Page 152 - Risk quantification and modification in older patients with colorectal cancer

Chapter 7
Appendix A Comprehensive multidisciplinary care program
Colonoscopy
When indicated
When indicated
Baseline assessment by a nurse practitioner (NP) Including:
Psychosocial screeninga
Geriatric screeningb
Dietary counselling and nutritional support
BMR (Harris-Benedict)c Protein intake 1.2-1.5gr/kg/day
Radiological workupd
Geriatric consultation
Consultationc Cardiologist Pulmonologist Social worker Psychologist
Multidisciplinary oncology team (MDT) Treatment advice
Treating physician and NP Shared decision making Motivational coaching AND Prehabilitation and rehabilitation counseling
Surgeon and NP Surgical intake and planning Informed consent Prehabilitation decision
aPsychosocial stress in the oncologic practice[20]. bISAR-HP and G8 screenings tools [14,15].cBasal Metabolic Rate [16]. dDutch national guidelines [21]. eWhen deemed safe. fPatients in a rehabilitation center were evaluated on location.
Prehabilitation (4-6 weeks): Supervised physical training (30-45 min. 2 sessions a week) including breathing exercises and exercises for home Training goals: endurance, balance, strength
Pre-clinical treatment options
Surgery < 3 week OR
Surgery after prehabilitation OR
Short-course neoadjuvant radiotherapy with integrated prehabilitation OR
Long-course neadjuvant chemoradiation with integrated prehabilitation ending before re-staging and surgery
Clinical pathway
Enhanced Recovery After Surgery (ERAS) AND Preferred laparoscopic surgery AND
Planned discharge to a rehabilitation center or home at day 6e
Post-discharge pathway
To home without additional support OR
Rehabilitation in a rehabilitation center or extended physical training at home AND Individualized post-surgery follow-upf
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CASEMANAGEMENT BY A NURSE PRACTITIONER (NP)
CLINICAL AND POST- DISCHARGE PATHWAYS
PRECLINICAL PATHWAYS (3-6 WEEKS) DIAGNOSTIC PATHWAY (1-1.5 WEEK)