The current project aims to improve the quality of care delivered to oncologic surgical
candidates during the COVID-19 pandemic. The specific objectives of the study are: 1. to
assess the feasibility of a distance-delivered prehabilitation program to oncologic surgical
candidates in light of the current global pandemic, 2. to measure the effect of
technology-supported prehabilitation on preoperative and postoperative functional capacity
and clinical outcomes, and 3. To qualitatively investigate the impact of distance-delivery of
prehabilitation on health-related quality of life, anxiety and depression, which may be
exacerbated by the current global phenomenon.
To do so, a convenient study group of 100 patients on the waiting lists to undergo elective
thoracic and abdominal surgery, initially at the Montreal General Hospital (MGH) will be
recruited over the next year and a half.
Program:
The program for the current study will consist of two parts, the first being individual
counseling with different healthcare professionals, the second component would be a
home-based prehabilitation program for patients awaiting their surgery. The healthcare
providers available for participants' respective needs include exercise physiologist (a),
nutritionists (b), psychosocial (c), and if needed smoking cessation (d) personnel who would
contact patients via phone, and a videoconferencing platform (Zoom) if possible, facilitated
by the use of the tablet.
Exercise physiologists will follow-up with patients regularly throughout the continuum of
care (before and after their surgery) and refer them to the relevant specialists as needed.
The patients will also have access to premade videos prepared by POP to provide additional
support in their application of the preoperative recommendations: physical activity (aerobic,
resistance, and flexibility), nutrition optimization (healthy eating, improving protein and
energy intake, portion size, glycemic control), psychological exercises (breathing exercise,
relaxation, imaging, visualization) and smoking cessations. These videos will be available to
the patients on their tablets, in addition, the exercises will be demonstrated in the
booklets.
Outcome Measures:
All outcomes will be captured via patient chart review, self-report questionnaires, data
collected from the Polar watch, and digital surveys. Chart review outcomes include the length
of hospital stay, surgical and postoperative complications.
The primary outcome of the current study is to assess the feasibility of distance-delivery of
Prehabilitation to these high-priority cancer patients using a digital platform. In order to
ascertain if the program was feasible, the evaluation criteria included quantitative measures
such as recruitment rate, adherence to program (self-reported measures and crude data from
the polar), program completion rate, frequency of technological failures, adverse events, in
addition to qualitative measures such as rationale for refusal to participate, low compliance
and drop-outs.
Secondary outcomes also include parameters of functional health, nutritional and metabolic
status, self-reported outcomes, and surgical outcomes.
Potential confounding variables:
The current study will investigate a diverse patient population. A large degree of
variability is to be expected in the observed functional and clinical outcomes. Several
factors are known to affect patient prognosis and recovery, among them baseline BMI, smoking
status, comorbidities (CCI), type of cancer, neoadjuvant therapies (type and duration) and
duration of the prehabilitation program. Therefore, the current study will investigate the
impact each factor on the reported outcomes.
