Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Prehabilitation before gastrointestinal cancer surgery (PREHAB-GI): an implementation study. (#51)

Kristy-Lee Raso 1 2 , Michael Suen 2 3 , Sonia Khatri 3 , Yanlan Lin 3 , Carolyn Wildbore 3 , Jane Turner 3 , Caoimhe Scales 3 , Shannon Gerber 3 , Carol Chan 2 , Gemma Collett 2 , Puneet Ranote 4 , Guillermo Becerril-Martinez 2 3 , Phil Le Page 3 , Sim Yee (Cindy) Tan 2 3 , Janette Vardy 2 3
  1. Nutrition and Dietetics, Concord Hospital, Concord, NSW, Australia
  2. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  3. Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
  4. Anaesthetics Department, Concord Hospital, Concord, NSW, Australia

Background: Surgery is the standard treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. We aimed to evaluate the implementation of a multimodal prehabilitation program in gastrointestinal cancer surgery patients.

Methods: Single-arm implementation trial using a pre-post study design. Colorectal or UGI cancer patients scheduled for curative intent surgery at Concord Hospital, with ≥14 days pre-surgery were recruited. Intervention delivered face-to-face or by telehealth (COVID adaptations): 2-4-week program consisting of: i) supervised exercise (minimum 1/week); ii) dietary education session and daily high protein supplement; iii) weekly nursing support. Assessments: baseline, pre-surgery, and 30-days post-surgery. Primary outcome: implementation using RE-AIM (Reach/Efficacy/Adoption/Implementation/Maintenance) framework. Secondary outcomes included functional capacity, nutritional and psychological status changes.

Results: 198 were screened over 16 months; 100 (51%) were eligible.

Reach/representativeness: 77/100 recruited (64 colorectal, 13 UGI). Mean (SD) age 67 (12.4) years; 46 (60%) males. Median intervention duration 16 days (IQR:8).

Adoption: 91% (70/77) referrals directly from surgeons.

Implementation: 72/77 completed the intervention (34% of assessments and intervention sessions delivered by telehealth). 5 withdrew: psychological stress (n=2), medical (n=1), disease progression (n=1), noncompliance COVID precautions (n=1). Adherence to all modalities was 34% (64% exercise, 81% nutrition, 63% nursing). Adherence rate for 31/35 patients was affected by staff unavailability.

Efficacy: Functional capacity (mean 6-minute walk test) change from baseline to pre-surgery 464.4m to 471.7m (p=0.775); and baseline to after surgery 464.4m to 482m (p=0.052). No significant changes were seen in nutritional and psychological outcomes.

Patient satisfaction: 96% strongly recommended prehabilitation. Clinician satisfaction was high.

Conclusions: Our results show a brief prehabilitation intervention (exercise, nutrition, psychological support) can be successfully implemented in a real-world setting; with a trend to improvement in functional capacity. Prehabilitation is an opportunity to optimise patients’ function before gastrointestinal cancer surgery.