A toolbox for a structured risk-based prehabilitation program in major surgical oncology

Area of Science:

• Perioperative Medicine
• Evidence-Based Practice
• Health Services Research

Background:

• Prehabilitation is a multimodal approach to enhance patient resilience before surgery, encompassing physical, nutritional, and psychosocial elements.
• Existing literature on prehabilitation outcomes and definitions is heterogeneous, necessitating a structured review.

Purpose of the Study:

• To conduct a scoping review of Class 1 and 2 evidence to identify key aspects of prehabilitation within the treatment pathway.
• To provide recommendations for developing systematic approaches and clinical standards for prehabilitation.

Main Methods:

• Inclusion of Class 1 and 2 evidence to identify seven main aspects of prehabilitation.
• Analysis of risk assessment tools, exercise principles (FITT), outcome measures, nutrition, patient blood management, mental wellbeing, and economic potential.

Main Results:

• Recommended risk assessment tools include Risk Analysis Index, Charlson Comorbidity Index (CCI), ASA Score, and ECOG.
• Optimal exercise protocols involve 3-6 weeks of 3-4 sessions/week (30-60 min) of breathing exercises and moderate-to-high intensity intervals.
• The 6-Minute Walking Test is suitable for assessing aerobic capacity, while long-term outcomes include survival rates and morbidity reduction (up to 50%).

Conclusions:

• Prehabilitation offers significant potential for reducing morbidity and improving patient outcomes, with a favorable cost-revenue assessment.
• Standardized, validated tools and repeated assessments are crucial for effective prehabilitation.
• These recommendations form a toolbox for developing robust clinical prehabilitation standards.