Feasibility, acceptability and clinical outcomes of a real-world, regional lung cancer prehabilitation programme for patients undergoing curative intent radiotherapy

Abstract

Introduction: Prehabilitation improves both physiological measurements and clinical outcomes for patients undergoing surgery for lung cancer. The feasibility, acceptability and efficacy of prehabilitation for patients having curative-intent radiotherapy for lung cancer is uncertain.

Methods: Prehab4Cancer (P4C) is a regional, community-based prehabilitation service for patients with cancer in Greater Manchester in the United Kingdom. We present an evaluation of the P4C service for patients undergoing curative-intent radiotherapy for lung cancer over a 2-year period. Feasibility was evaluated against prespecified key performance indicators. Objective physiological and subjective functional assessments were recorded before and after completion. Effects on mortality in comparison to a non-prehab cohort were assessed in an exploratory regression analysis.

Results: A total of 381 patients were referred to P4C via a web-based portal. 86 % (329/381) were contacted by phone and 73 % (279/381) completed an initial assessment. 45 % (172/381) completed the prehab programme with a median of 7 (IQR 3-11) sessions during a median time to commencing treatment of 23 days (IQR 16-34). Median time from referral to assessment was 4 days (IQR 3-6) and 86 % (239/279) were completed within 7 days of referral. Six-Minute Walk Tests improved by an average of 30 m (95 % CI 20.6-41 m, p = <0.001). 16 % (n = 21/132) of participants initially score "Medium" or "High" on IPAQ for weekly physical activity, improving to 52 % (n = 66/132) on programme completion. Participants had a median reduction in score of -2.5 (95 % CI -3.0 to -1.5) in WHODAS 2.0. There was an 8 % reduction in 1-year mortality in patients completing prehab (11 %, 17/160) vs those that did not complete prehab (19 %, 30/158, OR 0.5, 95 % CI 0.24-1.00, p = 0.054) after adjustment for age, gender, performance status and cancer staging.

Conclusions: The P4C programme has demonstrated feasibility, acceptability and effectiveness in patients with lung cancer undergoing curative-intent radiotherapy.

Keywords: Exercise therapy; Lung cancer; Prehab; Prehabilitation; Quality of healthcare; Radiotherapy.