Maier AB (2018) Physical and nutritional prehabilitation in older patients with colorectal carcinoma: a systematic review. J Geriatr Phys Ther 41(4):236–244. https://doi.org/10.1519/JPT.0000000000000125 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Self-monitoring is a classic strategy for engaging patients in behavior adoption and adherence.

    “Finally, self-monitoring is a classic strategy to engage patients in behavior adoption and adherence [43].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Ormel HL, van der Schoot GGF, Sluiter WJ, Jalving M, Gietema JA, Walenkamp AME (2018) Predictors of adherence to exercise interventions during and after cancer treatment: a systematic review. Psycho-oncology 27(3):713–724. https://doi.org/10.1002/pon.4612 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    The present study is unique in combining personalized upfront assessment and a physical activity plan, involving caregivers throughout, integrating wearable devices for self-monitoring, and using telehealth for accessibility.

    “The present study builds on our experience and is unique in that it uses a combination of a personalized upfront assessment and physical activity plan, involving the caregivers throughout the entire process, integrating wearable devices for self-monitoring, and leveraging telehealth for participant accessibility to the intervention.”
    Quote in the paperSubstantial claim
29 of 29

  • The paper relies on this without support.

    In the United States, the interval between initial surgical consultation and surgery is much shorter than in the Spanish study, which makes multiple preoperative in-person sessions difficult to implement.

    “Although promising, this model of multiple preoperative sessions is challenging to implement in the United States, where the time between initial surgical consult and day of surgery is much shorter.”

  • The paper relies on this without support.

    The Vivofit 3 wristband pedometer worn on the non-dominant hand accurately measures daily steps in this population.

    “wristband pedometer (Vivofit 3; Garmin Ltd) wearing on the non-dominant hand for monitoring daily steps”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • SPPB change is described as an improvement but the numbers decrease

    Major

    The sentence says the SPPB score improved by more than 1 point, but both diagnosis groups show lower post-discharge values than baseline. The reported direction is opposite to the listed numbers.

    Reported 1 · recomputed -3

  • Lung patients' walking distance did not exceed baseline

    Major

    The stated post-discharge distance for lung patients is 420 meters, below the baseline value of 426 meters, contrary to the claim that it exceeded baseline.

  • Session 2 is described as both remote and in person

    Minor

    The intervention description says all five sessions used videoconferencing, but the procedures identify Session 2 as an in-person encounter.

  • Post-discharge session schedules disagree

    Minor

    The two methods descriptions give different days for Sessions 3 and 4: days 7 and 14 in one, but days 2 and 7 in the other.

  • Recruitment period is given as seven and eight months

    Minor

    The methods state a seven-month recruitment period, whereas the results give November 2017 through June 2018 and describe accrual over eight months.

5 of 5

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Related

Authors
Lafaro, K. J., Raz, D. J., Kim, J. Y., Hite, S., Ruel, N., Varatkar, G., Erhunmwunsee, L., Melstrom, L., Lee, B., Singh, G., Fong, Y., & Sun, V.
Affiliations
City Of Hope National Medical Center (US)
Corresponding author
Sun, Virginia
ORCID
Venue
Supportive Care in Cancer
Publisher
Springer Science and Business Media LLC
Published
2019-12-16
Volume
28
Issue
8
Pages
3867-3876
ISSN
  • 0941-4355 (ISSN-L)
  • 1433-7339
DOI
10.1007/s00520-019-05230-0
PMC
PMC8805142
OpenAlex
W2995081512
Cited by
64
References
45
Citations by year
2026: 3 · 2025: 12 · 2024: 9 · 2023: 14 · 2022: 13 · 2021: 9 · 2020: 4
FWCI
3.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Supportive Care in Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Comprehensive Cancer Center, City of Hope (Center for Cancer and Aging)
  • National Cancer Institute (P30CA033572)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Keywords
telemedicine, older adults, cancer surgery, caregivers, gastrointestinal cancer, lung cancer, physiotherapy, occupational therapy, functional recovery, postoperative outcomes, geriatric assessment, feasibility, self-monitoring, behavior change
MeSH terms
Aged, Female, Humans, Male, Neoplasms, Pilot Projects, Postoperative Period, Quality of Life, Caregivers, Telemedicine

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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