A mixed methods evaluation of a multimodal cancer prehabilitation programme for colorectal, lung and head and neck cancer patients

Abstract
BackgroundGrowing evidence indicates patients’ outcomes can be enhanced by cancer prehabilitation (CP)1; although not uniformly embedded as a standard of care. CP aims to optimise patients physiological and psychological for cancer treatments,1 shorten recovery time, reduce complications, promote healthier lifestyles and improve quality of life.2 South-Eastern Health and Social Care Trust piloted and evaluated an adaptation of multimodal CP programme 3 across three tumour groups, which included exercise, nutrition and emotional support, and encouraged behavioural alcohol and smoking change.
MethodsFollowing screening, patients were referred to appropriate CP pathways (T0). Baseline functional and patient-reported outcome measures were collected pre-CP (T1), end of CP (before definitive treatment) and 3 months later (T3). Data was analysed using SPSS v28.0. Qualitative evaluation comprised of semi-structured interviews with 24 professional stakeholders and eight patients; using Framework Analysis.
ResultsAvailable screening data for 135 patients (x ̅= 68 years) across 3 tumours groups colorectal (n=90), head and neck (n=30) and lung (n=15) was analysed, with the majority referred to universal pathways for exercise (73%), nutritional (71%) and emotional wellbeing (86%). All had a Rockwood Clinical Frailty Scale of CP was 22 days. Given COVID-19 backdrop, virtual/telecommunication methods were employed; however, these participants had higher dropout rates. CP demonstrated no statistically significant improvement (p=>0.5) in QOL but improvement in exercise self-efficacy. Qualitative findings highlighted: 1) identifying key stakeholders at inception, promoting successful engagement; 2) shared vision essential to develop and tailor CP; 3) necessity to equip team to deliver CP, 4) and lessons learned to move forward.
ConclusionsStakeholders and patients realised many benefits to CP, but short timeframe (and treatment presented implementation challenges. Appropriate funding, addressing gaps in training and communication across multi-sectoral agencies, plus reviewing data collection processes could enhance effective delivery and robust data capture.