Feasibility of a prehabilitation programme dedicated to older patients with cancer before complex medical–surgical procedures: the PROADAPT pilot study protocol

Abstract

BackgroundAgeing is associated with an increased prevalence of comorbidities and sarcopenia as well as a decline of functional reserve of multiple organ systems, which may lead, in the context of the disease-related and/or treatment-related stress, to functional deconditioning. The multicomponent ‘Prehabilitation & Rehabilitation in Oncogeriatrics: Adaptation to Deconditioning risk and Accompaniment of Patients’ Trajectories (PROADAPT)’ intervention was developed multiprofessionally to implement prehabilitation in older patients with cancer.MethodsThe PROADAPT pilot study is an interventional, non-comparative, prospective, multicentre study. It will include 122 patients oriented to complex medical–surgical curative procedures (major surgery or radiation therapy with or without chemotherapy). After informed consent, patients will undergo a comprehensive geriatric assessment and will be offered a prehabilitation kit that includes an advice booklet with personalised objectives and respiratory rehabilitation devices. Patients will then be called weekly and monitored for physical and respiratory rehabilitation, preoperative renutrition, motivational counselling and iatrogenic prevention. Six outpatient visits will be planned: at inclusion, a few days before the procedure and at 1, 3, 6 and 12 months after the end of the procedure. The main outcome of the study is the feasibility of the intervention, defined as the ability to perform at least one of the components of the programme. Clinical data collected will include patient-specific and cancer-specific characteristics.Ethics and disseminationThe study protocol was approved by the Ile de France 8 ethics committee on 5 June 2018. The results of the primary and secondary objectives will be published in peer-reviewed journals.Trial registration numberNCT03659123. Pre-results of the trial.

Exercise Training in Elderly Cancer Patients: A Systematic Review

“…Considering this evidence, over the years prehabilitation programs have been born to better prepare patients for cancer treatments, both surgical and medical [ 131 ]. Based on some studies that have demonstrated the feasibility of a prehabilitation program in geriatric patients with cancer [ 132 , 133 ], numerous studies are underway, in different disease settings, with the aim of demonstrating the effectiveness of a rehabilitation program before starting anti-cancer treatment. One is a multi-center study of over 700 patients which aims to demonstrate the efficacy of multimodal prehabilitation in cancer patients undergoing elective surgery for colorectal cancer [ 134 ].…”

Ovarian cancer in the older patient: where are we now? What to do next?

“…In addition, prehabilitation protocols could be adapted to the geriatric population, with the inclusion of specific geriatric interventions such as pharmaceutical optimization, bridging interventions for hospital-to-home transition, and by adapting the physical and nutritional rehabilitation programs to the specificities of the older patient. 73 – 75 Specific attention should be particularly paid to the adherence of the patient to the prehabilitation program, 76 but also of the surgical team to the enhanced recovery after surgery program.…”

Challenges in Geriatric Oncology—A Surgeon’s Perspective

“…A number of hopefully pivotal studies on prehabilitation are ongoing. The PROADAPT study led by Roche et al in France [ 57 ] is a prospective pilot study conducting both CGA and prehabilitation in 122 older adults planned for curative treatment. The PREHAB study based in Canada led by McIsaac et al [ 58 ] will randomise older patients having elective intra-abdominal or intra-thoracic cancer surgery to home-based exercises prehabilitation versus standard care.…”