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Making patients fit for surgery

introducing a four pillar multimodal prehabilitation program in colorectal cancer

van Rooijen, Stefanus J.1; Molenaar, Charlotte J.L.1; Schep, Goof2; van Lieshout, Rianne H.M.A.3; Beijer, Sandra4; Dubbers, Rosalie5; Rademakers, Nicky5; Papen-Botterhuis, Nicole E.1; van Kempen, Suzanne6; Carli, Francesco7; Roumen, Rudi M.H.1; Slooter, Gerrit D.1

American Journal of Physical Medicine & Rehabilitation: May 13, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001221
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Background Considering the relation between preoperative functional capacity and postoperative complications, enhancing a patients functional capacity prior to surgery with a prehabilitation program may facilitate faster recovery and improve quality of life. However, time before surgery is short, mandating a multimodal and high-intensity training approach. This study investigated feasibility and safety of a prehabilitation program for colorectal cancer.

Methods Multimodal prehabilitation was offered to patients eligible for participation. They were assigned to an intervention or control group by block randomisation. The prehabilitation program consisted of four interventions: in-hospital high-intensity endurance and strength training, high-protein nutrition, smoking cessation and psychological support. Program attendance, patient satisfaction, adverse events and functional capacity were determined.

Results Fifty patients participated in this study (prehabiilitaiton 20, control 30). Program evaluation revealed a high (90%) attendance rate and high level of patient satisfaction. No adverse events occurred. Endurance and/or strength were improved. 86% of patients with prehabilitation recovered to their baseline functional capacity 4 weeks post-operatively, 40% in the control group (p<0.01).

Conclusions Multimodal prehabilitation including high-intensity training for colorectal cancer patients is feasible, safe and effective. A randomized controlled trial (NTR5947) was initiated to determine whether prehabilitation may lower morbidity and mortality rates in colorectal surgery.

1Department of Surgical Oncology, Máxima Medical Center, Veldhoven, the Netherlands

2Department of Sports Medicine, Máxima Medical Center, Veldhoven, the Netherlands

3Department of Nutrition, Máxima Medical Center, Veldhoven, the Netherlands

4Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands

5Department of Psychology, Máxima Medical Center, Veldhoven, the Netherlands

6Department of Physiotherapy, Máxima Medical Center, Veldhoven, the Netherlands

7Department of Anesthesiology, the Montréal General Hospital, McGill University, Montréal, Canada

Corresponding author + request for reprints: S.J. van Rooijen MD PhD, Máxima Medical Center, Department of Surgery, P.O. Box 7777, Veldhoven, the Netherlands, stefanvanrooijen@msn.com / prehab.resurge@mmc.nl

This pilot was financially supported (MMC2620) by the National Foundation against Cancer (Nationaal Fonds tegen Kanker). FrieslandCampina provided the Refit®TMP 90 Shakes. The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results.

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