Authors (including presenting author) :
Cheng P(1),Tang SF(1), Pang CY(1), Ng SMA(1), Lam PL(1), Chan SY(2), Wei R(2), Yu V(3)
Affiliation :
(1) Department of Physiotherapy (2) Department of Surgery, (3) Department of Dietetic, Queen Mary Hospital
Introduction :
Surgery is considered as curative therapy for many gastrointestinal(GI) cancers. Poor pre-operative physical condition may delay functional recovery. “Prehabilitation” is the process of care, initiated before surgery, to strengthen patients’ physical, nutritional and medical status, aiming at a fast return to preoperative status. On 1 May 2019, a pilot PREHAB program was launched for GI cancer patients who plan for surgery after neoadjuvant therapy.
Objectives :
To evaluate the outcome of patients joining PREHAB program
Methodology :
The PREHAB program involves baseline assessment of functional status, a 12-session physiotherapist-supervised training, intensive nutritional intervention and counselling. The supervised-exercise program consists of stretching, aerobic, muscle strengthening exercise and inspiratory muscle training, followed by home-based training and telephone follow-up. 6-minute walk test(6MWT), hand grip strength test(HGST) and European Organization for Research and Treatment and Cancer quality of life questionnaire (EORTC QLQ-C30) were measured at 5 time points including 1st and 12th prehabilitation training, 1-3 day(s) before surgery, and 4 and 8 weeks after surgery. Maximal inspiratory pressure(MIP) was measured for esophageal cancer patients whose surgery involving thoracoscopy or thoracotomy. Patient’s Experience Survey(PES) was done at 8 weeks after surgery. Post-operative mobility status, length of stay(LOS) and discharge destination were documented.
Result & Outcome :
From 1 May 2019 to 31 Oct 2021, 24 patients were recruited. Fifteen patients (Male=8, female=7; rectal cancer=13, esophageal cancer=2), mean age of 63, completed the PREHAB program. Three patients received some training sessions via telecare during COVID-19 pandemic. Nine patients did not complete the prehabilitation due to various reasons including disease progression, deconditioning and patient refusal. 6MWT improved progressively before surgery (1st prehabilitation, 449.6m; 12th prehabilitation, 463.5m (p>0.05); pre-operation, 490.6m (p<0.05)) and returned quickly to baseline at 8 weeks after surgery. Resumption of premorbid mobility status was achieved at a mean of 3.25 days after surgery. Fourteen patients (93%) were discharged home and the mean LOS was 4.87 days. PES showed that patients were highly satisfied with the program. No adverse effect was reported. To conclude, PREHAB program is labour intensive but worthwhile in view of the good clinical outcome and high patient satisfaction. Training with telecare is feasible during COVID-19 pandemic and may incorporate into future program.
