Feasibility of a Multimodal Prehabilitation Programme in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: A Pilot Study

Abstract

Introduction: Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We aimed to evaluate the feasibility and postoperative impact of a multimodal prehabilitation programme in AOC patients undergoing surgery. Methods: This single-centre, before-and-after intervention pilot study included 34 patients in two cohorts: the prehabilitation cohort prospectively included 15 patients receiving supervised exercise, nutritional optimisation, and psychological preparation from December 2019 to January 2021; the control cohort included 19 consecutive patients between January 2018 and November 2019. Enhanced Recovery After Surgery guidelines were followed. Results: The overall adherence to the multimodal prehabilitation programme was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimisation, and 80% adherence to psychological preparation. The median hospital stay was shorter in the prehabilitation cohort (5 (IQR, 4–6) vs. 7 days (IQR, 5–9) in the control cohort, p = 0.04). Differences in postoperative complications using the comprehensive complication index (CCI) were not significant (CCI score: 9.3 (SD 12.12) in the prehabilitation cohort vs. 16.61 (SD 16.89) in the control cohort, p = 0.08). The median time to starting chemotherapy was shorter in the prehabilitation cohort (25 (IQR, 23–25) vs. 35 days (IQR, 28–45) in the control cohort, p = 0.03). Conclusions: A multimodal prehabilitation programme before cytoreductive surgery is feasible in AOC patients with no major adverse effects, and results in significantly shorter hospital stays and time to starting chemotherapy.

Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity?

“…As chemotherapy is an integral part of ovarian cancer management, a delay in adjuvant treatment beyond 25 to 35 days due to surgical morbidity will result in a significantly poorer prognosis [29]. Other studies, however, failed to demonstrate such improvements [26][27][28]30]. Whilst this may be related to differences in the outcome measures reported, it is also likely that bias related to confounding and selection impacted on the ability of these studies to accurately measure the true effectiveness of the interventions.…”

“…A postoperative outcomes o evidence of beneficial effe A total of seven stud gynaecological cancer pa outcome measures were with adequate handling improvements in time to patients [28]. As chemoth in adjuvant treatment be significantly poorer prog Diaz-Feijoo [28] had a significant selection bias, with Arnaboldi et al allocating patients to the intervention based on their preoperative psychological distress inventory (PDI) score and Seibaek et al allocating patients to the intervention based on presence of ascites [25,27]. Fernández-Candela et al reported significant differences in baseline characteristics between intervention and control groups [30].…”

“…This review summar programmes on postop gynaecologic cancer. A postoperative outcomes o evidence of beneficial effe A total of seven stud gynaecological cancer pa outcome measures were with adequate handling improvements in time to patients [28]. As chemoth in adjuvant treatment be significantly poorer prog Fernández-Candea [30] methods used to measure outcomes, such as questionnaires [27]; and significant differences in standard care between intervention and control groups [30].…”

“…Four studies reported on a prehabilitation programme in patients with ovarian cancer, including a total of 428 patients, the vast majority of whom underwent surgery for confirmed or suspected cancer (Table 1) [26][27][28]30]. Two studies reported on multimodal programmes [27,28] training. In addition, patients underwent respiratory physiotherapy with a spirometer.…”

“…A total of seven stud gynaecological cancer pa outcome measures were with adequate handling improvements in time to patients [28]. As chemoth in adjuvant treatment be significantly poorer prog Aubrey [29] al.…”