Implementing a Multimodal Prehabilitation Program to Radical Cystectomy in a Comprehensive Cancer Center: A Pilot Study to Assess Feasibility and Outcomes.

Abstract

Radical cystectomy(RC) often leads to postoperative morbidity and complications. We conducted a pilot study on the effectiveness of multimodal prehabilitation, a preoperative conditioning method shown to be effective for colorectal surgery, in bladder cancer patients soon to undergo RC. We assessed patients' adherence to the prehabilitation regimen and changes in their physical condition. Thirty-two bladder cancer patients at Memorial Sloan Kettering from February to August 2015 scheduled for RC were included in a standardized prehabilitation program. The 2-week program consisted of general physical exercises for the major muscle groups used for everyday activities, and sufficient protein intake. Patients received a program journal to document physical and nutritional achievements. Patients were physically tested using handgrip strength and bio-impedance at 2 weeks pre-surgery, day of surgery, and 6 weeks post-surgery. Additionally, a six-minute walk test (6MWT) 2 weeks before and 6 weeks after surgery were measured. Adherence to the exercises and nutritional recommendations respectively, was 62% (95% confidence interval [CI] 42-78%) for the exercise component and 81% (95% CI 62-93) for the nutritional component. The 6MWT results, showing physical capacity, significantly improved from baseline to 6-week follow-up, with an increase of 9.2% (95% CI 0.3-20.99; p=0.03). The handgrip strength, a proxy for nutritional status, improved 6.8% (95% CI 1.4-14.4; p=0.001) from baseline to admission, and maintained until 6-week follow-up (p=0.7). In a United States comprehensive cancer center, implementing a multimodal prehabilitation program is feasible in clinical practice and maintained. or even improved, physical functioning post-surgery compared to baseline.