Medical Delta Living Lab Better In Better Out starts research line for faster recovery of people with bowel cancer

A healthy lifestyle in preparation for an operation can ensure that fewer complications occur and people recover more quickly. The Medical Delta Living Lab Better In Better Out focuses on researching and developing e-health applications and technologies that improve the fitness of people with cancer. The lab also researches the cooperation between different care professionals and patients after an operation.

To this end, the Living Lab recently set up a research line called 'Working together on accessible care; applied research into the implementation of perioperative and recovery care in the living environment of people with bowel cancer'. Since September, graduates and students have started research projects within this research line.

Research projects before and after surgery

Healthcare before and after surgery is called 'perioperative healthcare'. When patients enter an operation in good shape, they stay in hospital for shorter periods and can get back to their lives more quickly.

Within Medical Delta Living Lab Better In Better Out, graduates and students in the minor Oncology started early September with applied research in the field of perioperative care, recovery care and colorectal cancer. Students from the study programs Skin Therapy, Nutrition & Dietetics and Nursing of The Hague University of Applied Sciences and Rotterdam University of Applied Sciences work together in groups on various research assignments, such as 'factors for implementation of prehabilitation program' and 'multidisciplinary recovery care in the first line'. The students' findings are a stepping stone to grant applications for large projects in cooperation with various parties, including the 'Stichting Darmkanker' and Mammarosa.

Some components of lifestyle programs have been proven effective for bowel cancer patients who are facing surgery. However, implementation is a challenge. At the Reinier de Graaf Gasthuis hospital in Delft, a study is currently being conducted into the effect of a perioperative program called BeBop (better be on top). This program is aimed at frail elderly people with bowel cancer. The program consists of a physical training program, a change of diet, stop smoking support and psychosocial support. The researchers are looking at effects such as the number of participants who die within a year, the occurrence of complications due to the surgery, the person's functioning in daily life and the quality of life.

This research will possibly be followed up in HMC Antoniushove. In order to properly investigate the effect of the program, it is important that it fits within the care process of HMC. Because little is known about how a health program like this can be successfully linked to existing care, the students of the universities of applied sciences are carrying out an implementation study by order of the Living Lab. They will map out the parties involved and examine what barriers and support factors there are for the implementation of the BeBop program in HMC Antoniushove. They also look at the acceptance of the program by the participating patients and their relatives, and at the practical feasibility. Finally, they draw up an advice. The results of these student studies serve as a prelude to future applied research that the living lab wants to carry out.

In physiotherapy practice we see promising effects on prehabilitation for surgical procedures, but reimbursement is currently holding back. It is expected that fewer physiotherapy treatments are needed overall when prehabilitation treatment is given to a group of cancer patients who fit that need. This could reduce healthcare costs. -Remondo Goedkoop, oncology physiotherapist B&B Healthcare

Research projects on home recovery care

Some people need more to be able to function well again in daily life. For this, 'restorative healthcare' is important: care provided by healthcare professionals in their own environment that meets the challenges these people face. Little is known about how successful cooperation in the area of restorative care for bowel cancer between primary care professionals (such as physiotherapist, skin therapist and dietician) and the patient can be established.

After discharge from hospital, recovery actually begins for people with bowel cancer. It is important that the right care is offered so that someone can recover well and function optimally again. Paramedic care such as physiotherapy and dietetics can make a major contribution here. While during admission to a hospital, a rehabilitation center or a nursing home, various care disciplines work together to ensure optimum recovery, this is not always well organized at home. This is why it is important to conduct research into how the first-line paramedics in the region can better cooperate on treatment goals for optimal recovery.

Lifestyle interventions are not always part of insured care, especially if they are not already part of the guidelines. When we make lifestyle interventions part of a treatment, we have to start from well-founded and proven programs that suit patients and are cost-effective. Only then could this care be reimbursed for all patients with bowel cancer. - Onno Guicherit, surgeon-oncologist HMC

The first exploratory studies are currently being conducted by students participating in the Oncology minors of The Hague University of Applied Sciences and Rotterdam University of Applied Sciences. These studies provide input for the writing of a grant proposal for ZonMw that focuses on the substantive strengthening of paramedic cooperation in recovery care on which the Medical Delta Living Lab Better In Better Out is working.

Presentation of findings

In January 2022, the students and their supervisors will present their findings, thus contributing to more knowledge on pre-surgery preparation and post-surgery recovery care for colorectal cancer patients. Would you like to attend the presentation? Please register with Lottie Kuijt - Evers L.F.M.Kuijt-Evers@hhs.nl.

Are you interested in participating in one of the above-mentioned studies or would you like to collaborate with the living lab? Please contact Assia Kraan a.kraan@hhs.nl.