Attitudes and Perceptions to Prehabilitation in Lung Cancer

Abstract

Background: Prehabilitation to maximize exercise capacity before lung cancer surgery has the potential to improve operative tolerability and patient outcomes. However, translation of this evidence into clinical practice is limited. Aims: To determine the acceptability and perceived benefit of prehabilitation in lung cancer among thoracic surgeons. Procedure: 198 cardiothoracic surgeons within Australia and New Zealand were surveyed to evaluate their attitudes and perceived benefits of prehabilitation in lung cancer. Results: Response rate was 14%. A moderate proportion of respondents reported that there is a need to refer lung resection patients to preoperative physiotherapy/prehabilitation, particularly high-risk patients or those with borderline fitness for surgery. 91% of surgeons were willing to delay surgery (as indicated by cancer stage/type) to optimize patients via prehabilitation. The main barriers to prehabilitation reported were patient comorbidities and access to allied health professionals, with 33% stating that they were unsure who to refer to for prehabilitation in thoracic surgery. This is despite 60% of the cohort reporting that pulmonary rehabilitation is available as a preoperative resource. 92% of respondents believe that further research into prehabilitation in lung cancer is warranted. Conclusion: The benefits of prehabilitation for the oncology population have been well documented in the literature over recent years and this is reflected in the perceptions surgeons had on the benefits of prehabilitation for their patients. This survey demonstrates an interest among cardiothoracic surgeons in favor of prehabilitation, and therefore further research and demonstration of its benefit is needed in lung cancer to facilitate implementation into practice.

Physiotherapy and Exercise Management of People Undergoing Surgery for Lung Cancer: A Survey of Current Practice across Australia and New Zealand

“…Our study identified a number of potential barriers to the implementation of exercise into routine lung cancer care, some of which have been identified previously in the literature, including clinician knowledge, workplace culture, constraints of the health care system (e.g., clinician time, staffing, and protocols), and patient appointment burden [ 20 , 21 , 22 ].…”

Feasibility and outcomes of a real-world regional lung cancer prehabilitation programme in the UK

“…This challenge is not unique to the UK; a recent survey of thoracic surgeons in Australia identified a high perceived need for prehabilitation, but only 16.7% of respondents could access services. 13 The Greater Manchester (GM) Prehab4Cancer (P4C) programme is a system-wide prehabilitation programme for patients in GM delivered as a collaboration between hospitalbased clinical teams, the regional cancer alliance (GM Cancer), and the community leisure sector (GM Active). Here, we examine the feasibility, uptake, participation, and clinical outcomes from this service delivery model.…”

“…This challenge is not unique to the UK; a recent survey of thoracic surgeons in Australia identified a high perceived need for prehabilitation, but only 16.7% of respondents could access services. 13 …”

Redesigning the Preoperative Clinic

“…However, implementation of prehabilitation remains a challenge. Despite evidence of effectiveness, barriers include access to specialized services, lack of awareness as to which patients need referrals, and resource limitations . Physically integrating the prehabilitation platform into an existing preoperative clinic represents an opportunity to address implementation barriers, shifting the role of the preoperative clinic paradigm from risk assessment to risk attenuation where at-risk patients are offered a tailored prehabilitation plan that is designed and delivered seamlessly and on site (Figure).…”