Introduction and objectives The new BTS lung cancer surgery guidelines mention patient optimisation to reduce risk. Our aim was to develop a multi-stranded pragmatic rehabilitation programme for this group of patients, apply it in a pilot study and look at feasibility, process indicators, outcome measures, local adaptability, compliance and potential cost benefit.
Methods An outpatient based complex intervention was developed by doctors, allied health professional and patients to optimise physical status, prepare for inpatient journey and support through recovery after surgery. Tested in an enriched cohort study over 11 months 45 patients received the intervention compared to 198 who received standard care.
Results Potential surgical candidates at a regional thoracic unit were identified early at lung cancer multidisciplinary team meetings and enrolled on a COPD-type rehabilitation programme which included exercise classes, smoking cessation, dietary advice and patient education. Patients attended exercise classes twice a week until surgery, (which was not delayed). On average patients waited 7 days (range 0–29) to be seen in a rehabilitation class and attended on 5 sessions (range 1–12) resulting in 39 m improvement in 6-minute walk test. The education classes were delivered by lung cancer nurse and addressed diet, smoking, lifestyle change, inpatient expectations, preparation for discharge, and pain management. Six patients identified as potentially or at risk of being malnourished received nutritional supplementation. 5 out of 10 current smokers agreed to be fast tracked into locally available smoking cessation pathways and were biochemically proven to have given up. In the two referring hospitals one delivered classes in outpatient individualised setting while the other in community based group class. An additional four patients following further investigations did not receive surgery. Both groups were matched for age, lung function comorbidity and type of surgery and outcomes are presented in Abstract S28 table 1. The intervention resulted in cash releasing saving to the PCT of £938 per patient.
Conclusion A viable outpatient based complex intervention pathway of enhanced recovery/pulmonary rehabilitation has been developed and tested. Initial results are promising but a multicentre randomised controlled trial is warranted to test efficacy.
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