Multimodal Prehabilitation Programs as a Bundle of Care in Gastrointestinal Cancer Surgery: A Systematic Review

Abstract

Although small studies are supportive of multimodal interventions, there are insufficient data to make a conclusion about the integration of prehabilitation in GI cancer surgery as a bundle of care. Larger, prospective trials, utilizing uniform objective risk stratification and structured interventions, with predefined clinical and health economic end points, are required before definitive value can be assigned to prehabilitation programs.

Reply to Lawday et al.

“…We hypothesized that an intervention period of about 3 weeks would be necessary. This is supported by more recent research, showing that the prehabilitation period should be of 3–4 weeks’ duration . In our study, median prehabilitation time was only 6 days, making it difficult to improve the health status of individual patients sufficiently before surgery.…”

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

“…Prehabilitation aims to optimize patients’ physical and mental well-being in anticipation of an upcoming stressor rather than a reactive process in which care is provided to restore wellness (ie, rehabilitation) 16. There is currently no consensus-based definition, but a multimodal approach that encompasses the following principles is gaining popularity: (1) aerobic and resistance exercises to improve physical function, body composition, and cardiorespiratory fitness; (2) targeted functional exercises to minimize/prevent impairments; (3) dietary interventions to support exercise-induced anabolism as well as mitigate disease and/or treatment-related malnutrition; (4) psychological interventions to reduce stress, support behavior change, and encourage overall well-being 17…”

A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation

“…[10][11][12] There has also been emerging research in prehabilitation, for multimodal programs involving exercise, nutrition, smoking cessation, and psychologic support. 13,14 Nevertheless, it is unclear if this interest has translated into the clinical domain. This evidence-to-practice gap in healthcare is typically 17 years 15 ; implementation science in the field of perioperative care is only an emerging field.…”

“…Recent research into multimodal programs has examined a variety of combinations of different interventions, including physical fitness, nutrition, hematinic, smoking and alcohol cessation, and psychologic interventions, but an ideal combination of interventions has yet to be determined. 14 The overall use of prehabilitation is low and there is not enough evidence for a change in practice to occur. These barriers and opportunities identified may serve as a basis for implementation of science studies in the perioperative literature.…”