Teleprehabilitation for Surgical Cancer Patients

Virtual Prehabilitation of Surgical Cancer Patients in Times of the Covid-19 Pandemic

There is a general concern that the backlog of cancer patients waiting for surgery during this period is going to increase and the general impact on patients isolated in their homes is going to cause potential physiological and psychological impairments. Therefore, we propose a distanced-delivered personalized home-based prehabilitation program to all cancer patients scheduled for surgery at the MUHC. The program will be delivered by qualified professionals, supported by technology provided by POP, to all cancer patients waiting for surgery, addressing the patients' risk factors in patients' pandemic reality perspective. Participant contacts will primarily occur virtually using technologies such as video conferencing and digital applications. This will enable us to continue to support people with cancer and deliver safe remote counseling by specialist healthcare providers in their own homes, whilst adhering to the Governmental guidelines on social distancing, self-isolation and shielding.

Study Overview

• Status: Recruiting
• Conditions: Thoracic Cancer; Abdominal Cancer
• Intervention / Treatment: Behavioral: Multimodal Teleprehabilitation

Detailed Description

The current project aims to improve the quality of care delivered to oncologic surgical candidates during the COVID-19 pandemic. The specific objectives of the study are: 1. to assess the feasibility of a distance-delivered prehabilitation program to oncologic surgical candidates in light of the current global pandemic, 2. to measure the effect of technology-supported prehabilitation on preoperative and postoperative functional capacity and clinical outcomes, and 3. To qualitatively investigate the impact of distance-delivery of prehabilitation on health-related quality of life, anxiety and depression, which may be exacerbated by the current global phenomenon.

To do so, a convenient study group of 100 patients on the waiting lists to undergo elective thoracic and abdominal surgery, initially at the Montreal General Hospital (MGH) will be recruited over the next year and a half.

Program:

The program for the current study will consist of two parts, the first being individual counseling with different healthcare professionals, the second component would be a home-based prehabilitation program for patients awaiting their surgery. The healthcare providers available for participants' respective needs include exercise physiologist (a), nutritionists (b), psychosocial (c), and if needed smoking cessation (d) personnel who would contact patients via phone, and a videoconferencing platform (Zoom) if possible, facilitated by the use of the tablet.

Exercise physiologists will follow-up with patients regularly throughout the continuum of care (before and after their surgery) and refer them to the relevant specialists as needed.

The patients will also have access to premade videos prepared by POP to provide additional support in their application of the preoperative recommendations: physical activity (aerobic, resistance, and flexibility), nutrition optimization (healthy eating, improving protein and energy intake, portion size, glycemic control), psychological exercises (breathing exercise, relaxation, imaging, visualization) and smoking cessations. These videos will be available to the patients on their tablets, in addition, the exercises will be demonstrated in the booklets.

Outcome Measures:

All outcomes will be captured via patient chart review, self-report questionnaires, data collected from the Polar watch, and digital surveys. Chart review outcomes include the length of hospital stay, surgical and postoperative complications.

The primary outcome of the current study is to assess the feasibility of distance-delivery of Prehabilitation to these high-priority cancer patients using a digital platform. In order to ascertain if the program was feasible, the evaluation criteria included quantitative measures such as recruitment rate, adherence to program (self-reported measures and crude data from the polar), program completion rate, frequency of technological failures, adverse events, in addition to qualitative measures such as rationale for refusal to participate, low compliance and drop-outs.

Secondary outcomes also include parameters of functional health, nutritional and metabolic status, self-reported outcomes, and surgical outcomes.

Potential confounding variables:

The current study will investigate a diverse patient population. A large degree of variability is to be expected in the observed functional and clinical outcomes. Several factors are known to affect patient prognosis and recovery, among them baseline BMI, smoking status, comorbidities (CCI), type of cancer, neoadjuvant therapies (type and duration) and duration of the prehabilitation program. Therefore, the current study will investigate the impact each factor on the reported outcomes.

• Study Type: Interventional
• Enrollment (Anticipated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Francesco Carli, MD, MPhil; Phone Number: 43728 514-934-1934; Email: franco.carli@mcgill.ca

Study Locations

• Canada
  • Quebec
    • Montréal, Quebec, Canada, H3G 1A4
      • Recruiting
      • Muhc-Rimuhc
      • Contact: Francesco Carli, MD; Phone Number: 44188 5149341934; Email: franco.carli@mcgill.ca

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults scheduled for elective cancer surgery that is delayed due to COVID-19 referred by a surgeon;
• Covered by the RAMQ
• Have medical clearance to exercise (as provided on the physician referral);
• Are able to understand English or French.

Exclusion Criteria:

• N.A.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: SUPPORTIVE_CARE
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: Teleprehabilitation cohort; Patients in this single-arm study will receive multimodal teleprehabilitation.

Behavioral: Multimodal Teleprehabilitation; Exercise Prescription: patients will be instructed on how to perform aerobic exercise (5 times/week: minimum 30-minute/day) and resistance training (3 times/week: 2-3 sets of 6-8 exercises repeated 8-12 times) at home. Exercise counseling will be weekly, using the video-conferencing application (Zoom). Nutrition: nutritional status and dietary intake will initially be assessed by the nutritionist using zoom. All patients will receive daily whey protein supplements. Special precautions will be considered if patients have specific medical conditions. Psychosocial intervention: Patients will have access to 1.5 hours of mental relaxation and coping mechanisms session within the first week of enrolment, using Zoom. Smoking Cessation: Patients with smoking habits will meet with a respiratory specialist using Zoom, who will establish recommendations and contact the physician for the recommended smoking cessation protocol. More counseling sessions will be provided as needed.; Other Names: Virtual Prehabilitation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment Rate	Recruitment rate is defined as the number of participant recruited, compared to the number of eligible participant contacted.	Through study completion, for an expected duration of of 1.5 year.
Adherence	based on self-reported measures and data from the polar watch, compared to prescribed intervention	Through study completion, for an expected duration of of 1.5 year.
Program Completion Rate	The completion rate is defined as the number of participant completing all evaluations, compared to the number of participants recruited.	Through study completion, for an expected duration of of 1.5 year.
frequency of Technological Failures	Frequency of technological failures is defined as the number of any technological challenge that would prevent participants from doing their interventions or contacting the research team member.	Through study completion, for an expected duration of of 1.5 year.
Intervention-Related Adverse Events	Intervention-related adverse events is defined as any event that would cause harm to patients' physical or mental health.	Through study completion, for an expected duration of of 1.5 year.
Rational for Refusal to Participate	When possible, patients' rational for refusing to participate in the project was collected.	Through study completion, for an expected duration of of 1.5 year.
Rational for Low Compliance	When possible, participant's rational for low compliance to the project was collected.	Through study completion, for an expected duration of of 1.5 year.
Rational for Drop-Outs	When possible, participant's rational for abandoning the project was collected.	Through study completion, for an expected duration of of 1.5 year.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30 Second Sit-to-Stand	Assessed the strength of the lower body, by sitting on a chair and standing up as many times as possible during 30 seconds.	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
Time-Up and Go (TUG)	Assessed mobility, balance and locomotor performance associated to the tasks of walking and turning. The patients starts seated, and needs to stand up, walk turn around a cone and sit back down as fast as possible, the results is the numbers of seconds to perform the 3-meter distance to a cone and back.	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
2- or 6-Minute Walk Test	The 2- or 6-minute walk test is a functional capacity measure, surrogate to the assessment of cardiopulmonary capacities. The patient walks in a 20-meter corridor, back and forth, for 2 or 6 minutes and the result of the test is the distances traveled in meters.	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
Abridged-Scored Patient-Generated Subjective Global Assessment (PG-SGA)	Assessed the state of nutrition, classification A, B or C ( B and C being states of nutritional risk).	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
Body Mass Index (BMI)	Assessed the body composition, ranging 18 to 30 (>30 is obesity, and <18 is malnourished).	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
CRP	Assessed the degree of inflammation (>10mg/L indicates high inflammation )	During baseline assessment (beginning of prehabilitation period; T0)
Serum Albumin	Assessed the degree of inflammation (<35g/L indicates high inflammation)	During baseline assessment (beginning of prehabilitation period; T0)
Duke Activity Status Index (DASI)	Assessed the level of physical activity and is measured in 12 questions, going up to a score of 58 (58 being the best score).	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
Quality of Life (EQ5D)	Assessed the quality of life of the previous week, on a scale of 0 to 100 ( 100 being the best health).	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
The Hospital Anxiety and Depression Scale (HADS)	Assessed the degree of anxiety and depression, separately, ranging from 0 to 18 respectively (18 being the worst score).	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
Distress Thermometer	Assessment of the level of anxiety and distress, on a scale from 0 to 10 (10 being the worst score).	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
The WHO Disability Assessment Schedule v2.0 (WHODAS)	the WHO Disability Assessment Schedule is a scale of disability free survival, measured at different times,	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
The Energy Expenditure (CHAMPS)	the energy expenditure related to physical activities of daily living, measured in kilocalories/kg/week.	During baseline assessment (beginning of prehabilitation period; T0), at the preoperative assessment (within the 24 hours prior to surgery; T1) and further at the 4- (T2) and 8-weeks (T3) follow-ups after surgery
The Clavien-Dindo Classifications(CDC)	The Clavien-Dindo Classifications(CDC) indicates the resource utilization of complication post-operatively, ranging from 0 to 4 (4 being patient admitted to the intensive care).	During the post-operative period, data collected on average up to 2 months after the surgery date.
The Comprehensive Complication Index (CCI)	The comprehensive complication index (CCI) is a score of the r severity of post-operative complications, ranging from 0 to 100 (100 being mortality).	During the post-operative period, data collected on average up to 2 months after the surgery date.
The 30-day Mortality	The 30-day mortality will assess the number of deaths within the first 30 days post-surgery.	During the post-operative period, for a month after the surgery date.
Length of Intensive Care Stay	Length of intensive care stay will be assessed as the number of hours from arrival to the unit.	During the post-operative period, data collected on average up to 2 months after the surgery date.
Days with a chest tube	Days with a chest tube will be assessed as the number of days and hours for the last day, if applicable.	During the post-operative period, data collected on average up to 2 months after the surgery date.
Length of Hospital Stay	Length of Hospital Stay will be assessed as a number of post-operative hours until discharge	During the post-operative period, data collected on average up to 2 months after the surgery date.

Collaborators and Investigators

• Sponsor: McGill University Health Centre/Research Institute of the McGill University Health Centre
• Collaborators: Montreal General Hospital; Peri Operative Program, Montreal

Publications and helpful links

General Publications

• Lambert G, Drummond K, Tahasildar B, Carli F. Virtual Prehabilitation in Patients With Cancer Undergoing Surgery During the COVID-19 Pandemic: Protocol for a Prospective Feasibility Study. JMIR Res Protoc. 2022 May 6;11(5):e29936. doi: 10.2196/29936.

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 12, 2021
• Primary Completion (ANTICIPATED): September 15, 2022
• Study Completion (ANTICIPATED): December 15, 2022

Study Registration Dates

• First Submitted: March 1, 2021
• First Submitted That Met QC Criteria: March 11, 2021
• First Posted (ACTUAL): March 16, 2021

Study Record Updates

• Last Update Posted (ACTUAL): September 30, 2021
• Last Update Submitted That Met QC Criteria: September 24, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Telehealth; Supportive Care; Prehabilitation; Telemedecine
• Other Study ID Numbers: MUHC-2021-6730

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