Cost-effectiveness of a technology-supported multimodal prehabilitation program in moderate-to-high risk patients undergoing lung cancer resection: randomized controlled trial protocol

Abstract

Background: Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients' functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality are needed to clarify the benefits of prehabilitation. The main aim of the current protocol is to evaluate the cost-effectiveness of a multimodal prehabilitation program supported by information and communication technologies in moderate-to-high risk lung cancer patients undergoing thoracic surgery. Methods: A Quadruple Aim approach will be adopted, assessing the prehabilitation program at the following levels: i) Patients' and professionals' experience outcomes (by means of standardized questionnaires, focus groups and structured interviews); ii) Population health-based outcomes (e.g. hospital length of stay, number and severity of postoperative complications, peak oxygen uptake and levels of systemic inflammation); and, iii) Healthcare costs. Discussion: This study protocol should contribute not only to increase the scientific basis on prehabilitation but also to detect the main factors modulating service adoption.

Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review

“…Each study used a different method for nutritional assessment, with most studies using a combination of various nutritional assessment tools, parameters, and indicators. The most commonly used tools to screen or assess for malnutrition were Subjective Global Assessment/Patient-Generated-Subjective Global Assessment ( 8 , 27 , 31 , 35 , 51 ), Nutrition Risk Screening-2002 ( 8 , 19 , 51 , 52 ), Mini Nutritional Assessment ( 23 , 28 , 40 , 41 ), Simplified Nutritional Appetite Questionnaire ( 23 , 37 , 41 ), and Malnutrition Universal Screening Tool ( 22 , 46 ). The most common nutritional parameters were pre-albumin or albumin ( 18 , 19 , 23 , 34 , 38 , 41 , 46 ), which were reported by 19% ( n = 7) of studies as a nutritional parameter [although, it is not considered to robustly reflect nutritional status in patients with cancer ( 54 )], and 27% ( n = 10) reported use of food records or recalls ( 8 , 18 , 27 , 34 , 35 , 48 – 51 , 53 ).…”

“…In most cases, the cut-points or criteria for nutritional risk or diagnosis of a nutrition problem requiring treatment (e.g., malnutrition) were not specified. Only 16% ( n = 6) of studies specified their diagnostic criteria rather than cut-points ( 22 , 23 , 28 , 40 , 44 , 46 ).…”

“…As an example, “Usual care for all participants included review by specialist dietitians if they were struggling nutritionally ( 20 ).” Little more than half ( n = 21) of the prehabilitation studies with a nutrition treatment component specified a goal for the nutrition intervention; of these, 67% ( n = 14) referenced the stated goals and only 43% ( n = 9) used a reference standard or accepted guideline, including European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines ( 8 , 21 , 25 , 35 , 48 – 51 , 53 ). Most goals were related to meeting estimated protein needs ( 8 , 22 , 25 , 27 , 28 , 31 , 35 , 37 , 48 , 51 , 53 ) or meeting estimated energy and protein needs ( 19 , 21 , 23 , 39 , 41 , 49 , 50 ). Protein needs were estimated at 1.2–2.0 g/kg/day and energy needs were estimated using 25–30 kcal/kg/day, indirect calorimetry, Harris Benedict equation, or WHO formula.…”

The Role of Behavioral Science in Personalized Multimodal Prehabilitation in Cancer

“…While many recent and ongoing trials do not include reference to behavior change support there are notable exceptions. Barberan-Garcia et al ( 2020 ) describe a personalized program to promote physical activity in moderate-to-high risk lung cancer patients undergoing thoracic surgery. They report inclusion of behavior change strategies including self-monitoring; comparison of behavior with goal; a daily motivational message; positive reinforcement once a goal is achieved; and provision of educational material.…”

“…In addition, the cognitive behavioral therapy included in the program aims to “reinforce patients' motivation. and to foster patients' engagement for healthy lifestyles” p. 4 (Barberan-Garcia et al, 2020 ). Furthermore, in an ongoing trial described by McCourt et al ( 2020 ) the role of behavioral science is explicitly described.…”