Moving from theory to practice: implementing a prehabilitation program before gastrointestinal cancer surgery (PREHAB-GI)

Abstract

Purpose: Surgery remains the primary treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, it can lead to postoperative complications and reduced functionality. Prehabilitation aims to improve functional reserves before surgery. We aimed to evaluate the implementation of a multimodal prehabilitation program in “real-world” patients undergoing gastrointestinal cancer surgery. Methods: An implementation study evaluating prehabilitation in patients undergoing gastrointestinal (colorectal or UGI) cancer surgery at Concord Hospital. The prehabilitation program included supervised exercise, nutrition and nursing support delivered face-to-face or by telehealth (COVID-19 adaptations). Assessments: baseline, pre-surgery and 30 days after surgery. Primary outcome: implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework. Secondary outcomes: functional, nutritional and surgical outcomes, with comparisons to historical controls. Results: Between January 2020 and December 2021, 181 patients were screened; 91 (50%) were eligible. Reach: 77/91 recruited (63 colorectal, 14 UGI). Median age, 70 years (IQR, 59–79); 60% were males. Median intervention duration, 16 days (IQR, 12.25–19.75). Effectiveness: quality of life, anxiety and functional capacity improved from baseline to pre-surgery (6-min walk test (+16.1 m, p=0.038) and 2-min step test (+10.0 steps, p<0.001)). Compared to historical controls, hospital length of stay was reduced by 2.1 days (p=0.010), with no differences in complications. Adoption: 91% of referrals came directly from surgeons. Implementation: 94% completed the intervention, with high adherence and satisfaction levels. Maintenance: after study completion, the program was incorporated into standard care with some modifications. Conclusions: Prehabilitation can be implemented in a real-world setting, with a trend towards improving functional and surgical outcomes, but dedicated resources are necessary to implement and maintain the program.