The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

Abstract

Patients awaiting cancer treatment were classified as “vulnerable” and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.

Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study

“…Future feasibility work could explore approaches which allow for more accurate prescription and monitoring, such as repetitions in reserve or using 1-RM prediction calculations [ 78 , 79 ]. Other internet-based exercise programmes did not use live telehealth group calls, and instead provided thorough instructions for exercises, delivered either in-person or online, which patients would perform unsupervised at home [ 80 , 81 ].…”

Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

“…Evidence from interviews among patients who underwent major abdominal surgery for cancer demonstrated that many patients prefer home-based prehabilitation (Ferreira et al 2018 ; Beck et al 2022 ). A home-based approach offers safety for patients who experience nausea, diarrhea, or physiological issues (Beck et al 2022 ), provides flexibility towards medical/personal commitments (Wu et al 2021 ), resolves transportation issues (Wu et al 2021 ), and enhances social support (Wu et al 2021 ). In addition, home-based prehabilitation enables patients to combine prehabilitation with practical tasks and social activities of everyday life that are perceived as meaningful in the often short and stressful period between cancer diagnosis and treatment (Beck et al 2022 ).…”

“…Evidence in patients with musculoskeletal conditions suggests that, compared to classic unsupervised home-based programs, tele-monitoring can improve adherence (Lambert et al 2017 ). To date, a few studies have investigated the feasibility of home-based tele-prehabilitation programs prior to colorectal cancer surgery (Wu et al 2021 ; Bruns et al 2019 ), and concluded that tele-prehabilitation was feasible, appreciated by patients, and has the potential to improve physical fitness. However, these studies (Wu et al 2021 ; Bruns et al 2019 ) failed to report full feasibility as adherence to the physical exercise training’s frequency, intensity, and time was lacking.…”

“…To date, a few studies have investigated the feasibility of home-based tele-prehabilitation programs prior to colorectal cancer surgery (Wu et al 2021 ; Bruns et al 2019 ), and concluded that tele-prehabilitation was feasible, appreciated by patients, and has the potential to improve physical fitness. However, these studies (Wu et al 2021 ; Bruns et al 2019 ) failed to report full feasibility as adherence to the physical exercise training’s frequency, intensity, and time was lacking. Moreover, none of these studies (Wu et al 2021 ; Bruns et al 2019 ) specifically included patients at high risk for postoperative complications determined by preoperative cardiopulmonary exercise testing (CPET).…”

Considerations for multimodal prehabilitation in women with gynaecological cancers: a scoping review using realist principles

“…The coronavirus pandemic has accelerated the trend towards remotely delivered interventions, and several of the ongoing trials identified in this review utilise home-based prehabilitation models. Completed studies suggest that home-based multimodal prehabilitation is feasible and leads to improvements in a range of outcomes [ 51 ]. However, findings from qualitative studies reveal the importance of accessible support and supervision as a motivator, either through an opportunity to meet others face to face or to monitor and encourage patients to keep on track with their prehabilitation goals.…”