Feasibility and Preliminary Effectiveness of a Tele-Prehabilitation Program in Esophagogastric Cancer Patients

Abstract

<jats:p>Tele-rehabilitation provides better access to healthcare services and optimizes exercise adherence. However, its feasibility and effectiveness are unknown in the preoperative period in esophagogastric cancer patients. We aimed to assess the feasibility and the preliminary effects of a “tele-prehabilitation” program in esophagogastric cancer patients requiring surgery. Enrolled participants performed an internet-based tele-prehabilitation including aerobic, resistance and inspiratory muscle training over 2–4 weeks. The primary outcome was feasibility, measured in terms of recruitment, retention and attendance rates, adverse events and patient satisfaction. Secondary outcomes (functional exercise capacity, fatigue, quality of life, anxiety and depression) were assessed at baseline, presurgery, and 4 and 12 weeks postsurgery. Among the 24 eligible subjects, 23 were enrolled, 22 performed the intervention and 15 completed the study. Recruitment and retention rates were both 96%. Attendances to aerobic and resistance sessions and inspiratory muscle training were 77% and 68%, respectively. No adverse events occurred, and the satisfaction was excellent. After prehabilitation, participants significantly improved fatigue (p = 0.039), quality of life (p = 0.009), physical well-being (p = 0.034), emotional well-being (p = 0.005) and anxiety (p = 0.044). This study demonstrated the feasibility of a tele-prehabilitation in esophagogastric cancer patients undergoing surgery, with a high recruitment rate, retention rate and satisfaction, a good attendance to exercise sessions and no exercise-related adverse events.</jats:p>

The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

“…Much of the evidence in support of prehabilitation has studied the effects of in-person supervised programs [ 9 , 10 ]. There has been little attention given to telehealth-delivered and/or home-based programs [ 11 , 12 , 13 , 14 ]. In response to the pandemic, following the UK government’s announcement of a national lockdown, we sought to use digital technologies and telecommunication methods to continue the benefits of prehabilitation and to mitigate the consequences of shielding [ 15 , 16 ].…”

Impact of curative treatment on the physical fitness of patients with esophageal cancer: A systematic review and meta-analysis

“…In several studies an exercise intervention was implemented in the pre-or postoperative phase as part of the usual care treatment (see Supplementary Table A.1). Four studies described a preoperative exercise intervention with the duration of at least one week [30,33,37,40]. In two studies patients were only advised to be physically active [41,48], and in two studies patients only received breathing exercises [34,38].…”

“…To explore whether the impact of esophagectomy differed between studies with and without a pre-or postoperative exercise program, therefore, a subgroup analysis was performed. In the first month after surgery, subgroup analyses showed no significant difference (p ¼ .22) in the impact of esophagectomy on exercise capacity between studies with an exercise intervention (SMD -0.86 (À1.27; À0.45) [33,37], p < .01, I 2 ¼ 2%), and studies without an exercise intervention (SMD -1.24 (À1.70; À0.79), p < .01, I 2 ¼ 8%) [9,38,42]. Between one and three months after surgery.…”

“…The results for the change of exercise capacity showed high heterogeneity. In the analyses within one month after surgery and between one and three months after surgery, two studies included a preoperative exercise intervention [33,37], and one study included a postoperative exercise intervention [34]. To explore whether the impact of esophagectomy differed between studies with and without a pre-or postoperative exercise program, therefore, a subgroup analysis was performed.…”

“…Studies with an exercise intervention showed a restore in exercise capacity (SMD 0.13 (À0.25; 0.51), p ¼ .50, I 2 ¼ 0%) [34,37], and studies without an exercise intervention showed a decrease in exercise capacity (SMD -0.51 (À0.73; À0.29), p < .01, I 2 ¼ 39%) [27,35,36,42]. The difference between subgroups was significant (p < .01).…”