Prehabilitation service for cancer patients undergoing major abdominal surgery

Purpose

Prehabilitation has been shown in clinical trials to improve fitness, improve quality of life, reduce complications, reduce hospital length of stay and improve recovery. It is not currently standard of care in routine clinical practice. This prospective observational study reports the outcomes of a newly introduced prehabilitation service for patients undergoing major abdominal surgery for cancer.

Approach

The Aintree Prehab service commenced in August 2017, all patients prior to major abdominal surgery for cancer were eligible for referral. All patients referred were invited to attend a multi-disciplinary prehabilitation clinic. Baseline assessments were undertaken including 6-minute walk test (6MWT), SF-36 and full nutritional and physiotherapy assessment. Patients were given individualised exercise and dietetic plans and invited to either supervised exercise classes or individual follow up sessions. Where distance was a barrier to participation, telephone clinics were undertaken. All patients were invited back to a review 6 weeks postoperatively where baseline assessments and surveys were repeated.

Outcomes

142 patients underwent baseline assessment. 26 of 142 were telephone assessments with 116 of 142 face-to face. Of these 28 participated in exercise classes, with a median of 3 classes attended (Range 1-14). 33 patients attended post-surgery follow-up by, and full data analysis was undertaken on these patients. Of these patients 13 underwent colorectal resection, 12 Liver resection, 1 Gynaecological cyroreductive surgery, and 1 did not require surgery following a complete response from chemo-radiotherapy. 12 of 32 suffered a complication following surgery. Median length of stay was 6 days (Interquartile range 4-8). At 6 week follow-up patients had maintained BMI, restored SF 36 quality of life to baseline, and improved the 6MWT distance from 484m to 539m (p= 0.03). Patients reported that enrolling in the programme made them feel 91% more able to cope with their surgery. On survey patients reported 86% more likely to make long term lifestyle changes having attended the service, and that their family are 60% more likely to do the same.

Implications

A prehabilitation service is feasible and improves fitness whilst maintaining BMI and quality of life following major cancer surgery. Attending such a service helps patients feel they can manage their treatment better and encourage both them and their families to make positive long term health changes.

There should be further analysis of data to continue to review the benefits of the service as more patients complete the prehab programme.

Fund acknowledgements

Service pilot funded by Macmillan Cancer Support

Additional notes

This work was presented at Physiotherapy UK 2018.