Background

Prehabilitation, or multimodality patient optimisation before major treatment, has demonstrated meaningful improvements in patients' outcomes. In the setting of lung cancer surgery, postoperative complications and length of hospital stay are reduced, but there is currently limited access to prehabilitation. Prehab4Cancer (P4C) is an innovative regional programme serving all areas of Greater Manchester (GM).

Methods

The lung cancer P4C service commenced in 2019 as a collaboration between the GM Cancer alliance and 12 leisure and community organisations. Patients planning surgical resection could be referred to receive exercise, nutrition, and well-being assessment and interventions before surgery. We evaluated the programme's feasibility, uptake, and outcomes during the 11 months before COVID-19 restrictions.

Results

In total, 377 patients were referred to the lung cancer P4C service from all 11 hospitals in GM. Of the patients reached by telephone, 80.0% (n=280/348) attended initial P4C assessment, which occurred a median of 8 days (inter-quartile range [IQR]: 4–14) after referral. In addition, 74.3% (n=280/377) attended for baseline assessment and 47.7% (n=180/377) completed prehabilitation, attending a median of six sessions (IQR: 4–9). Statistically significant improvements in all objective physiological and subjective functional assessments were observed preoperatively, including a mean increase in the incremental shuttle walk test of 50 m (95% confidence interval: 25–74; P<0.001).

Conclusions

The P4C programme demonstrated feasibility at scale, high uptake, and promising impact on the status of patients with lung cancer before surgery. P4C is the first regional prehabilitation service internationally, and this evaluation provides a framework for implementing similar services in other regions.

中文翻译：

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英国现实世界区域性肺癌康复计划的可行性和结果

背景

主要治疗前的预康复或多模式患者优化已证明对患者的结果有有意义的改善。在肺癌手术的背景下，术后并发症和住院时间减少，但目前获得预康复的机会有限。Prehab4Cancer (P4C) 是一项创新的区域计划，服务于大曼彻斯特 (GM) 的所有地区。

方法

作为 GM 癌症联盟与 12 个休闲和社区组织之间的合作，肺癌 P4C 服务于 2019 年启动。计划手术切除的患者可以在手术前接受锻炼、营养和健康评估和干预。我们在 COVID-19 限制之前的 11 个月内评估了该计划的可行性、采用率和结果。

结果

共有 377 名患者从 GM 的所有 11 家医院转诊至肺癌 P4C 服务。在通过电话联系到的患者中，80.0% ( n =280/348) 参加了初始 P4C 评估，转诊后的中位时间为 8 天（四分位间距 [IQR]：4-14）。此外，74.3% ( n =280/377) 参加了基线评估，47.7% ( n =180/377) 完成了预康复，参加了六节课的中位数 (IQR: 4–9)。术前观察到所有客观生理和主观功能评估的统计学显着改善，包括增量穿梭步行测试平均增加 50 m（95% 置信区间：25-74；P <0.001）。

结论

P4C 计划展示了大规模的可行性、高吸收率以及对肺癌患者手术前状态的有希望的影响。P4C 是国际上第一个区域性预康复服务，该评估为在其他地区实施类似服务提供了一个框架。