WHAT IS CANCER PREHABILITATION?
Cancer prehabilitation is the process of care that we
initiate before surgery or treatment for cancer.
It consists of a series of assessments and interventions
initiated before the cancer treatment (e.g., surgery, chemotherapy or radiotherapy) with the goals of improving the patient's health and fitness. It facilitates post-treatment recovery and helps the patient to tolerate adjuvant treatment better, reducing the chance of treatment disruption or termination.
BENEFITS OF CANCER PREHABILITATION
There is an increasing proportion of surgical patients
who are considered high risk due to advanced age
and the presence of frailty or multiple comorbidities,
making them more likely to have postoperative
complications, protracted functional recovery and
mortality. The traditional approach is to rehabilitate these
patients postoperatively after functional decline has
set in.
However, in recent years, there has been a paradigm
shift towards preparing patients pre-emptively
prior to cancer treatment – which allows improved
postoperative functional recovery, reduced postoperative
complications and shortened length of
hospital stay.
Recent studies and systematic reviews1 have supported
the evidence of these benefits, on top of improving psychological well-being and quality of life measures.
Figure 1a Prevalence of cancer among males in Singapore2
Figure 1b Prevalence of cancer among females in Singapore2
Home-Based Cancer Prehabilitation Programme
at Changi General Hospital
One-stop initiative with reduced hospital visits
Prehabilitation programmes typically target four
major domains: medical optimisation, physical
activity, nutrition and mental health; and usually
require multiple visits to see various healthcare
professionals based on their specialised domain (e.g.,
doctor, physiotherapist, dietitian and mental health
professional).
At Changi General Hospital (CGH), our home-based
cancer prehabilitation programme consists of a one-stop
screen-and-intervene initiative3, which reduces
the time spent in the hospital and allows patients to
focus fully on the various domains of prehabilitation to
reap its benefits prior to treatment.
Personalised intervention plans
Patients are scheduled for visits to a prehabilitation
coordinator and rehabilitation physician on the same day, after their visit to the surgeon. They undergo
a holistic health assessment comprising frailty,
functional and mental wellness tests by the
prehabilitation coordinator.
Based on the results and their medical conditions,
the rehabilitation physician draws up a personalised
intervention plan. The rehabilitation physician is a
specialist who manages both medical and functional
issues. He is certified in exercise prescription, and
through focused cross-training by the dietitian and
psychologist, is able to intervene in multiple domains.
This allows patients’ existing chronic conditions to
be optimised while they receive dietary and mental
health advice, as well as a personalised exercise
prescription.
Empowering patients to take charge of
their health
To empower patients to take charge of their health at
home, the exercise prescription is easily accessible
via the Cancer Prehabilitation Exercise Diary on the
Health Buddy app. Within the diary, there are exercise
videos, reminders and an exercise log.
During the consultation, the prehabilitation coordinator
will guide the patient and their caregivers on using the
app to watch and follow their customised exercises,
according to the rehabilitation physician’s prescription.
Follow-up and support – from hospital to home
Our prehabilitation team continues to care for and
support the patient throughout the entire continuum of
recovery, from hospital to home. The prehabilitation
coordinator follows up with phone calls and a
preoperative follow-up clinic visit.
The patient is reviewed inpatient after the surgery
and three months post-surgery. The eventual aim is
to transit them to community-based resources such as Active SG or Active Health Lab to sustain the healthy
lifestyle changes initiated prior to cancer treatment.
THE CGH COLORECTAL CANCER
PREHABILITATION PILOT STUDY
In a pilot study of some 60 colorectal cancer patients
conducted from January 2020 to June 2021, the
patients who have undergone prehabilitation showed
statistically significant improvements in several
domains. These include functional capacity as
measured by the 6-minute walk test, mental health
as measured by the Hospital Anxiety and Depression Scale and EQ-5D questionnaires.
Compared to historical data, this group of patients
went home 1.5 days earlier and the 30-day
readmission and mortality rates were reduced.
The prehabilitation programme has been expanded
to include prostate, bladder, liver, biliary, pancreatic,
oesophagus and gastric cancer patients planned for
surgery at CGH.
To refer cancer patients who are awaiting surgery, chemotherapy or radiotherapy and would like to be
enrolled in a prehabilitation programme, please contact the prehabilitation coordinator to find out the patients’
suitability:
Tel: 6936 6452
Email: [email protected] |
Our Care Team
Clin Asst Prof Tay San San
Chief & Senior Consultant,
Dept of Rehabilitation Medicine
Clin Asst Prof Kwok Kah Meng
Consultant,
Dept of Rehabilitation Medicine
Dr Li Yiding
Associate Consultant,
Dept of Rehabilitation Medicine
Dr Insali Soe
Resident Physician,
Dept of Rehabilitation Medicine
Mr Christopher De Conceicao Paul
Prehabilitation Coordinator,
Dept of Rehabilitation Medicine
Ms Lina Jia
Nurse Clinician,
Dept of Rehabilitation Medicine
REFERENCES
Perry R, Herbert G, Atkinson C, England C, Northstone K, Baos S, Brush T, Chong A, Ness A, Harris J, Haase A, Shah S, Pufulete M. Pre-admission interventions (prehabilitation)to improve outcome after major elective surgery: a systematic review and meta-analysis. BMJ Open. 2021 Sep 30;11(9):e050806.
Singapore Cancer Registry Annual Report 2019
San San, Tay & Kah Meng, Kwok. (2021). Setting Up A Cancer Prehabilitation Framework in Singapore. 10.48252/JCR5.
