Multimodal Prehabilitation in Patients with Non-Small Cell Lung Cancer Undergoing Anatomical Resection: Protocol of a Non-Randomised Feasibility Study

Abstract

BackgroundThe preoperative period can be used to enhance a patient’s functional capacity with multimodal prehabilitation and, consequently improve and fasten postoperative recovery. Especially non-small cell lung cancer (NSCLC) surgical patients may benefit from this intervention, since the affected and resected organ is an essential part of the cardiorespiratory fitness. Drafting a prehabilitation programme is a challenge, since many disciplines are involved, and time between diagnosis of NSCLC and surgery is limited. We designed a multimodal prehabilitation programme prior to pulmonary surgery and conduct a study to assess feasibility and efficacy of the programme. Publication of this protocol may help other health care facilities to implement such a programme. MethodsThe multimodal prehabilitation programme consists of an exercise programme, nutritional support, mental support, smoking cessation programme, patient empowerment and respiratory optimisation. In two Dutch teaching hospitals, 40 adult patients with proven or suspected NSCLC will be included. In a non-randomised fashion, 20 patients follow the multimodal prehabilitation programme and 20 will be assessed in the control group, according to patient preference. Assessments take place at four time points: baseline, week before surgery, six weeks postoperatively and three months postoperatively. Feasibility and efficacy of the prehabilitation programme will be assessed as primary outcomes. DiscussionSince the time between diagnosis of NSCLC and surgery is limited, it is a challenge to implement a prehabilitation programme. This study will assess whether this is feasible and effective. The non-randomised fashion of the study might result in a selection bias. However, the control group is necessary, to put the prehabilitation group in perspective and to assess feasibility further. By publishing this protocol of our feasibility study, we aim to facilitate others to evaluate and implement a multimodal prehabilitation programme for surgical lung cancer patients.Trial registrationThis feasibility study is registered as NL8080 in the Netherlands Trial Register on the 10th of October 2019, https://www.trialregister.nl/trial/8080. Secondary identifiers: CCMO (Central Committee on Research Involving Human Subjects) number NL70578.015.19, reference number of the Medical Ethical Review Committee of Máxima MC W19.045.