Introduction and Objectives Surgical resection for lung cancer is physically and emotionally demanding for patients, with risks of complications and morbidity. Prehabilitation aims to maximise patients’ fitness, nutrition and wellbeing before treatment to improve outcomes. The existing literature on lung cancer prehabilitation points to improved functional capacity, post-operative length of stay & frequency of complications. As such, it is recommended in current guidelines.1
Methods Prehab4Cancer, a Greater Manchester (GM) Cancer funded project, is the first regional system in the UK to introduce large-scale prehab as a standard of care for cancer patients.2 Surgical lung cancer patients are rapidly assessed at one of 17 clinics. Tailored prehab interventions span exercise (re-HIIT: high intensity interval training and muscle strengthening), nutrition, and psychological support. It is delivered by ‘GM Active’, a collective of 12 community organisations utilising cancer rehabilitation-qualified exercise specialists. A 12-week post-op rehabilitation programme follows. Measures of fitness are recorded at baseline, pre-operatively, post-operatively, and after rehabilitation.
Results Since April 2019, 380 lung cancer patients have been referred from 11 hospitals, with 75% participating. Average age was 70y; 53% were female. Median duration of prehab was 39 days, with mean 2.2 sessions/week. Physiological assessments such as incremental shuttle walk test (ISWT) improved from median 350 m at baseline to 380 m. Health-related quality of life measures also demonstrated improvement (see table 1).
Conclusions Prehab4cancer has successfully implemented a regional cancer prehab programme that demonstrates feasibility and excellent uptake and improved patient experience. Collaboration has been key, between GM-wide healthcare professionals working together with the GM Cancer alliance, people affected by cancer and GM Active. Validated measures of fitness and quality of life show promising trends toward improvement among surgical lung cancer patients.
Batchelor TJP, et al.Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery after Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardio-thoracic Surg 2019;55:91–115.
Moore J, Merchant Z, Rowlinson K, et al. Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester’s ‘Prehab4cancer’. Eur J Surg OncolPublished Online First: 2020.
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