ABSTRACT
Keywords: Prehabilitation, Cancer, Colorectal Purpose: Prehabilitation (Prehab) refers to a mulitmodal preoperative strategy aiming to enhance patients’ funcitonal capacity. A stepwise implementation of a pilot prehab program was undertaken and led by a Specialist Physiotherapist and Dietitian for all patients referred for colorectal surgery in Princess Royal University Hospital funded by South East London Cancer Alliance. The objective was to design and evaluate a pilot service that could be replicated in other NHS Trust/cancer centres. Methods: Prehab was offered to a cohort of all newly diagnosed colorectal cancer patients planned for curative treatment. Patient Demographics, oncological characteristics, anthropometric data, frailty scores and patient-reported global health assessment were recorded at baseline and during follow up after intervention and treatment (surgery). Clinical outcomes included hospital length of stay (LOS), morbidity, mortality, readmission rates. The intervention was delivered via telephone for dietetics and a multi-modal telephone, video and/or face to face physiotherapy intervention from July 2020 to December 2020. Personalised prehabilitation programmes were created for each patient including resistance and aerobic training. All patients were stratified into universal, targeted or specialist prehab input (based on Macmillan 2019 guidance) for physiotherapy and dietetics respectively. Results: 39 patients were treated ‘straight to surgery’. Time available for prehab for Physiotherapy was 10 days (range 1-31) and Dietetics was a median 14 days (range 2-62). One third of patients had experienced significant weight loss pre-operatievely. Dietary prehab impeded further decline: there was no difference in median Body Mass Index (BMI) between baseline and 6 weeks post-op. Physiotherapy observed an improvement in physical activity levels (measured with the GODIN leisure time questionnaire) and self-reported general health quality of life scores. The Median EQ5D5L score at follow up was 90%(range 70-99%), improved from a medial baseline pre-surgery score of 75% (range 50-83%). As the pilot reaches its conclusion favourable clinical outcomes were recorded with no mortality and reduced readmission from 15% in 2019 to 5% in 2020. The total hospital LOS did not differ from historical data. Conclusion(s): Prehabilitation can impede the nutritional and functional decline post colorectal cancer surgery. Prehabilitation contributed to reduced readmission during covid helping to keep vulnerable patients out of hospital. No differences in LOS were recorded. Holistic clinical approach to prehab and tailoring interventions to individual patient can be successfully delivered through telehealth intervention with short prehabilitation time frames. Future prehabilitation services should offer multiple appointment/intervention options with a focus on readmissions and patient quality of life data to contribute to business case development. Impact: Prehabilitation can be delivered and led by a Band 7 AHP team utilising telephone and video options to reduce travel time and provide intervention for patients with a short time frame prior to surgery. This joint dietetic and physiotherapy prehab pathway can be replicated in other district general hospitals that are diagnosing and treating colorectal cancer patients. Prehabilitation is a valuable part of the personalised care cancer strategy and NHS long term plan for cancer patients. Funding acknowledgements: South East London Cancer Alliance.