PREHABILITATION IN ESOPHAGEAL CANCER CARE: WHAT MOVES THE PATIENT?

E. Reijneveld¹, J. Dronkers¹, E. van Adrichem², M. Velthuis³, S. Beijer³, J. Ruurda⁴, C. Veenhof^5,1

¹Utrecht University of Applied Sciences, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, ²Hanze University of Applied Sciences, School of Nursing, Groningen, Netherlands, ³Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands, ⁴University Medical Center Utrecht, Utrecht University, Department of Surgery, Utrecht, Netherlands, ⁵University Medical Center Utrecht, Department of Rehabilitation, Physiotherapy Science and Sport, Utrecht, Netherlands

Background: Prehabilitation programs are increasingly implemented in usual care pathways to optimize physical fitness before major oncological surgery and to improve postoperative outcomes. Previous research shows that adherence to prehabilitation programs during cancer treatment varies between patients. In addition, each patient group requires an intervention adapted to their specific situation. To optimize a preoperative intervention for patients with esophageal cancer, it is therefore important to have insight into factors that contribute to the participation of patients in a prehabilitation program, and to investigate the experiences of this specific patient group.

Purpose: A) To investigate which factors contribute to the participation of patients with esophageal cancer in a prehabilitation program and B) to investigate the experiences of patients after participation in the program.

Methods: This qualitative study included patients who finished a curative trajectory of neoadjuvant chemoradiotherapy and surgery for esophageal cancer and who were offered a prehabilitation program in the period between chemoradiotherapy and surgery. Patients followed the prehabilitation program as part of the usual care pathway, involving nutritional support by a dietician and a six-week training program under supervision of a primary care physical therapist. Semi-structured interviews were performed in the first year after surgery with twelve patients from five different hospitals. Data were analyzed using an inductive thematic analysis.

Results: Main themes identified were ‘attitudes’, ‘motivation’ and ‘experiences’ related to the prehabilitation program. All interviewed patients had a positive attitude towards the training program. Patients found it important to be physically fit before surgery to promote their postoperative recovery. Attitudes towards nutrition varied between patients. Some patients paid little attention to their diet because of the absence of nutritional problems. Other patients had such difficulty in achieving an adequate diet that patients ceased to pay attention to their nutrition. Main motivating factors to participate in the program were ‘a clear purpose (to get through surgery)’, which was consistently communicated by the different healthcare providers, ‘limited training period’ (six weeks), ‘supervision by healthcare providers’ and ‘mental support from family members’. Patients experienced an improved physical fitness after participation in the program, and felt better prepared for surgery. Some patients preferred to perform the training without supervision, because they already performed exercise before diagnosis or because they did not like supervised exercise in a training room. The intake of protein-rich foods and oral nutritional supplements was experienced as difficult by several patients.

Conclusions: This study shows that prehabilitation is acceptable and feasible for patients with esophageal cancer. Patients have a positive attitude towards a prehabilitation program. A clear purpose and support from healthcare providers and family members are key elements to motivate patients for participation in the program, resulting in the feeling of a better preparation for surgery.

Implications: In prehabilitation care, coordination of information by different healthcare providers is important to provide patients a clear purpose. Supervised training and active involvement of family members are recommended facilitating a personalized training program. Nutritional care may be optimized by a more frequent coaching.

Funding acknowledgements: This study was funded by the foundation ‘Vrienden Integrale Oncologische Zorg’.

Keywords:
Prehabilitation
Cancer
Exercise

Topics:
Oncology, HIV & palliative care
Disability & rehabilitation

Did this work require ethics approval? No

Reason: The prehabilitation program was designed as a quality improvement program for patients with esophageal cancer and the intervention (including measurements of physical fitness and nutritional status) was offered to patients as part of the standard of care in the participating hospitals. For this study, patients were asked once to participate in an interview of maximum 60 minutes, about their needs and experiences regarding the prehabilitation program. The burden of this research for patients was minimal, and therefore, the medical ethics committee advised that formal ethics approval was not required. Patients signed informed consent for the use of their data for scientific research.