Background: Surgery remains the primary treatment for colorectal cancer (CRC).
Aim: Determine the feasibility of a short-term, multimodal prehabiliation program in patients with stage I-III CRC awaiting surgery.
Methods: Adults scheduled for elective CRC resection at Concord Hospital were recruited from Pre-admission clinic. Intervention: 2-4 week program of i) supervised exercise sessions (2/week); ii) nurse phone support (2/week); iii) written nutritional information. Assessments: baseline and pre-surgery. Primary outcome was adherence to intervention. Secondary outcomes: exercise levels, functional status, body composition, nutritional status, Patient Reported Outcomes, participant experience.
Results: In total, 22 of 34 (65%) eligible patients were recruited from January-November 2018: median age 73 (56-86) years, 55% male. Six (28%) were non-English speaking and required an interpreter. At baseline: 15 participants were overweight/obese; and 19 had 1+ comorbidity. Median intervention length was 11.5 days (range 7-29). Participants attended 79% of exercise sessions (range 33-100%, mean 3.5 sessions) and 66% of nurse support calls (range 0-100%, mean 2.6 sessions). Between baseline and surgery, participants reported increasing mean unsupervised moderate exercise from 17 (range 0-210) to 73 minutes/week (range 0-276) and mean vigorous exercise from 0 to 24 minutes/week (range 0-300). Unsupervised resistance exercise sessions increased from 0.6 (range 0-7) to 2.6/week (range 0-7). Mean 6-minute walk test distance increased by 48metres (435m to 483m) and 30-second chair stand by 1.6 repetitions.
Post-intervention, no changes were seen in body composition (fat mass, fat free mass, skeletal muscle mass) and nutritional variables. Waist circumference reduced (mean 0.8cm). Small improvements were seen in global quality-of-life (6.8%), fatigue, physical functioning. All participants were satisfied/strongly satisfied with the program and would recommend to others.
Conclusion: Patients awaiting elective CRC surgery can successfully attend a multimodal prehabilitation program. The program enabled positive changes in exercise levels and aerobic fitness.