Multimodal prehabilitation for enhancing perioperative outcomes in major cancer surgeries – A prospective feasibility study
K. Shiv Kumar, Kalyani Manasa Rapeti, Y. Harish Krishna, Aveek Jayant, Seshadri Ramkiran, Noothanapati Nageswara Rao, Pinnaka Vamsi, Gayatri Karnik, Alisha Karim, Priyasha SharmaBackground and Aims:
Cancer therapies do have systemic impact on the patient, which lowers the individual’s physiologic reserve and affects their quality of life (QoL). Enhanced recovery after surgery programs focused upon intraoperative and postoperative period but little emphasis on preoperative optimization. Prehabilitation is a multimodal, interdisciplinary team management addresses functional capacity building and also QoL outcomes by intervening before surgery. The aim of the study was to establish the feasibility of establishing the prehabilitation clinic in major cancer surgeries and to assess its effectiveness in patient outcomes.
Methodology:
Prospective feasibility study conducted with team comprising of Anesthesiologist, Surgeon, Physiotherapist, Psychologist, and Dietician. Outcome measure was feasibility, 6-min walk test distance and Patient health questionnaire-9, generalized anxiety disorder-7, and QLQ-C30 scores. Assessments were done on prior to surgery once, after surgery but prior to starting adjuvant therapy once. Interventions were advised based on individual patient status.
Results:
Our result show high recruitment rate (96%) and adherence but subsequently lost to follow-up because of travel time constraints. Functional capacity improved by 21 m from preoperative to postoperative. Anxiety and depression scores were improved significantly from preoperative to postoperative with no change in QoL parameters. Wilcoxon signed-rank test was used to compare the variables.
Conclusion:
Multimodal prehabilitation program for major cancer surgeries was both feasible and beneficial, but robust follow-up plans should be integrated into it.