Optimizing prehabilitation in gynecologic oncology (476)

Abstract

<b>Objectives:</b> Prehabilitation, or therapy implemented prior to surgery, has demonstrated an improved return to physical baseline in colorectal, surgical oncology, and urologic literature but has never been evaluated specifically in gynecologic oncology patients. The intervention generally involves physical therapy (PT); however, reduced stress and anxiety have been noted with the addition of cognitive- behavioral therapy (CBT). Extrapolating from improved outcomes in other surgical literature, we sought to identify the optimal therapy program in gynecologic oncology. We hypothesize that women receiving trimodal treatment with PT, CBT, and nutrition counseling will have earlier physical recovering and higher quality of life (QOL) scores compared to unimodal PT alone. <b>Methods:</b> Women aged 18-90 years undergoing surgery for known or suspected gynecologic malignancy were enrolled. All patients underwent PT assessments at baseline (preoperative), four and eight weeks postoperative. Trimodal patients also had CBT stress reduction and dietician counseling at the same schedule. QOL was assessed with the Functional Assessment of Cancer Therapy-General (FACT- G) at baseline and eight weeks postoperative. Nutritional status was assessed with the Patient-Generated Subjective Global Assessment at baseline and eight weeks. Each patient, therefore, served as her own PT and QOL control. An anonymous survey was completed at the study conclusion. <b>Results:</b> To date, 42 patients have enrolled; 15 withdrew secondary to canceled surgery or scheduling/financial constraints, whereas 17 (five unimodal, 12 trimodal) have mature data for analysis. Patients undergoing unimodal therapy had a significant improvement in PG-SGA scores 5.0 ± 3.4 to 2.0 ± 1.9 (p<0.05) compared to trimodal patients (2.8 ± 2.4 to 1.7 ± 0.9, p=0.39) though they started at poorer scores. Trimodal patients had a significant improvement in QOL scores (81.7 ± 15.5 to 92.0 ± 9.0, p < 0.05) compared to unimodal patients (82.5 ± 23.7 to 6.8 ± 17.9, p=0.43). PT assessments included a 6-Minute Walk Test (6MWT), Timed Up and Go (TUG), Hand Grip Strength (HGS), and 30-Second Sit to Stand (30CST). Overall, at least a trend toward improvement in all PT assessments was noted other than unimodal stable HGS with the greater trimodal trend and significant TUG improvement in both groups at eight weeks (p < 0.05). All patients who completed the anonymous survey reported a helpful experience, with more trimodal patients reporting benefit in surgery expectations (100% vs 71%, p=0.18), faster strength recovery (88% vs 71%, p=0.57), and stress reduction (100% vs 86%, p=0.44). <b>Conclusions:</b> Prehabilitation is feasible and positively received by gynecologic oncology patients regardless of treatment method. Trimodal is associated with reduced stress and improved QOL. Further study enrollment may delineate an optimal group though centers seeking to apply such programs may find any prehabilitation to provide a positive, meaningful patient experience.