The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

Fiona Wu, Oloruntobi Rotimi, Roberto Laza-Cagigas, Tarannum Rampal, Fiona Wu, Oloruntobi Rotimi, Roberto Laza-Cagigas, Tarannum Rampal

Abstract

Patients awaiting cancer treatment were classified as "vulnerable" and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.

Keywords: cancer care; deconditioning; exercise oncology; pandemic; prehabilitation; shielding; surgical oncology.

Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Patient flow chart.
Figure 2
Figure 2
Number of patients per dimension (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and level of problems (no problems, some problems, extreme problems), before and after undergoing prehabilitation. A greater number of patients selecting “No problems” in the different dimensions after undergoing prehabilitation suggests the intervention was effective in improving quality of life.
Figure 3
Figure 3
Boxplots depicting self-rated health (EQ-VAS), fatigue, and EQ-5D values, before and after prehabilitation. Statistically significant improvements were found in self-rated health (p = 0.001) and fatigue (p = 0.000).

References

    1. Güner R., Hasanoğlu I., Aktaş F. COVID-19: Prevention and control measures in community. Turk. J. Med. Sci. 2020;50:571–577. doi: 10.3906/sag-2004-146.
    1. Peçanha T., Goessler K.F., Roschel H., Gualano B. Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease. Am. J. Physiol. Heart Circ. Physiol. 2020;318:H1441–H1446. doi: 10.1152/ajpheart.00268.2020.
    1. Bailey L., Ward M., DiCosimo A., Baunta S., Cunningham C., Romero-Ortuno R., Kenny R.A., Purcell R., Lannon R., McCarroll K., et al. Physical and mental health of older people while cocooning during the COVID-19 pandemic. QJM Int. J. Med. 2021 doi: 10.1093/qjmed/hcab015.
    1. Laza-Cagigas R., Chan S., Sumner D., Rampal T. Effects and feasibility of a prehabilitation programme incorporating a low-carbohydrate, high-fat dietary approach in patients with type 2 diabetes: A retrospective study. Diabetes Metab. Syndr. Clin. Res. Rev. 2020;14:257–263. doi: 10.1016/j.dsx.2020.03.010.
    1. Wu F., Laza-Cagigas R., Pagarkar A., Olaoke A., El Gammal M., Rampal T. The Feasibility of Prehabilitation as Part of the Breast Cancer Treatment Pathway. PM&R. 2020 doi: 10.1002/pmrj.12543.
    1. Tew G.A., Bedford R., Carr E., Durrand J.W., Gray J., Hackett R., Lloyd S., Peacock S., Taylor S., Yates D., et al. Community-based prehabilitation before elective major surgery: The PREP-WELL quality improvement project. BMJ Open Qual. 2020;9:e000898. doi: 10.1136/bmjoq-2019-000898.
    1. Hijazi Y., Gondal U., Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int. J. Surg. 2017;39:156–162. doi: 10.1016/j.ijsu.2017.01.111.
    1. Hanna K., Ditillo M., Joseph B. The role of frailty and prehabilitation in surgery. Curr. Opin. Crit. Care. 2019;25:717–722. doi: 10.1097/MCC.0000000000000669.
    1. Gillis C., Li C., Lee L., Awasthi R., Augustin B., Gamsa A., Liberman A.S., Stein B., Charlebois P., Feldman L.S., et al. Prehabilitation versus Rehabilitation. Anesthesiology. 2014;121:937–947. doi: 10.1097/ALN.0000000000000393.
    1. Minnella E.M., Awasthi R., Loiselle S.-E., Agnihotram R.V., Ferri L.E., Carli F. Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery. JAMA Surg. 2018;153:1081–1089. doi: 10.1001/jamasurg.2018.1645.
    1. Bland K.A., Bigaran A., Campbell K.L., Trevaskis M., Zopf E.M. Exercising in Isolation? The Role of Telehealth in Exercise Oncology during the COVID-19 Pandemic and Beyond. Phys. Ther. 2020;100:1713–1716. doi: 10.1093/ptj/pzaa141.
    1. Karlsson E., Farahnak P., Franzén E., Nygren-Bonnier M., Dronkers J., Van Meeteren N., Rydwik E. Feasibility of preoperative supervised home-based exercise in older adults undergoing colorectal cancer surgery—A randomized controlled design. PLoS ONE. 2019;14:e0219158. doi: 10.1371/journal.pone.0219158.
    1. Ngo-Huang A., Parker N.H., Bruera E., Lee R.E., Simpson R., O’Connor D.P., Petzel M.Q.B., Fontillas R.C., Schadler K., Xiao L., et al. Home-Based Exercise Prehabilitation During Preoperative Treatment for Pancreatic Cancer Is Associated With Improvement in Physical Function and Quality of Life. Integr. Cancer Ther. 2019;18 doi: 10.1177/1534735419894061.
    1. Piraux E., Caty G., Reychler G., Forget P., Deswysen Y. Feasibility and Preliminary Effectiveness of a Tele-Prehabilitation Program in Esophagogastric Cancer Patients. J. Clin. Med. 2020;9:2176. doi: 10.3390/jcm9072176.
    1. Diamond R., Willan J. Coronavirus disease 2019: Achieving good mental health during social isolation. Br. J. Psychiatry. 2020;217:408–409. doi: 10.1192/bjp.2020.91.
    1. Silver J.K. Prehabilitation could save lives in a pandemic. BMJ. 2020;369:m1386. doi: 10.1136/bmj.m1386.
    1. Stratton R.J., Hackston A., Longmore D., Dixon R., Price S., Stroud M., King C., Elia M. Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br. J. Nutr. 2004;92:799–808. doi: 10.1079/BJN20041258.
    1. Physical Activity Guidelines: UK Chief Medical Officers’ Report. [(accessed on 24 March 2021)];2021 Available online: .
    1. Monteiro C.A., Cannon G., Levy R.B., Moubarac J.-C., Louzada M.L., Rauber F., Khandpur N., Cediel G., Neri D., Martinez-Steele E., et al. Ultra-processed foods: What they are and how to identify them. Public Health Nutr. 2019;22:936–941. doi: 10.1017/S1368980018003762.
    1. Deer R., Volpi E. Protein intake and muscle function in older adults. Curr. Opin. Clin. Nutr. Metab. Care. 2015;18:248–253. doi: 10.1097/MCO.0000000000000162.
    1. Teixeira F.J., Santos H.O., Howell S.L., Pimentel G.D. Whey protein in cancer therapy: A narrative review. Pharmacol. Res. 2019;144:245–256. doi: 10.1016/j.phrs.2019.04.019.
    1. UK Alcohol Unit Guidance: Chief Medical Officer’s Low Risk Drinking Guidelines. [(accessed on 18 April 2021)]; Available online: .
    1. Thompson A.J., Turner A.J. A Comparison of the EQ-5D-3L and EQ-5D-5L. PharmacoEconomics. 2020;38:575–591. doi: 10.1007/s40273-020-00893-8.
    1. Dolan P. Modeling Valuations for EuroQol Health States. Med. Care. 1997;35:1095–1108. doi: 10.1097/00005650-199711000-00002.
    1. Hagstrom A., Marshall P.W.M., Lonsdale C., Cheema B.S., Singh M.F., Green S.M. Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: A randomised controlled trial. Eur. J. Cancer Care. 2015;25:784–794. doi: 10.1111/ecc.12422.
    1. Position Statement on Use of the EQ-5D-5L Value Set for England. [(accessed on 23 May 2021)];2019 Available online: .
    1. Ferreira V., Agnihotram R.V., Bergdahl A., Van Rooijen S.J., Awasthi R., Carli F., Scheede-Bergdahl C. Maximizing patient adherence to prehabilitation: What do the patients say? Support. Care Cancer. 2018;26:2717–2723. doi: 10.1007/s00520-018-4109-1.
    1. Graley C.E., May K.F., McCoy D.C. Postcode Lotteries in Public Health—The NHS Health Checks Programme in North West London. BMC Public Health. 2011;11:738. doi: 10.1186/1471-2458-11-738.
    1. Robinson A., Oksuz U., Slight R., Slight S., Husband A. Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review. JMIR mHealth uHealth. 2020;8:e19237. doi: 10.2196/19237.
    1. Sell N.M., Silver J.K., Rando S., Draviam A.C., Mina D.S., Qadan M. Prehabilitation Telemedicine in Neoadjuvant Surgical Oncology Patients during the Novel COVID-19 Coronavirus Pandemic. Ann. Surg. 2020;272:e81–e83. doi: 10.1097/SLA.0000000000004002.
    1. Lambert G., Drummond K., Ferreira V., Carli F. Teleprehabilitation during COVID-19 pandemic: The essentials of “what” and “how”. Support. Care Cancer. 2021;29:551–554. doi: 10.1007/s00520-020-05768-4.

Source: PubMed

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