Authors (including presenting author) :
Tang SF(1), Pang CY(1), Ng SMA(1), Lam PL(1), Cheng P(1), Chan SY(2), Lo O(2)
Affiliation :
(1) Department of Physiotherapy, Queen Mary Hospital (QMH), (2) Department of Surgery, QMH
Introduction :
Surgery is the only curative option for patients with GI cancer. Poor preoperative physical condition may increase risk of prolonged functional recovery. “Prehabilitation” is the process of enhancing patients’ functional capacity before surgery leading to better postoperative recovery.
On 1 May 2019, a pilot multi-disciplinary PREHAB program was launched for patients with GI cancer who will undergo surgery, and receive neoadjuvant therapy before surgery. The program was comprehensive and comprised of physiotherapists, doctors, case managers and dietitians.
Objectives :
To evaluate the feasibility and safety of PREHAB program (supervised exercise program by physiotherapists)
Methodology :
Suitable patients were referred by the Department of Surgery into the PREHAB program.
The program started with a 12-sessions supervised hospital-based training consisting aerobic, strengthening and stretching exercises, followed by a home-based training for 5-times/week and monthly telephone follow-up before surgery. For patients with esophageal cancer, inspiratory muscle training was also prescribed.
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 day, pre-operation, post-operation 4-week and 8-week. Maximal inspiratory pressure (MIP) was measured for patients with esophageal cancer. Patient’s Experience Survey (PES) was done at post-operation 8-week. For patients admitted for surgery, post-operation mobility status, length of stay (LOS), destination of patients were documented.
Result & Outcome :
From 1 May 2019 to 30 November 2020, 20 patients were referred. 8 patients (4 males) with mean age of 64.5 completed the program. One patient received telecare due to COVID-19 pandemic. The diagnosis of rectum and esophageal cancer were 7 and 1 respectively. 4 patients are still under the program but not yet completed. 8 patients did not complete the program due to various reasons including disease progress (37.5%).
6MWT was significantly improved from 416.8m on 1st prehabilitation day to 461.2m on pre-operation (p=0.008). 6MWT on 1st prehabilitation (416.8m) vs post-operation 8-weeks (419.8m) showed improving trend (p=0.204).
There was no significant difference in HGST and EORTC QLQ-C30 among different time points. After operation, the number of days resuming premorbid mobility status was 3.25. The total LOS was 4.87. The PES showed that patients were highly satisfying with the program. 7 patients (88%) were discharged home directly. No adverse effect was reported.
To conclude, the pilot PREHAB program is feasible and safe. It may be beneficial in improving functional capacity of patients before surgery. Early recovery after surgery was also shown and patients highly appreciated our service. Investigation will be continued to further evaluate the effectiveness of the program.
