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Bladder CarcinomaENHANCENCT05480735

EffectiveNess of a Multimodal preHAbilitation Program in patieNts With Bladder canCEr Undergoing Cystectomy

A study testing Prehabilitation in people with Bladder Carcinoma, run by The Netherlands Cancer Institute at 8 sites in Netherlands.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Currently, the potential value of a multimodal prehabilitation program in bladder cancer has not been extensively studied. The investigators designed the ENHANCE study to assess the effect of a structured multimodal prehabilitation program in 154 patients with bladder cancer on the number (primary endpoint) and… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Bladder Carcinoma
What is being tested?
Prehabilitation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
154 participants
Where
8 sitesNetherlands
Study dates
11 Aug 2022to Oct 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histologically confirmed, primary, bladder cancer (cTa-4N0/N+M0),
  • Planned to undergo radical cystectomy,
  • Age ≥ 18 years.

Who cannot join

  • Subjects with severe cognitive or psychiatric disorders,
  • Subjects who are operated within 3 weeks,
  • Subjects with insufficient command of the Dutch language, which precludes them from following study instructions or completing study questionnaires,
  • Subjects who have contraindications to safely perform exercise training or testing (i.e., CPET),
  • Subject who are unable or unwilling to participate in the intervention.

Trial locations and contacts

8 sites in 1 country.

Martijn Stuiver, PhD contact

+31205124136

m.stuiver@nki.nl

Emine Akdemir, MSc contact

+31683395101

e.akdemir@nki.nl

8 sites in 1 country

Netherlands8 sites, 8 recruiting
  • Noordwest Ziekenhuisgroep

    Alkmaar, Wilhelminalaan 12, 1815 JD

    Siebe Bos

    Recruiting
  • Rijnstate

    Arnhem, Wagnerlaan 55, 6815 AD

    Carl Wijburg

    Recruiting
  • Catharina Ziekenhuis

    Eindhoven, Michelangelolaan 2, 5623 EJ

    Evert Koldewijn

    Recruiting
  • UMC Groningen

    Groningen, Hanzeplein 1, 9713 GZ

    Annemarie Leliveld

    Recruiting
  • Maastricht UMC+

    Maastricht, P. Debyelaan 25, 6229 HX

    Bart Bongers

    Recruiting
  • Radboudumc

    Nijmegen, Geert Grooteplein Zuid 10, 6525 GA

    Toine van der Heijden

    Recruiting
  • Erasmus Medical Center

    Rotterdam, Doctor Molewaterplein 40, 3015 GD

    Joost Boormans

    Recruiting
  • UMC Utrecht

    Utrecht, Heidelberglaan 100, 3584 CX

    Anne M. May, Prof. dr., a.m.may@umcutrecht.nl

    Recruiting

Other trials in Netherlands

About this study

Official title: EffectiveNess of a Multimodal preHAbilitation Program in patieNts With Bladder canCEr Undergoing Cystectomy. The ENHANCE Randomized Controlled Trial

Currently, the potential value of a multimodal prehabilitation program in bladder cancer has not been extensively studied. The investigators designed the ENHANCE study to assess the effect of a structured multimodal prehabilitation program in 154 patients with bladder cancer on the number (primary endpoint) and severity of complications within 90 days, length of hospital stay, readmissions, physical fitness, muscle strength, physical functioning, nutritional status, smoking behaviour, anxiety and depression, fatigue, quality of life, physical activity, tumor tissue characteristics, and healthcare costs.

Read the detailed description

The ENHANCE study is a multicenter, randomized controlled trial. The intervention group will participate in a prehabilitation program of 4-6 weeks before surgery, and additionally during neoadjuvant chemotherapy if applicable. The prehabilitation program consist of a tailored exercise program, nutritional support and if relevant smoking cessation and/or psychological counselling. The exercise program is under supervision of an oncology specialized physiotherapist and comprises aerobic-, resistance- and breathing- and relaxation exercises. Patients will be asked to be physically active for an additional 2 times a week for at least 30 minutes. A dietician will provide nutritional support and give dietary advice to increase protein intake to enhance the anabolic effect on muscle mass. Additionally, patients will receive a supplement containing 30 g of high quality whey-protein daily preferably before sleep and after the supervised training. Patients who score high on anxiety and depression will be offered a referral to a psychological support. Intensive counselling and nicotine replacement therapy will be offered to all patients who smoke. Patients in the intervention group will be asked to keep a diary to track unsupervised activity and to track intake of the protein supplementation. The physical activity level in both groups will be obtained via questionnaire.

Being tested
Prehabilitation
Keywords
prehabilitation, bladder cancer, exercise, smoking cessation, nutritional support, surgical complications, cystectomy
Medical subject headings
Urinary Bladder Neoplasms, Motor Activity, Smoking Cessation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PrehabilitationBehavioural

    Multimodal prehabilitation program

Study groups in NCT05480735
Study groupRoleWhat they receive
Prehabilitation groupExperimentalThe intervention group will participate in a prehabilitation program of approximately 4-6 weeks before surgery, and additionally during neoadjuvant chemotherapy if applicable. The program consist of a tailored exercise program, nutritional support and if relevant smoking cessation and/or psychological counselling. The exercise program is under supervision of an oncology specialized physiotherapist and comprises aerobic-, resistance- and breathing- and relaxation exercises. A dietician will provide nutritional support and give dietary advice to increase protein intake, including a supplement containing 30 g of whey-protein daily and after supervised training. Patients who score high on anxiety and depression will be offered a referral to a psychologist. Intensive counselling and nicotine replacement therapy will be offered to all patients who smoke. Patients will be asked to keep a diary to track unsupervised activity and to track intake of the protein supplementation.
Receives: Behavioral: Prehabilitation
Control groupNo interventionPatients randomized to the control group will receive care as usual according to local ERAS guideline implementation. In addition, they will receive a leaflet with the recent guidelines regarding physical activity, dietary advice, and smoking cessation. Their actual physical activity level will be obtained via questionnaire.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Complications

    The proportion of patients having Clavien-Dindo grade 2 or higher perioperative complications; obtained from the medical records

    Measured: 0-12 weeks post-surgery (measured 4 weeks and 12 weeks post-surgery)

Secondary outcomes (27)
  1. High grade complications

    Clavien Dindo grade 3 or higher

    Measured: 0-12 weeks post-surgery

  2. Duration of hospital stay

    Time from admission until hospital discharge

    Measured: 0-12 weeks post-surgery

  3. Readmissions

    Hospital readmission as recorded in medical file

    Measured: 0-12 weeks post-surgery

  4. Disease status

    Progression/recurrence, any additional treatment as recorded in medical file

    Measured: 0-12 weeks post-surgery

  5. Change in cardiorespiratory fitness

    Assessed via cardiopulmonary exercise test (CPET)

    Measured: T0a (baseline), T1 (within 1 week before surgery)

  6. Change in muscle strength

    Grip strength

    Measured: T0a (baseline), T1 (within 1 week before surgery), T3 (12 weeks post-surgery)

  7. Change in muscle strength

    30s chair stands

    Measured: T0a (baseline), T1 (within 1 week before surgery), T3 (12 weeks post-surgery)

  8. Change in physical performance

    Short Physical Performance Battery (SPPB)

    Measured: T0a (baseline), T1 (within 1 week before surgery), T3 (12 weeks post-surgery)

  9. Change in nutritional status

    Short Form- Patient Generated Subjective Global Assessment (SF-PGSA)

    Measured: T0a (baseline), T1 (within 1 week before surgery), T3 (12 weeks post-surgery)

  10. Change in body composition

    Fat free mass and fat mass assessed by Scale Bioelectrical Impedance Analysis (BIA)

    Measured: T0a (baseline), T1 (within 1 week before surgery), T3 (12 weeks post-surgery)

  11. Nil per mouth consumption during hospitalization

    The total days as recorded in medical file

    Measured: 0-12 weeks post-surgery

  12. Change in weight

    Measured in KG

    Measured: T0a (baseline), T1 (within 1 week before surgery), T3 (12 weeks post-surgery)

  13. Height

    Measured in cm

    Measured: T0a (baseline) - T3 (12 weeks post-surgery)

  14. Change in smoking status

    Self-developed questionnaire

    Measured: T0a (baseline), T0b (if applicable: after neoadjuvant chemotherapy), T1 (within 1 week before surgery), T2 (4 weeks post-surgery), T3 (12 weeks post-surgery)

  15. Sense of coherence (SOC)

    13-item SOC questionnaire

    Measured: T0a (baseline)

  16. Change in fatigue

    MFI questionnaire

    Measured: T0a (baseline), T0b (if applicable: after neoadjuvant chemotherapy), T1 (within 1 week before surgery), T2 (4 weeks post-surgery), T3 (12 weeks post-surgery)

  17. Change in HRQoL

    EORTC QLQ-C30

    Measured: T0a (baseline), T0b (if applicable: after neoadjuvant chemotherapy), T1 (within 1 week before surgery), T2 (4 weeks post-surgery), T3 (12 weeks post-surgery)

  18. Change in muscle invasive bladder cancer specific scores

    EORTC QLQ-BLM30

    Measured: T0a (baseline), T0b (if applicable: after neoadjuvant chemotherapy), T1 (within 1 week before surgery), T2 (4 weeks post-surgery), T3 (12 weeks post-surgery)

  19. Change in health status

    EQ-5D-5L

    Measured: T0a (baseline), T0b (if applicable: after neoadjuvant chemotherapy), T1 (within 1 week before surgery), T2 (4 weeks post-surgery), T3 (12 weeks post-surgery)

  20. Change in physical activity

    SQUASH questionnaire

    Measured: T0a (baseline), T0b (if applicable: after neoadjuvant chemotherapy), T1 (within 1 week before surgery), T2 (4 weeks post-surgery), T3 (12 weeks post-surgery)

  21. Change in anxiety and depression

    HADS questionnaire

    Measured: T0a (baseline), T0b (if applicable: after neoadjuvant chemotherapy), T1 (within 1 week before surgery), T2 (4 weeks post-surgery), T3 (12 weeks post-surgery)

  22. Intervention costs

    Cost analysis

    Measured: T0a (baseline) - T3 (12 weeks post-surgery)

  23. Healthcare resources consumption

    Medical Consumption Questionnaire (iMCQ)

    Measured: T0a (baseline) - T3 (12 weeks post-surgery) (measured within 1 week before surgery, 4 and 12 weeks post-surgery and if applicable : after neoadjuvant chemotherapy)

  24. Work status

    Productivity Cost Questionnaire (iPCQ)

    Measured: T0a (baseline) - T3 (12 weeks post-surgery)

  25. Satisfaction with prehabilitation in intervention group and evaluation in control group

    Self-developed questionnaire

    Measured: T3 (12 weeks post-surgery)

  26. Non participation analysis

    Identify clinical and sociodemographic variables that are related to non-participation of patients in this trial via questionnaire

    Measured: T0a (baseline)

  27. Hypoxia

    To study the effectiveness of the prehabilitation program in terms of inducing favorable changes in tumor hypoxia markers

    Measured: T3 (12 weeks post-surgery)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jul 2022
  2. Study start11 Aug 2022
  3. Primary completionDec 2024 (estimated)
  4. Study completionOct 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized Controlled Trial
Masking
None (open label)
Enrolment
154 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05480735
Sponsor's protocol ID
NL78792.031.22
Acronym
ENHANCE
Status last verified
Oct 2022
First submitted
14 Jul 2022
Last updated
31 Oct 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Patients are asked informed consent for data sharing with POLARIS consortium

Publications

  • Akdemir E, Sweegers MG, Vrieling A, Rundqvist H, Meijer RP, Leliveld-Kors AM, van der Heijden AG, Rutten VC, Koldewijn EL, Bos SD, Wijburg CJ, Marcelissen TAT, Bongers BC, Retel VP, van Harten WH, May AM, Groen WG, Stuiver MM. EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial. BMJ Open. 2023 Mar 7;13(3):e071304. doi: 10.1136/bmjopen-2022-071304.

    PubMed 36882246

Questions about this trial

What is this clinical trial studying?

A study testing Prehabilitation in people with Bladder Carcinoma, run by The Netherlands Cancer Institute at 8 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 31 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Martijn Stuiver, PhD (+31205124136, m.stuiver@nki.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Complications (time frame: 0-12 weeks post-surgery (measured 4 weeks and 12 weeks post-surgery)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05480735, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Oct 2022.

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