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

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.