Evaluation of a multimodal personalized prehabilitation program in colon cancer patients undergoing surgery, focussing on changes in nutritional status, physical fitness and exploring clinical outcomes.

内容摘要

Many hospitals implemented prehabilitation programs for colon cancer (CC), but only few studies evaluated prehabilitation in clinical practice. We evaluated the results of a prehabilitation program that was implemented as usual care in our hospital on changes in nutritional status and physical fitness, and by exploring clinical outcomes. We conducted a prospective observational study to evaluate the prehabilitation program. The prehabilitation program that was implemented was as follows: at diagnosis (T0), patients were screened to assess whether they were physically unfit or fit: being unfit was defined as severe malnutrition (following the criteria of the Global Leadership Initiative on Malnutrition) and/or low cardiorespiratory fitness (VO2max <18.2 ml/kg/min). Unfit patients were referred to a 4-6 weeks prehabilitation program supervised by a physiotherapist. Patients who were fit were referred to unsupervised (2 weeks) prehabilitation. Follow-up measurements were conducted 3 days before (T1) and 6 weeks after (T2) surgery. Nutritional status was assessed by fat free mass and protein intake. Physical fitness was evaluated through VO2max, handgrip strength, 5 times-sit-to-stand test and maximal inspiratory pressure. Clinical outcomes were postoperative surgical and non-surgical complications, length of hospital stay and readmission, postoperative mortality and the Modified Iowa Level of Assistance Scale (mILAS). Between July 2022 and September 2023, 90 CC patients were screened for prehabilitation. Of those, 33% were unfit and referred to supervised prehabilitation. At diagnosis, 32% of supervised and 42% of unsupervised patients reached the minimally recommended daily protein intake. This changed to respectively 78% and 81% at T1. Between T0 and T1, improvements in physical fitness were most pronounced in the supervised group. Median length of hospital stay was 4 days (Q1-Q3: 3-7) in the supervised group and 3 days (Q1-Q3: 3-4) in the unsupervised group, while the mILAS score was similar. Complication rates, postoperative mortality and readmission rates appeared similar across groups. Our findings suggest that improvements in nutritional status and physical fitness were most pronounced in the unfit patients. Supervised and unsupervised groups appeared to have similar complication rates after surgery, but these findings should be interpreted with caution given the small sample size.