Colorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the only curative option. However, postoperative complications occur in up to 50% of patients and are associated with higher morbidity and mortality rates, lower health related quality of life (HRQoL) and increased expenditure in health care. The number and severity of complications are closely related to preoperative functional capacity, nutritional state, psychological state, and smoking behavior. Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes. However, recent evidence shows that the preoperative period might be the optimal moment for intervention. This study will determine the impact of multimodal prehabilitation on patients’ functional capacity and postoperative complications. This international multicenter, prospective, randomized controlled trial will include 714 patients undergoing colorectal surgery for cancer. Patients will be allocated to the intervention group, which will receive 4 weeks of prehabilitation (group 1, prehab), or the control group, which will receive no prehabilitation (group 2, no prehab). Both groups will receive perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines. The primary outcomes for measurement will be functional capacity (as assessed using the six-minute walk test (6MWT)) and postoperative status determined with the Comprehensive Complication Index (CCI). Secondary outcomes will include HRQoL, length of hospital stay (LOS) and a cost-effectiveness analysis. Multimodal prehabilitation is expected to enhance patients’ functional capacity and to reduce postoperative complications. It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer. Trial Registry: NTR5947 – date of registration: 1 August 2016.

DURING THE 1990s, the newer more receptor-selective antidepressive agents were used increasingly, partly because of their relatively few adverse effects and low toxicity. Several clinical reports have indicated an association between use of all types of the selective serotonin reuptake inhibitors (SSRIs) and bleeding disorders, ranging from prolonged bleeding time, ecchymoses, purpura, and epistaxis^1-10 to more serious conditions, such as gastrointestinal (GI) tract, genitourinary tract, and intracranial bleeding.^1,11 Release of serotonin by platelets plays an important role in hemostasis, and serotonin is taken up from the blood stream by serotonin transporters, similar to those transporting serotonin in the brain.¹² Because platelets are not capable of synthesizing serotonin, depletion of serotonin stores could induce hemorrhagic complications. The older antidepressants, the tricyclic and tetracyclic agents, have differing degrees of selectivity on the serotonin receptor relative to the other monoamine receptors,¹³ and some of them may also interfere with hemostatic function.

Hydroxymethylglutaryl‐CoA reductase inhibitors (statins) have been linked with potential chemopreventive effects; however, the data are conflicting. We conducted a population‐based cohort study using data from the Prescription Database of North Jutland County and the Danish Cancer Registry for the period 1989–2002. In a study population of 334,754 county residents, we compared overall and site‐specific cancer incidence among 12,251 statin users (≥2 prescriptions) with cancer incidence among nonusers and users of other lipid‐lowering drugs (n = 1,257). Statistical analyses were based on age‐standardization and Poisson regression analysis, adjusting for age, gender, calendar period and use of NSAIDs, hormone replacement therapy and cardiovascular drugs. We identified 398 cancer cases among statin users during a mean follow‐up period of 3.3 years (range 0–14 years). The age‐ and gender‐standardized incidence rates of cancer overall were 596 per 100,000 person‐years among statin users, 645 per 100,000 person‐years among nonusers and 795 per 100,000 person‐years among users of other lipid‐lowering drugs. Adjusted rate ratios for cancer overall among statin users were 0.86 (95% CI, 0.78–0.95) compared to nonusers and 0.73 (95% CI, 0.55–0.98) compared to users of other lipid‐lowering drugs. No significantly increased or decreased rate ratios were observed for any of the studied site‐specific cancers (liver, colorectum, lung, breast, prostate, female genital organs and lymphatic and haematopoietic tissue), but most estimates tended to be less than 1.0. Stratification by duration of follow‐up or number of prescriptions revealed no clear trends. In summary, individuals prescribed statins experienced a slightly reduced cancer incidence compared to population controls of nonusers and users of other lipid‐lowering drugs. Larger and longer‐term studies are needed to determine the potentially protective effect of statin use on cancer development.

The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly.