PREHABILITATION IN THORACIC CANCER SURGERY: FROM RESEARCH TO STANDARD OF CARE

ABSTRACT Objective To determine whether personalized stepped prehabilitation care is a feasible, safe and effective implementation strategy. Design Quality improvement project. Data prospectively collected from August 2018 to December 2019 were retrospectively analyzed to describe the clinical implementation of a prehabilitation in elective lung cancer surgery. Setting Single centre, a tertiary university hospital. Participants Eighty-one consecutive adult patients living in the metropolitan area of Montreal were included if an elective resection of suspected or confirmed lung cancer was planned. Interventions At the earliest contemplation of surgery, the whole cohort was screened for impaired physical, nutritional, and/or psychological status. Patients screened at higher risk received dedicated assessment, and received a personalized prehabilitation care upon specific needs. Measurements and Main Results patients’ specific needs, and their access and flow through the different services were described. Prehabilitation effectiveness was evaluated using walking and exercise tests, and adverse events were monitored. Eighty-one patients were screened for functional impairments. Forty patients showed reduction of physical function, 7 of them refused the specific assessment, 1 refused in-hospital exercise; 48 patients showed nutritional risk, 8 of them refused or did not comply with nutritional therapy. Overall, 45 high-risk patients received a 1-month personalized prehabilitation program: 16 partook in a trimodal program (exercise, nutrition, and psychological), and 22 received a program with both nutrition and exercise. No adverse events occurred during the study time. After prehabilitation, 6MWD improved by 29.9 meters (SD 47.3 m) (N=35, P=0.001), and VO2AT by 1.6 (1.7) mL•kg−1•min−1 (N=13, P=0.004). Length of hospital stay was 2 (IQR 1-4) days in prehabilitated patients, vs. 3 (2-7) days in the usual care group (P=0.101). Conclusions A personalized stepped prehabilitation program targeting high-risk patients undergoing elective lung cancer surgery was feasible, safe, and effective.