Feasibility of Implementation and the Impact of a Digital Prehabilitation Service in Patients Undergoing Treatment for Oesophago-Gastric Cancer

Background: Home-based and supervised prehabilitation programmes are shown to have a positive impact on outcomes in patients with oesophago-gastric (OG) cancer. The primary aim of this study was to establish the feasibility of delivering a digital prehabilitation service. Methods: Patients undergoing treatment for OG cancer with curative intent were recruited into the study. During the COVID-19 pandemic, patients were offered a digital prehabilitation service. Following the lifting of COVID-19 restrictions, patients were also offered both a hybrid clinic-based in-person service and a digital service. Implementation and clinical metrics from the two prehabilitation models were compared. Results: 31 of 41 patients accepted the digital service (75%). Of the people who started the digital programme, 3 dropped out (10%). Compliance with the weekly touchpoints was 86%, and the median length of programme was 12 weeks. Twenty-six patients enrolled in the in-person service. Two patients dropped out (10%). Average compliance to weekly touchpoints was 71%, and the median length of programme was 10 weeks. In the digital group, sit to stand (STS) increased from 14.5 (IQR 10.5–15.5) to 16 (IQR 16–22); p = 0.02. Median heart rate recovery (HRR) increased from 10.5 (IQR 7.5–14) to 15.5 (IQR 11–20) bpm; p = 0.24. There was a significant drop in distress (median 3 (IQR 0–5) to 1 (IQR 0–2); p = 0.04) and a small drop in anxiety (median 3 (0–5) to 2 (0–3); p = 0.22). There was no difference in the postoperative complication rate and length of hospital stay between the two groups. Discussion: This study has shown that digital prehabilitation can be delivered effectively to patients with OG cancer, with high engagement and retention rates. We observed improvements in some physical and psychological parameters with the digital service, with comparable clinical outcomes to the in-person service.

[1]  T. Kowatsch,et al.  Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis , 2021, Journal of medical Internet research.

[2]  Stephen M. Schueller,et al.  Grand Challenges in Human Factors and Digital Health , 2021, Frontiers in Digital Health.

[3]  L. Fallowfield,et al.  Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives , 2020, Kompass Nutrition & Dietetics.

[4]  G. Hanna,et al.  The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison , 2020, Journal of Gastrointestinal Surgery.

[5]  S. Marzolini,et al.  Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World , 2020, medRxiv.

[6]  Wai Hoong Chang,et al.  Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study , 2020, BMJ Open.

[7]  G. Meyerowitz-Katz,et al.  Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis , 2020, Journal of medical Internet research.

[8]  R. Sanderman,et al.  Beating cancer‐related fatigue with the Untire mobile app: Results from a waiting‐list randomized controlled trial , 2020, Psycho-oncology.

[9]  Patricia A. H. Williams,et al.  Health literacy, digital health literacy, and the implementation of digital health technologies in cancer care: the need for a strategic approach. , 2020, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[10]  P. Scott,et al.  Digital health and care in pandemic times: impact of COVID-19 , 2020, BMJ Health & Care Informatics.

[11]  J. Silver,et al.  Prehabilitation Telemedicine in Neoadjuvant Surgical Oncology Patients During the Novel COVID-19 Coronavirus Pandemic. , 2020, Annals of surgery.

[12]  K. Moorthy,et al.  Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients , 2020, Journal of Gastrointestinal Surgery.

[13]  A. Chang,et al.  Benchmarking Complications Associated with Esophagectomy , 2017, Annals of surgery.

[14]  Alessandro Blasimme,et al.  Elements of Trust in Digital Health Systems: Scoping Review , 2018, Journal of medical Internet research.

[15]  M. Rubio-Valera,et al.  Reasons for dropout from cardiac rehabilitation programs in women: A qualitative study , 2018, PloS one.

[16]  M. Schluchter,et al.  Short Physical Performance Battery, usual gait speed, grip strength and Vulnerable Elders Survey each predict functional decline among older women with breast cancer. , 2017, Journal of geriatric oncology.

[17]  K. Winters-Stone,et al.  A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005‐2017) , 2017, PM & R : the journal of injury, function, and rehabilitation.

[18]  L. Feldman,et al.  Surgical Prehabilitation in Patients with Cancer: State-of-the-Science and Recommendations for Future Research from a Panel of Subject Matter Experts. , 2017, Physical medicine and rehabilitation clinics of North America.

[19]  Ann Blandford,et al.  Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis , 2016, Translational behavioral medicine.

[20]  J. Trachtenberg,et al.  Enablers and barriers in delivery of a cancer exercise program: the Canadian experience. , 2015, Current oncology.

[21]  Arnulf H Hölscher,et al.  International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy: Esophagectomy Complications Consensus Group (ECCG). , 2015, Annals of surgery.

[22]  F. Berrino,et al.  Exercise training improves heart rate recovery in women with breast cancer , 2015, SpringerPlus.

[23]  J. Lagergren,et al.  Early Complications Following Oesophagectomy for Cancer in Relation to Long-Term Healthcare Utilisation: A Prospective Population-Based Cohort Study , 2015, PloS one.

[24]  N. Altorki,et al.  Outcomes in the management of esophageal cancer , 2014, Journal of surgical oncology.

[25]  L Vogt,et al.  Validity of the Six-Minute Walk Test in Cancer Patients , 2013, International Journal of Sports Medicine.

[26]  J. Lagergren,et al.  Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study. , 2012, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[27]  Richard W. Bohannon Test-Retest Reliability of the Five-Repetition Sit-to-Stand Test: A Systematic Review of the Literature Involving Adults , 2011, Journal of strength and conditioning research.

[28]  A. Mitchell,et al.  Can the Distress Thermometer be improved by additional mood domains? Part I. Initial validation of the Emotion Thermometers tool , 2010, Psycho-oncology.

[29]  J. Byles,et al.  Equity of access to cardiac rehabilitation: the role of system factors , 2010, International journal for equity in health.

[30]  P. Abete,et al.  Exercise-based cardiac rehabilitation improves heart rate recovery in elderly patients after acute myocardial infarction. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[31]  S. Grace,et al.  Patient preferences for home-based versus hospital-based cardiac rehabilitation. , 2005, Journal of cardiopulmonary rehabilitation.

[32]  K. Courneya,et al.  Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors , 2004 .

[33]  B. Ainsworth,et al.  International physical activity questionnaire: 12-country reliability and validity. , 2003, Medicine and science in sports and exercise.

[34]  K. Courneya Exercise Interventions During Cancer Treatment: Biopsychosocial Outcomes , 2001, Exercise and sport sciences reviews.