Prehabilitation before gastrointestinal cancer surgery (prehab-gi): an implementation study

BACKGROUND Surgery continues to be the primary treatment option for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, up to 30-40% will experience a major complication. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. We aimed to evaluate the implementation of a multimodal prehabilitation program in gastrointestinal cancer surgery patients. METHODS A single-arm implementation study using a pre-post design. Colorectal or UGI cancer patients scheduled for curative intent surgery at Concord Hospital with ≥14 days pre-surgery were recruited. The intervention was face-to-face or by telehealth (COVID adaptations): a 2-4-week program consisting of i) supervised exercise, ii) dietary education and protein supplements, iii) nursing support. The primary outcome was implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework. Secondary outcomes included functional, nutritional, and surgical outcomes. RESULTS Over 16 months, 181 were screened; 95 (52%) were eligible. Reach: 77/95 recruited (64 colorectal, 13 UGI). The median age was 70 years; 46 (60%) were males. Median intervention duration was 16 days. Effectiveness: Functional capacity using the 6-minute walk test and 2-minute step test improved from baseline to pre-surgery; 9.3m (p=0.038) and 6.5 steps (p=<0.001), respectively. Self-reported moderate, vigorous and resistance training statistically increased from baseline to pre-surgery. Hospital length of stay decreased by 1.9 days (p=0.010). There was no difference in total complications and readmissions. Adoption: 91% of referrals were directly from surgeons. Implementation: 72 completed the intervention; 5 withdrew after baseline assessment. 34% of assessments and intervention were delivered by telehealth. Adherence to the intervention was high; 94% exercise, 97% nutrition, 98% nursing. Overall, participant and clinician satisfaction was high. Maintenance: The program has been adopted as standard care with modifications post-study completion. CONCLUSIONS Our study shows that multimodal prehabilitation can be successfully implemented in a real-world setting, with a trend to improve functional and surgical outcomes.