Northern Ireland ovarian cancer prehabilitation project

Abstract

Patients with ovarian cancer are often diagnosed late, in advanced stages (stages III-IV) and are often deconditioned due to disease burden. Frailty is reported in up to 60% of gynaecological oncology patients and many report malnutrition, anxiety and depression. As surgery is the mainstay of treatment for ovarian cancer, with maximum surgical effort being a priority, patients are at increased risk of perioperative morbidity and mortality.Multimodal prehabilitation aims to improve the functional capacity of surgical patients. Prehabilitation commonly includes physical, nutritional, medical optimisation, smoking cessation and emotional well-being interventions. Many surgical specialties have well established evidence for the use of prehabilitation showing a reduction in length of stay and perioperative complications. There is, however, limited evidence for the use of prehabilitation in the surgically vulnerable group of patients with advanced ovarian cancer.This project aimed to introduce a multimodal prehabilitation pathway for patients with advanced ovarian cancer. All patients with advanced ovarian cancer were included, regardless of the treatment modality decided at the regional gynaecological oncology multidisciplinary team meeting. The pathway included exercise, nutritional and psychological interventions. The outcome measures included the Rockwood Frailty Score, 6 min Walk Test (6MWT), 30 s Chair to Stand test, grip strength and Eastern Cooperative Oncology Group performance status as a measure of functional capacity. Nutritional intervention outcomes included the Malnutrition Universal Screening Tool (MUST) score, Body mass index and mid-arm circumference. The psychological intervention outcomes included a holistic needs assessment, the distress thermometer and EQ-5D-5L quality of life status.Of the 75 patients enrolled, 45 (60%) completed the project. In patients who completed the project improved 6MWT and 30-CST was observed in 67% and 44%, respectively, while 67% of patients with moderate to extreme anxiety/depression scores reported lowering from baseline level and 71% of patients with medium to high-risk MUST scores baseline weight was maintained or increased.

Keywords: Allied Health Occupations; Healthcare quality improvement; Obstetrics and gynecology; Preoperative Care.

Figure 1. Primary treatment modalities of patients included in the prehabilitation programme. CRS, cytoreductive surgery; NACT, neoadjuvant chemotherapy.

Figure 2. Functional status evaluation. 30-CTS, 30 s Chair to Stand test; 6MWT, 6 min Walk Test.