Multidisciplinary Prehabilitation Reduces Hospitalization Time and Suggests Improved Survival in Patients with...

Lung cancer is the commonest cause of cancer death worldwide. Treatment efficacy is improving, but treatment rates remain low. We aimed to assess the impact of tri-modality early prehabilitation (single in-person interventions by a senior doctor in palliative/supportive care, physiotherapist and dietitian) on patients with a radiological diagnosis of lung cancer.

Patients were approached as soon as they were told they had a radiological diagnosis of lung cancer. Prehabilitation took place in parallel with a patient's investigative pathway for lung cancer. Routine data for admissions and survival was assessed retrospectively for prehabilitation patients and compared to an appropriate group of historical controls.

A total of 97 patients with stage 3 or 4 lung cancer underwent prehabilitation and were compared to 199 historical controls. There were no obvious statistical differences in gender or age between the cohorts. There was a trend towards reduced mean length of stay (LOS) from 7.6 days to 2.6 days in the patients who underwent all three interventions and from 7.6 days to 3 days in all comers (p = 0.053), with a significantly shorter admission in those who were admitted (p = 0.0014). There was a reduction in time spent in hospital from 486 days to 172 days per 100 patients receiving prehabilitation (a saving of 3.1 days per patient participating). Survival appeared to improve 6 months after diagnosis, at 61% in the prehabilitation cohort (95% CI: 51.8-72.0%, p = 0.029) vs. 47.7% in the historical controls (95% CI: 41.3-55.2%, p = 0.029). Life-prolonging treatment rates in stage 4 disease increased from 26% to 42% and all-comer best supportive care rates reduced from 45% to 28%.

Early prehabilitation appears to reduce time spent in hospital. It may also improve treatment rates and short-term survival in patients being investigated for lung cancer.