Observing the Perioperative Effects of Prehabilitation in Colorectal Cancer Patients

Observing the Perioperative Effects of Prehabilitation in Colorectal Cancer

Quality Improvement Project to evaluate how prehabilitation can be incorporated into our colorectal cancer pathway and assess its clinical benefits.

Study Overview

• Status: Completed
• Conditions: Colon Cancer
• Intervention / Treatment: Other: Prehabilitation

Detailed Description

The aim was to evaluate how prehabilitation (PH) can be incorporated into our colorectal cancer pathway and assess its clinical benefits.

Patients underwent PH (exercise, nutrition and psychological support) before resection of colorectal carcinoma in a DGH over fourteen months. Patients were matched by operation, age, sex and ASA to non-prehabilitation (NPH) patients using a prospectively maintained database. Length of stay (LoS) and complication rate and 90-day readmission rates were compared using Wilcoxon and McNemar's methods.

Prehabilitation significantly improved peak VO2 and AT. This corresponds to a reduction in predicted 30-day mortality. Despite a higher Charlson index LoS was unchanged suggesting prehabilitation may permit safe resection in comorbid patients.

• Study Type: Observational
• Enrollment (Actual): 52

Contacts and Locations

Study Locations

• United Kingdom
  • Kent
    • Gillingham, Kent, United Kingdom, ME7 5NY
      • Medway Hospitals NHS Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Consecutive patients over the age of 18 needing surgery were identified from clinics, endoscopy or weekly multidisciplinary meetings (MDT). Patients who were clinically judged to be frail or had multiple comorbidities were referred for prehabilitation prior to resection. Those that underwent prehabilitation were matched using operation type, age, sex and ASA with patients who did not have prehabilitation prior to resection. Surgery for all patients was carried out within the context of an enhanced recovery programme.

Description

Inclusion Criteria:

• Adults over the age of 18 who had prehabilitation for colorectal cancer

Exclusion Criteria:

• Children
• Patients who had prehabilitation but not for colorectal cancer

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Prehabilitation (PH); Patients who underwent prehabilitation prior to colorectal cancer resection	Other: Prehabilitation; Prehabilitation is a multimodal and multidisciplinary person-centred perioperative approach involving supervised exercise training, nutritional education, management of polypharmacy and psychological advice.
Non-Prehabilitation (NPH); Patients who did not undergo prehabilitation prior to colorectal cancer resection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of stay	Time spent in hospital	From date of operation to date of discharge in number of days over a 90 day follow up period
Complication rate	All Clavien-Dindo complications	Follow up over a period of 90 days following operation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anaerobic threshold	Measured by looking at CPET results pre- and post- prehab	CPET performed before prehabilitation and after prehabilitation (median of 36 days)

Collaborators and Investigators

• Sponsor: Medway Primary Care Trust
• Investigators: Principal Investigator: Richard A Dickson-Lowe, Medway PCT

Study record dates

Study Major Dates

• Study Start (ACTUAL): September 1, 2018
• Primary Completion (ACTUAL): December 31, 2019
• Study Completion (ACTUAL): December 31, 2019

Study Registration Dates

• First Submitted: January 22, 2021
• First Submitted That Met QC Criteria: February 17, 2021
• First Posted (ACTUAL): February 21, 2021

Study Record Updates

• Last Update Posted (ACTUAL): February 21, 2021
• Last Update Submitted That Met QC Criteria: February 17, 2021
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Keywords: Prehabilitation
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms
• Other Study ID Numbers: 2021.038N

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No