Neoadjuvant Prehabilitation Therapy for Locally Advanced Non–Small-Cell Lung Cancer: Optimizing Outcomes Throughout the Trajectory of Care

Schmid, Severin; Minnella, Enrico Maria; Pilon, Yohann; Rokah, Merav; Rayes, Roni F.; Najmeh, Sara; Cools-Lartigue, Jonathan; Ferri, Lorenzo; Mulder, David S.; Sirois, Christian; Owen, Scott; Shieh, Benjamin; Ofiara, Linda; Wong, A. S. Y.; Sud, Shelly; Baldini, Gabriele; Carli, Francesco; Spicer, Jonathan

doi:10.1016/j.cllc.2022.05.004

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…patients with slowly progressing diseases, such as osteoarthritis, can generally wait longer than those with more rapidly progressing diseases, such as most cancer types, who should often be operated within a few weeks following diagnosis [ 98 ]. However, cancer patients undergoing neoadjuvant treatment before surgery may be ideal candidates for prehabilitation [ 99 , 100 ]. Similarly, the waiting period for patients on organ transplant lists may present a window of opportunity to implement a prehabilitation programme [ 101 ], and waiting lists in general may aid the early identification of eligible patients [ 102 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

Rombey,

Eckhardt,

Kiselev

et al. 2023

BMC Med

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Background Prehabilitation aims at enhancing patients’ functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care. Methods We searched PubMed, Embase, the CRD database, ClinicalTrials.gov, the WHO ICTRP and the dissertation databases OADT and DART. Studies comparing prehabilitation for patients with elective surgery to usual preoperative care were included if they reported cost outcomes. All types of economic evaluations (EEs) were included. The primary outcome of the review was cost-effectiveness based on cost–utility analyses (CUAs). The risk of bias of trial-based EEs was assessed with the Cochrane risk of bias 2 tool and the ROBINS-I tool and the credibility of model-based EEs with the ISPOR checklist. Methodological quality of full EEs was assessed using the CHEC checklist. The EEs’ results were synthesised narratively using vote counting based on direction of effect. Results We included 45 unique studies: 25 completed EEs and 20 ongoing studies. Of the completed EEs, 22 were trial-based and three model-based, corresponding to four CUAs, three cost-effectiveness analyses, two cost–benefit analyses, 12 cost–consequence analyses and four cost-minimization analyses. Three of the four trial-based CUAs (75%) found prehabilitation cost-effective, i.e. more effective and/or less costly than usual care. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective. When excluding studies of insufficient credibility/critical risk of bias, this number reduced to 14/23 (60.9%). In 8/25 (32.0%), cost-effectiveness was unclear, e.g. because prehabilitation was more effective and more costly, and in one EE prehabilitation was not cost-effective. Conclusions We found some evidence that prehabilitation for patients awaiting elective surgery is cost-effective compared to usual preoperative care. However, we suspect a relevant risk of publication bias, and most EEs were of high risk of bias and/or low methodological quality. Furthermore, there was relevant heterogeneity depending on the population, intervention and methods. Future EEs should be performed over a longer time horizon and apply a more comprehensive perspective. Trial registration PROSPERO CRD42020182813.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

Rombey,

Eckhardt,

Kiselev

et al. 2023

BMC Med

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“…Few prehabilitation pathways exist for people who do not have surgery, despite the fact that 50%–60% of people with cancer in the UK are treated with primary, neoadjuvant or palliative chemotherapy and/or radiotherapy treatment 13. A small number of studies have investigated the use of prehabilitation in the neoadjuvant setting and have shown benefit in terms of postsurgical outcomes,14–18 but only one of these have been in lung cancer 19…”

Section: Introductionmentioning

confidence: 99%

“…A small number of studies have shown that prehabilitation before lung cancer surgery is feasible and can improve functional capacity and reduce postoperative complications. However, most of these studies focused on the benefits of exercise prehabilitation as opposed to a multimodal approach 19 22–30…”

Section: Introductionmentioning

confidence: 99%

“…13 A small number of studies have investigated the use of prehabilitation in the neoadjuvant setting and have shown benefit in terms of postsurgical outcomes, 14–18 but only one of these have been in lung cancer. 19 …”

Section: Introductionmentioning

confidence: 99%

“…However, most of these studies focused on the benefits of exercise prehabilitation as opposed to a multimodal approach. 19 22–30 …”

Section: Introductionmentioning

confidence: 99%

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Is personalised prehabilitation feasible to implement for patients undergoing oncological treatment for lung cancer at a London teaching hospital? Protocol of a feasibility trial

et al. 2023

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IntroductionThere is significant potential to improve outcomes for patients with lung cancer in terms of quality of life and survival. There is some evidence that prehabilitation can help, but, to date, this has only been tested in surgical populations, despite 70%–80% of patients with lung cancer in the UK receiving non-surgical treatment. The physiological and psychological benefits of prehabilitation seen in surgical patients could be extrapolated to those receiving non-surgical treatment, particularly in such a poor prognosis group. With patients and healthcare professionals, we have co-designed a personalised and evidence-based prehabilitation programme. This draws on a conceptual framework that aligns with patient values and needs as well as functional goals. We aim to investigate whether this programme is feasible to implement and evaluate in clinical practice.Methods and analysisAn open-label, single-group feasibility study incorporating quantitative assessments, a qualitative free text questionnaire and reflective field notes. Thirty participants will be recruited over an eight-month period from a single London teaching hospital. All recruited participants will receive a personalised prehabilitation programme during their oncological treatment. This includes a one-hour face-to-face appointment prior to, at week three and at week six of their treatment regimen as well as a weekly telephone call. Interventions including nutrition, physical activity and psychological well-being are stratified according to a patient’s priorities, level of readiness and expressed needs. The primary outcome will be feasibility of the personalised prehabilitation programme in clinical practice by investigating areas of uncertainty regarding patient recruitment, attrition, treatment fidelity, intervention adherence and acceptability of study outcome measures. Secondary outcomes will include quality of life, functional capacity and grip strength.Ethics and disseminationEthical approval has been obtained from the Health Research Authority (reference number 22/PR/0390). Results of this study will be disseminated through publication in peer-reviewed articles, presentations at scientific conferences and in collaboration with patient and public involvement representatives.Trial registration numberNCT05318807.

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Summary of the best evidence for prehabilitation management of patients with non-small cell lung cancer

Wu,

Li,

Fan

2024

Asia-Pacific Journal of Oncology Nursing

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Neoadjuvant Prehabilitation Therapy for Locally Advanced Non–Small-Cell Lung Cancer: Optimizing Outcomes Throughout the Trajectory of Care

Cited by 9 publications

References 29 publications

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

Is personalised prehabilitation feasible to implement for patients undergoing oncological treatment for lung cancer at a London teaching hospital? Protocol of a feasibility trial

Summary of the best evidence for prehabilitation management of patients with non-small cell lung cancer

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