JMIR Publications

ABSTRACT

Background:

Surgery remains the standard curative treatment for early-stage colorectal and upper gastrointestinal cancer. Reduced preoperative functional capacity, nutritional status, and psychological well-being is associated with poor postoperative outcomes. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. The integration of prehabilitation from a trial setting into a real-world health setting requires evaluation.

Objective:

The primary aim is to evaluate the implementation of a multimodal (supervised exercise, nutrition, and nursing support) prehabilitation program into standard care for patients with gastrointestinal cancer (colorectal and upper gastrointestinal cancer) scheduled for curative intent surgery. Secondary aims are to determine the impact of a multimodal prehabilitation program on functional capacity, nutritional and psychological status, and surgical outcomes.

Methods:

This is an implementation study that will investigate a multimodal prehabilitation intervention, in a non-blinded, non-randomised, single-group, pre-post design. Patients diagnosed with colorectal and upper gastrointestinal cancer scheduled for potentially curative intent surgery at Concord Repatriation General Hospital (CRGH), with >14 intervention days prior to surgery and are medically cleared to exercise will be eligible. The studies primary outcome will be evaluated using the RE-AIM Evaluation Framework.

Results:

The protocol was approved in December 2019 by the Concord Repatriation General Hospital Human Research Ethics Committee under reference number 2019/PID13679. Recruitment commenced in January 2020. In response to the COVID-19 pandemic recruitment was paused in March 2020 and reopened in August 2020 with virtual/telehealth intervention adaptations. Recruitment ended on the 31st of December 2021. Over the 16-month recruitment period a total of 77 patients were recruited.

Conclusions:

Prehabilitation represents an opportunity to maximise functional capacity and improve surgical outcomes. The study will provide guidance and contribute to the evidence on the integration of prehabilitation into standard care using adaptive models of healthcare delivery including telehealth. Clinical Trial: Australian and New Zealand Clinical Trials Registry ACTR 12620000409976.