Virtual Prehabilitation Is Efficacious Before Lung Cancer Surgery

Virtual prehabilitation may improve patients’ physical activity level and exercise capacity before they go in for lung cancer surgery, according to recent research presented at the 2020 World Conference on Lung Cancer.¹

“Prehabilitation is the practice of enhancing a patient’s functional capacity before surgery, with the aim of improving post-operative outcomes,” explained co-study author Stephanie Wynne, BSc. “In lung cancer surgery, [prehabilitation] is associated with improved functional capacity and quality of life and reduced hospital length of stay, post-operative complications and readmission.”

Wynne explained that lung resection is the most common radical treatment for lung cancer, yet only 10-30% of individuals referred are actual candidates for the procedure, “due to their disease stage and a number of surgical risk factors, including advanced age or performance status, high comorbidities, and reduced cardiopulmonary reserve.” Prehabilitation may help.

While prehabilitation typically occurs in a face-to-face setting, an at-home option is particularly attractive amidst the COVID-19 pandemic.

The study included 20 patients who were undergoing lung surgery at a National Health Service Trust unit in London. They were all given a personalized home-based exercise program, and a diary to monitor compliance. Patients also had written advice and counseling for symptom management and had virtual follow-ups weekly or every other week.

Participants were assessed before and after the interventions on the following outcomes:

• MRC Dyspnoea scale
• Physical activity levels (measured by the Godwin Leisure Time Exercise Questionnaire [GLTEQ])
• Dietary needs
• Mood (measured by the Hospital Anxiety and Depression Scale [HADS])
• Fatigue (measured by FACIT-fatigue)
• Exercise capacity (measured by the 1-minute sit-to-stand (STS) test)

The majority (65%) of participants were female, and the average age was 68. At baseline, average MRC Dyspnoea scale score was 2; 45% of patients had 5 or more comorbidities; 70% had a history of smoking and 15% were classified as “vulnerable-mildly frail” per the Rockwood Clinical Frailty Score.

While there was no change in average MRC-Dysponea scale, HADs, or fatigue levels after the intervention, the researchers did see an average improvement of 45.9 points in the GLTEQ scores, and 100% of patients met recommended levels of physical activity. Additionally, the average STS score improved by 5.1 points, which exceeded the minimum clinically significant difference of +3.

“To conclude, our findings demonstrate that remote, home-based prehab is feasible, [and it] may improve a patients’ pre-surgical physical activity and exercise level,” Wynne said. “This is pertinent given the ongoing uncertainty surrounding COVID-19 and its impact on face-to-face health care delivery.”

While this study showed that at-home prehabilitation may work in patients, the authors note it should be investigated further, especially for elderly or vulnerable patients who may have limited access to technology.

“We’re now designing a triage tool to best support patients based on their therapeutic needs and access to technology,” Wynne said.

Reference

Wynne S, Dickinson F. Providing thoracic prehabilitation during COVID-19: review of a virtual model. Presented at: 2020 World Conference on Lung Cancer. January 28-21, 2021.