Prehabilitation In Patients Research Articles

Short-term prehabilitation of patients with colorectal cancer — protocol of a randomized trial

AIM: to estimate effect of unimodal short preabilitation on functional reserves of patients, hospital stay, complication rate and quality of life.PATIENTS AND METHODS: a single-centre, prospective, randomized study will include 128 patients undergoing colon resection for colorectal cancer. Patients will be divided into an intervention group that will receive 14 days of unimodal prehab (Group 1) and a control group that will not receive prehab (Group 2). Perioperative management of patients in both groups will be carried out in accordance with the guidelines for accelerated recovery after surgery (ERAS). The primary endpoint of the study will be the six-minute walk test (6MWT). Secondary endpoints will be: number of postoperative complications (by Clavien-Dindo), duration of the postoperative period, postoperative mortality, quality of life of patients and adherence of patients to the passage of the prehabilitation program.DISCUSSION AND CONCLUSION: it is expected that short-term unimodal prehabilitation will improve the functional reserves of patients, reduce the duration of inpatient treatment and reduce the number and severity of postoperative complications, which can lead to a decrease in postoperative mortality and an improvement in the quality of life of patients. The adherence of the domestic cohort of patients to prehabilitation will be analyzed.

A health economic model to assess the impact of prehabilitation on hospital cost savings in gastrointestinal cancer, modelled on English National Health Service tariff.

6648 Background: Prehabilitation is increasingly being recognised as a high-priority intervention to improve physical and psychological health in cancer patients, prevent treatment-related functional decline and to reduce the incidence and severity of post-surgical complications. The aim of this study is to develop a health economic (HE) model to evaluate the impact of prehabilitation in patients undergoing gastrointestinal cancer surgery. Methods: The objective of the HE model is to estimate the impact of prehabilitation on reducing treatment costs. Data was extracted from systematic reviews and meta-analysis on the effects of prehabilitation in gastrointestinal cancer surgery to identify: i) treatment pathway, ii) prehabilitation components (nutrition/exercise/psychological intervention), and iii) effects on three study outcomes (length of hospital stay, reduction of post-operative complications, and reduced Intensive Care Unit (ICU) stay). The modelling study accounts for the number of hospital admissions and unit costs from NHS hospitals, including cost per bed-day from NHS Reference costs 2017-18 and complication costs and ICU cost from NHS Reference National Cost Schedule 2019-20. Double counting has been corrected to account for the compounded effects on length of stay and complications. The HE model considers the average effect of each study outcome and their confidence intervals. This provides a range of potential impact of prehabilitation in terms of cost reduction based on NHS tariff. Results: Patient weighted average cost savings from prehabilitation was £785, excluding ICU costs. Breakdown of cost savings include £178.6 from reduced length of hospital stay, £214.8 and £434.5 cost savings originating from reductions in minor and major complications, respectively (excluding ICU complication costs). ICU cost savings from prehabilitation were £1,620. For the NHS, based on 237,000 annual surgical procedures, this amounts up to £186,082,321 in cost savings, from a reduction in complications and 421,840 hospital days, and £52,761,227 from ICU stay. Conclusions: In addition to the impact on post-operative complications and hospital stay, this study has demonstrated that prehabilitation results in significant costs savings to healthcare systems. The cost savings are largely from a reduction in the incidence and severity of post-operative complications. The latter contributing to reduced ICU costs.

Correction to: O082 A pilot study on prehabilitation for patients undergoing surgery for cancer.

Correction to: O082 A pilot study on prehabilitation for patients undergoing surgery for cancer.

Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer.

Despite surgical advances, postoperative complications persist, affecting oncologic outcomes and increasing treatment costs. It is important to identify a marker that can predict postoperative complications, which can help prehabilitate patients before surgery. This study evaluated sarcopenia as a predictive marker of postoperative complications in patients undergoing surgery for gastrointestinal (GI) or hepato-pancreatico-biliary (HPB) cancer. Sarcopenia was assessed using the skeletal muscle index at the third lumbar vertebra on abdominal computed tomography. The predictive ability of sarcopenia was evaluated by adjusting for other clinicopathological factors. Of the 210 patients, 81 (38.57%) were sarcopenic. The overall morbidity and mortality were 33.81% and 2.86%, respectively. Major complications (Clavien-Dindo Grade ≥ III) were observed in 10.95% patients and sarcopenic patients were significantly more likely to develop major complications (p = 1.42 × 10-10 ). Sarcopenia (p = 6.13 × 10-6 ; odds ratio = 12.29) independently predicted postoperative complications and prolonged hospital stay (p = 0.01). Sarcopenia objectively predicted the development of postoperative complications and prolonged hospital stay in patients undergoing surgery for GI or HPB cancer. This may facilitate the prehabilitation of patients planned for surgery to reduce the risk of complications.

Exercise prehabilitation for patients with end-stage liver disease: a best practice implementation project.

This study aimed to promote exercise prehabilitation in patients with end-stage liver disease during their waiting period for liver transplantation. End-stage liver disease indirectly contributes to the development of sarcopenia and affects survival after liver transplantation because of low physiological reserves and insufficient aerobic capacity while awaiting transplantation. Exercise prehabilitation could reduce postoperative complications and promote postoperative recovery. Following the JBI Practical Application of Clinical Evidence System, this study used six audit criteria derived from the JBI Evidence Summary. A baseline audit of six patients and nine nurses was conducted, analyzed barriers, established a prehabilitation process and improved interventions, followed by the implementation of exercise prehabilitation and follow-up audit. In the baseline audit, the results of the six criteria [(1) multimodal prehabilitation that includes exercise and other interventions where appropriate is offered to patients scheduled for abdominal surgery; (2) prior to the commencement of an exercise program an assessment of exercise contraindications, health status, treatments, physical activity level, functional capacity and quality of life is completed; (3) exercise programs are designed by appropriately qualified personnel; (4) exercise is delivered and supervised by appropriately qualified personnel; (5) exercise prescription is tailored to each individual patient; and (6) patient response to exercise is monitored throughout prehabilitation] were 0-22%. After implementing the best-practice strategies, all six criteria were set to 100%. Patients were aware of and had high compliance with exercise prehabilitation, nurses' and patients' knowledge of exercise rehabilitation improved, and nurses' implementation rate was significantly higher than before implementation ( P < 0.05). The differences in the 6 min walking distance and Borg Fatigue Score between the preimplementation and postimplementation were statistically significant (all P < 0.05). This best-practice implementation project is feasible. These results indicate that exercise prehabilitation could improve the preoperative walking capacity and fatigue of patients with end-stage liver disease. Ongoing best practices will be expected to develop in the future.

O082 A pilot study on prehabilitation for patients undergoing surgery for cancer

Abstract Introduction In 2022 Nottingham University Hospital NHS Trust (NUH) began offering structured prehabilitation sessions for patients diagnosed with cancer, to help them better prepare for surgical treatment. We have undertaken an audit of patients enrolled onto the programme and examined key outcomes. Methods Patients requiring surgery for cancer were initially assessed (April – Oct 2022) and offered 2-3 prehabilitation sessions per week. During initial and final Prehabilitation assessments, patients completed a sit-stand test, shuttle walk test and Patient Reported Outcome Measures for anxiety (GAD-7) and depression (PHQ-9). Results Two hundred and twelve patients were enrolled onto the prehabilitation programme and 87 (41%) completed the pre- and post-assessment after 3-6 weeks. Colorectal (47, 54%) and gynaecological (17, 22%) surgery represented the two major procedures for those completing the programme. Mean (±sem) physical activity score (140.1±19.4, n=78) was significantly increased (p&amp;lt;0.001) at the end of the programme (315.3±23.8). Mean shuttle walk test score (340.2±28.7, n=54) increased by approximately 15% (p&amp;lt;0.001) at the end of the programme (394±32.8), while the sit-stand test (24.9±1.3, n=64) also improved significantly (30.9±1.5; p&amp;lt;0.001). The mean (±sem) anxiety GAD-7 score (6.06±0.64 n=85) and depression PHQ-9 score (5.38±0.69, n=85) were significantly reduced (p&amp;lt;0.001) by the programme (3.29±0.46 and 2.76±0.45, respectively). Conclusion Initial results from the NUH prehabilitation programme provide evidence for a significant increase in physical activity prior to surgery, accompanied by a general improvement in the mental well-being of the patients.

Prehabilitation for patients with colorectal cancer: a snapshot of current daily practice in Dutch hospitals

BackgroundMultimodal prehabilitation programmes are increasingly being imbedded in colorectal cancer (CRC) pathways to enhance the patient’s recovery after surgery. However, there is no (inter)national consensus on the content or design of such a programme. This study aimed to evaluate the current practice and opinion regarding preoperative screening and prehabilitation for patients undergoing surgery for CRC throughout the Netherlands.MethodsAll regular Dutch hospitals offering colorectal cancer surgery were included. An online survey was sent to one representative colorectal surgeon per hospital. Descriptive statistics were used for analyses.ResultsResponse rate was 100% (n = 69). Routine preoperative screening of patients with CRC for frailty, diminished nutritional status and anaemia was the standard of care in nearly all Dutch hospitals (97%, 93% and 94%, respectively). Some form of prehabilitation was provided in 46 hospitals (67%) of which more than 80% addressed nutritional status, frailty, physical status and anaemia. All but two of the remaining hospitals were willing to adopt prehabilitation. The majority of the hospitals offered prehabilitation to specific subgroups of patients with CRC, such as the elderly (41%), the frail (71%) or high-risk patients (57%). There was high variability in the setting, design and content of the prehabilitation programmes.ConclusionsWhereas preoperative screening is sufficiently incorporated in Dutch hospitals, standardised enhancement of the patient’s condition in the context of multimodal prehabilitation seems to be challenging. This study presents an overview of current clinical practice in the Netherlands. Uniform clinical prehabilitation guidelines are vital to diminish heterogeneity in programmes and to produce useful data to enable a nationwide implementation of an evidence-based prehabilitation programme.

Prehabilitation for Patients Undergoing Orthopedic Surgery

Prehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results. To evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery. Bibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022. Randomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included. Two independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Pain, function, muscle strength, and health-related quality of life (HRQOL). Forty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], -0.70 [95% CI, -1.08 to -0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, -8.20 [95% CI, -8.85 to -7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, -0.51 [95% CI, -0.85 to -0.17]) and at 6 months in those undergoing lumbar surgery (SMD, -2.35 [95% CI, -3.92 to -0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence. In this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.

Letter: Frailty-Based Prehabilitation for Patients Undergoing Intracranial Meningioma Resection.

To the Editor: Intracranial meningioma resection (IMR) carries significant morbidity and mortality despite being a benign tumor and less aggressive than malignant brain tumors.1,2 In recent years, moving beyond chronological age, baseline frailty status has been identified as a more robust predictor of postoperative outcomes of IMR.3-8 Frail patients undergoing IMR have been reported to have increased incidence of postoperative complications, increased length of hospital stay, and nonhome discharge destination.3-8 Cole et al3 reported that frail patients undergoing resection of intracranial meningiomas were approximately 11 times more likely to develop postoperative adverse events. Frailty affects how the body responds to the alteration of homeostasis during surgery,9 and frailty-based prehabilitation of patients at risk can lead to improved outcomes. Although this association has been extensively demonstrated using various frailty indices and preoperative risk stratification tools in spine surgery patients,10,11 frailty-based prehabilitation remains yet to be implemented for brain tumor resection patients in general and for IMR in particular. This remains relevant for IMR as most of these patients (apart from high-grade meningiomas with obstructive symptoms) do not require emergent/urgent surgery and can undergo frailty-based prehabilitation for improved outcomes (Figure).FIGURE.: A graphical representation of frailty-directed prehabilitation measures to improve postoperative outcomes.Several studies have reported on worse postoperative outcomes predicted by poor preoperative frailty status assessed by using different indices (Table), including the Risk Analysis Index (RAI) and the Modified Frailty Index (MFI).12,13 RAI is a robust frailty score based on 11 variables that captures the true phenotypic manifestation of frailty—sex, age, cancer diagnosis (excluding melanoma), unintentional weight loss, renal failure, congestive heart failure, poor appetite, shortness of breath at rest, residence defined as not independent living, cognitive deterioration, and activities of daily living (ADL) defined as functional status. Each component of RAI has significance in frailty assessment and serves as a guide to prehabilitation. For instance, interventions such as smoking cessation and inspiratory muscle training target shortness of breath and have been shown to reduce the overall LOS after elective surgical procedures.14 Exercise and physical therapy helps reduce functional dependence before surgery.15 Other frailty-specific interventions that have proven efficacy in enhancing postoperative outcomes include nutritional rehabilitation to target poor appetite and cognitive behavioral therapy in patients with excessive fear or cognitive deterioration.11 The 5-factor MFI assigns 1 point each based on the presence of diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status.13 It is largely made up on comorbid conditions that may not capture true frailty, thus compromising its effectiveness in determining prehabilitative measures. RAI has proven to be a better predictor of outcomes after surgery and could be a more useful tool during prehabilitation measures.16 TABLE. - Predictive Ability of Preoperative Frailty Score on Postoperative Outcomes of IMR Author Year FI Outcomes OR (95% CI) Thommen et al 6 2022 RAI Major complications 2.94 (1.39-6.20) Clavien IV complications 3.99 (1.68-9.46) LOS 15.73 (7.45-33.24) Nonhome discharge destination 13.61 (6.40-28.94) Cole et al 3 2022 mFI-5 Mortality 11.17 (3.45-36.19) Major complications 4.15 (2.46-6.99) Unplanned readmission 4.37 (2.68-7.12) Unplanned reoperation 2.31 (1.17-4.55) Extended LOS 4.28 (2.74-6.68) Nonhome discharge 9.34 (6.03-14.47) Dicpinigaitis et al 4 2021 mFI-11 LOS (1.20, 1.10-1.32) Life-threatening complications/mortality (1.40, 1.17- 1.68) Theriault et al 5 2020 mFI-11 Nonhome discharge 0.131 (0.022-0.773) Readmission 0.131 (0.022-0.773) Taricotti et al 7 2022 FI Early (14.752, 1.463-148.777) and late (35.457, 25.210-41.318) postoperative functional deterioration Ikawa et al 8 2022 mFI-5 Worsening Barthel Index score 1.4 (1.1-1.7) In-hospital mortality 5.0 (2.2-11.1) Complications 1.7 (1.4-2.0) FI, Frailty Index; IMR, intracranial meningioma resection; LOS, length of stay; OR, odds ratio; RAI, Risk Analysis Index. A recent study by our group has shown RAI's robust predictive ability for brain tumor resection outcomes including IMR,6 thus raising the possibility of using RAI-based prehabilitaion for IMR patients. Emphasizing on preoperative rehabilitation measures for IMR could improve a patient's physiological reserve and reduce postoperative adverse events.7 Unlike malignant tumors, intracranial meningiomas are associated with lower rates of mortality and recurrence.17 We believe that the less urgent need to proceed with surgical resection in patients harboring these tumors could allow for preoperative optimization of a patient's physiological reserve. This would guide clinical decision-making by allowing for a tailored approach to improving a patient's ability to cope with surgery.

Study protocol for a pilot trial analysing the usability, validity and safety of an interventional health app programme for the structured prehabilitation of patients before major surgical interventions: the PROTEGO MAXIMA trial

IntroductionMajor surgery is associated with a high risk for postoperative complications, leading to an increase in mortality and morbidity, particularly in frail patients with a reduced cardiopulmonary reserve. Prehabilitation, including...

Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies-A Systematic Review.

The advantages of prehabilitation in surgical oncology are unclear. This systematic review aims to (1) evaluate the latest evidence of preoperative prehabilitation interventions on postoperative outcomes after gastrointestinal (GI) cancer surgery and (2) discuss new potential therapeutic targets as part of prehabilitation. Randomized controlled trials published between January 2017 and August 2022 were identified through Medline. The population of interest was oncological patients undergoing GI surgery. Trials were considered if they evaluated prehabilitation interventions (nutrition, physical activity, probiotics and symbiotics, fecal microbiota transplantation, and ghrelin receptor agonists), alone or combined, on postoperative outcomes. Out of 1180 records initially identified, 15 studies were retained. Evidence for the benefits of unimodal interventions was limited. Preoperative multimodal programs, including nutrition and physical activity with or without psychological support, showed improvement in postoperative physical performance, muscle strength, and quality of life in patients with esophagogastric and colorectal cancers. However, there was no benefit for postoperative complications, hospital length of stay, hospital readmissions, and mortality. No trial evaluated the impact of fecal microbiota transplantation or oral ghrelin receptor agonists. Further studies are needed to confirm our findings, identify patients who are more likely to benefit from surgical prehabilitation, and harmonize interventions.

Multimodal Prehabilitation in Patients Undergoing Complex Colorectal Surgery, Liver Resection, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Pilot Study on Feasibility and Potential Efficacy.

Surgery for complex primary and metastatic colorectal cancer (CRC), such as liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), in academic settings has led to improved survival but is associated with complications up to 75%. Prehabilitation has been shown to prevent complications in non-academic hospitals. This pilot study aimed to determine the feasibility and potential efficacy of a multimodal prehabilitation program in patients undergoing surgery in an academic hospital for complex primary and metastatic CRC. All patients awaiting complex colorectal surgery, liver resection, or HIPEC from July 2019 until January 2020 were considered potentially eligible. Feasibility was measured by accrual rate, completion rate, adherence to the program, satisfaction, and safety. To determine potential efficacy, postoperative outcomes were compared with a historical control group. Sixteen out of twenty-five eligible patients (64%) commenced prehabilitation, and fourteen patients fully completed the intervention (88%). The adherence rate was 69%, as 11 patients completed >80% of prescribed supervised trainings. No adverse events occurred, and all patients expressed satisfaction with the program. The complication rate was significantly lower in the prehabilitation group (37.5%) than the control group (70.2%, p = 0.020). There was no difference in the type of complications. This pilot study illustrates that multimodal prehabilitation is feasible in the majority of patients undergoing complex colorectal cancer, liver resection, and HIPEC in an academic setting.

GI factors, potential to predict prostate motion during radiotherapy; a scoping review

PurposeA scoping literature review was conducted to identify gastrointestinal (GI) factors most likely to influence prostate motion during radiotherapy. We proffer that patient specific measurement of these GI factors could predict motion uncertainty during radiotherapy, facilitating personalised care by optimising treatment technique e.g., daily adaption or via bespoke patient pre-habilitation and preparation. MethodsThe scoping review was undertaken as per JBI guidelines. Searches were conducted across four databases: Ovid Medline®, EMBASE, CINAHL and EBSCO discovery. Articles written in English from 2010-present were included. Those pertaining to paediatrics, biological women exclusively, infectious and post-treatment GI morbidity and diet were excluded.Common GI factors impacting men were identified and related symptoms, incidence and measurement tools examined. Prevalence among persons with prostate cancer was explored and suitable assessment tools discussed. ResultsA preliminary search identified four prominent GI-factors: mental health, co-morbidity and medication, physical activity, and pelvic floor disorder. The scoping search found 3644 articles; 1646 were removed as duplicates. A further 1249 were excluded after title and abstract screening, 162 remained subsequent to full text review: 42 mental health, 53 co-morbidity and medication, 39 physical activity and 28 pelvic floor disorder.Six GI factors prevalent in the prostate cancer population and estimated most likely to influence prostate motion were identified: depression, anxiety, diabetes, obesity, low physical activity, and pelvic floor disorder. Reliable, quick, and easy to use tools are available to quantify these factors. ConclusionA comprehensive GI factor assessment package suitable to implement into the radiotherapy clinic has been created. Unveiling these GI factors upfront will guide improved personalisation of radiotherapy.

Oxygen Uptake and Heart Rate On-Kinetics during Prehabilitation in Patients with Scheduled Non-Small Cell Lung Cancer Resection

Background: Oxygen uptake (V̇O₂) and heart rate (HR) kinetics during a constant work-rate test (CWRT) are used to evaluate the response to exercise in healthy subjects as well as subjects with various pathologies. Objectives: This study aimed to explore the feasibility of these measures and their responsiveness to a prehabilitation program in patients with non-small cell lung cancer (NSCLC). Method: This study is preregistered (NCT04041297) ancillary analysis of a subgroup of individuals with NSCLC included in the Preo-Dens study (NCT03936764). Thirty individuals performed a moderate-CWRT before and after a 15-session prehabilitation program between July 2019 and April 2021. V̇O₂ and HR on-kinetics were extracted from the first 240 s of breath-by-breath data using Box-Jenkins transfer functions. Results: Pre/post V̇O₂ on-kinetic feature values were reliable for 25/30 participants, and pre/post HR kinetic feature values were reliable for 19/30. V̇O₂ time constant (τ) and mean response time reduced from pre-post prehabilitation (mean difference −7.8 s; 95% CI: −14.6 to −1.0, and −8.4 s; 95% CI: −14.7 to −2.0, respectively). For HR on-kinetics, τ did not change from pre-post prehabilitation (median difference −4.0 s; 95% CI: −36.0 to +11.0). V̇O₂ and HR response amplitudes reduced significatively from pre-post prehabilitation (mean difference −38.6 mL/min; 95% CI: −73.3 to −3.9, and −3.1 beats/min; 95% CI: −6.4 to −0.2, respectively). Conclusion: V̇O₂ on-kinetic analysis during moderate-CWRT is feasible in individuals with scheduled NSCLC resection, and results are responsive to prehabilitation. These results support a true speeding of the adaptation of aerobic metabolism after a 15-session prehabilitation program.

Steep ramp test protocol for preoperative risk assessment and short-term high-intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology.

Steep ramp test protocol for preoperative risk assessment and short-term high-intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology.

Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) – a study protocol

IntroductionPrehabilitation prior to surgery has been shown to reduce postoperative complications, reduce length of hospital stay and improve quality of life after cancer and limb reconstruction surgery. However, there are...

Effect of prehabilitation on patients with frailty undergoing colorectal cancer surgery: a systematic review and meta-analysis.

The effect of prehabilitation in patients with frailty undergoing colorectal cancer surgery remains controversial. This meta-analysis aimed to assess the impact of prehabilitation before colorectal surgery on the functional outcomes and postoperative complications in patients with frailty undergoing colorectal cancer surgery. PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for articles published up to November 9, 2022. We included randomized and non-randomized trials in which the effects of prehabilitation in patients with frailty undergoing colorectal cancer surgery were investigated against a control group. Data extracted for our meta-analysis included the 6-minute walk test (6MWT), postoperative incidence of complications (Clavien-Dindo classification ≥IIIa), comprehensive complication index (CCI), and length of stay (LOS) in the hospital. Compared with the control group, we found a significant improvement in the incidence of postoperative complications and shorter LOS in the hospital in the prehabilitation group. However, the 6MWT and CCI results showed no significant differences between the 2 groups. Prehabilitation in patients with frailty who underwent colorectal cancer surgery improved the incidence of postoperative complications and LOS in the hospital. Hence, clinicians should consider conducting or recommending prehabilitation exercises prior to colorectal cancer surgery in patients with frailty.

Multimodal prehabilitation in patients with non-small cell lung cancer: a feasibility study.

Anatomic pulmonary resection is the preferred curative treatment in operable non-small cell lung cancer (NSCLC) but is associated with postoperative complications and inevitable compromise in functional capacity. Preoperative enhancement of functional capacity can be achieved with prehabilitation, yet the window of opportunity in NSCLC patients is small because patients are required to undergo surgery within 3 weeks from diagnosis. The goal of this study was to assess the feasibility of a prehabilitation programme in NSCLC within a 3-week timeframe and its effect on functional capacity-although the study was not powered to confirm improvements in functional capacity. Prehabilitation consisted of six interventions: exercise programme, nutritional support, mental support, smoking cessation, patient empowerment, and optimisation of respiratory status and was executed in two large teaching hospitals in the Netherlands. Assessments were scheduled at baseline (T0), end of program preoperatively (T1), and 6 weeks postoperatively (T2). Feasibility was defined as ≥80% of participants completing ≥80% of the programme. Functional capacity [6-minute walk test (6MWT), steep ramp test (SRT), one repetition maximum (1RM), maximal inspiratory pressure (MIP), and hand grip strength (HGS)] was evaluated on T1 and T2 compared to T0 using mixed model analyses. In total, 24 patients were included. In 95.8% of patients, the program proved feasible and preoperative functional capacity significantly improved in all pre-specified tests on T1. 1RM sustained improved at T2. Multimodal prehabilitation for lung surgery is feasible within a timeframe of 3 weeks. Even though this study was not powered to confirm it, prehabilitation may improve preoperative functional capacity.

Oral prehabilitation for patients with head and neck cancer: getting it right - the Restorative Dentistry-UK consensus on a multidisciplinary approach to oral and dental assessment and planning prior to cancer treatment

Historically, oral and dental issues for head and neck cancer patients were often not considered until after cancer treatment was complete. As a result, outcomes for oral rehabilitation were sometimes suboptimal. Inconsistencies in service delivery models and qualification, training and experience of staff delivering dental care often compounded this problem, making research and audit almost impossible. Collaborative working by consultants in restorative dentistry from all over the UK as part of a Restorative Dentistry-UK (RD UK) subgroup, renamed more recently as the RD-UK Head and Neck Cancer Clinical Excellence Network (CEN), has re-emphasised the importance of specialist restorative dentistry intervention at the outset of the head and neck cancer pathway to optimise outcomes of patient care. The CEN has driven several initiatives, reflecting Getting It Right First Time (GIRFT) principles aimed at reducing unwarranted variation. This improved consistency in approach and optimised collaborative working of the team now presents a better environment for multicentre audit and research. Ultimately, this should result in a continued improvement in patient and carer experience.

Association of an Online Home-Based Prehabilitation Program With Outcomes After Colorectal Surgery

This quality improvement study evaluates the association of an online home-based patient prehabilitation program with colorectal surgery outcomes.