PMID- 36972114 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230428 IS - 1929-0748 (Print) IS - 1929-0748 (Electronic) IS - 1929-0748 (Linking) VI - 12 DP - 2023 Mar 27 TI - Prehabilitation Before Gastrointestinal Cancer Surgery: Protocol for an Implementation Study. PG - e41101 LID - 10.2196/41101 [doi] LID - e41101 AB - BACKGROUND: Surgery remains the standard curative treatment for early-stage colorectal and upper gastrointestinal cancer. Reduced preoperative functional capacity, nutritional status, and psychological well-being are associated with poor postoperative outcomes. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and psychological interventions. Yet, how it transitions from a trial setting to being integrated into a real-world health setting is unknown. OBJECTIVE: The primary aim is to evaluate the implementation of a multimodal (supervised exercise, nutrition, and nursing support) prehabilitation program into standard care for patients with gastrointestinal cancer (colorectal and upper gastrointestinal cancer) scheduled for curative intent surgery. The secondary aim is to determine the impact of a multimodal prehabilitation program on functional capacity, nutritional and psychological status, and surgical outcomes. METHODS: This is an implementation study that will investigate a multimodal prehabilitation intervention, in a nonblinded, nonrandomized, single-group, pre-post design. Patients diagnosed with colorectal and upper gastrointestinal cancer scheduled for potentially curative intent surgery at Concord Repatriation General Hospital, with >/=14 intervention days prior to surgery and are medically cleared to exercise will be eligible. The study will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Evaluation Framework. RESULTS: The protocol was approved in December 2019 by the Concord Repatriation General Hospital Human Research Ethics Committee (reference number 2019/PID13679). Recruitment commenced in January 2020. In response to the COVID-19 pandemic, recruitment was paused in March 2020 and reopened in August 2020 with remote or telehealth intervention adaptations. Recruitment ended on December 31, 2021. Over the 16-month recruitment period, a total of 77 participants were recruited. CONCLUSIONS: Prehabilitation represents an opportunity to maximize functional capacity and improve surgical outcomes. The study will provide guidance and contribute to the evidence on the integration of prehabilitation into standard care using adaptive models of health care delivery including telehealth. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTR 12620000409976; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378974&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/41101. CI - (c)Kristy-Lee Raso, Michael Suen, Jane Turner, Sonia Khatri, Yanlan Lin, Carolyn Wildbore, Guillermo Becerril-Martinez, Philip Le Page, Sim Yee Tan, Sam Egger, Janette Vardy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 27.03.2023. FAU - Raso, Kristy-Lee AU - Raso KL AUID- ORCID: 0000-0001-8525-9721 AD - Department of Nutrition and Dietetics, Concord Repatriation General Hospital, Concord, Australia. AD - Sydney Medical School, University of Sydney, Sydney, Australia. FAU - Suen, Michael AU - Suen M AUID- ORCID: 0000-0003-3215-0532 AD - Sydney Medical School, University of Sydney, Sydney, Australia. AD - Department of Colorectal Surgery, Concord Repatriation General Hospital, Concord, Australia. FAU - Turner, Jane AU - Turner J AUID- ORCID: 0000-0001-6423-4998 AD - Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia. FAU - Khatri, Sonia AU - Khatri S AUID- ORCID: 0000-0002-3799-1974 AD - Department of Colorectal Surgery, Concord Repatriation General Hospital, Concord, Australia. AD - Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia. FAU - Lin, Yanlan AU - Lin Y AUID- ORCID: 0000-0002-0968-9292 AD - Department of Colorectal Surgery, Concord Repatriation General Hospital, Concord, Australia. FAU - Wildbore, Carolyn AU - Wildbore C AUID- ORCID: 0000-0002-1035-1432 AD - Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia. AD - Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, Australia. FAU - Becerril-Martinez, Guillermo AU - Becerril-Martinez G AUID- ORCID: 0000-0001-5023-6386 AD - Sydney Medical School, University of Sydney, Sydney, Australia. AD - Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, Australia. FAU - Le Page, Philip AU - Le Page P AUID- ORCID: 0000-0002-0064-2471 AD - Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, Australia. FAU - Tan, Sim Yee AU - Tan SY AUID- ORCID: 0000-0002-8188-9395 AD - Department of Nutrition and Dietetics, Concord Repatriation General Hospital, Concord, Australia. AD - Sydney Medical School, University of Sydney, Sydney, Australia. AD - Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia. FAU - Egger, Sam AU - Egger S AUID- ORCID: 0000-0003-1808-6909 AD - The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, Australia. FAU - Vardy, Janette AU - Vardy J AUID- ORCID: 0000-0002-5739-5790 AD - Sydney Medical School, University of Sydney, Sydney, Australia. AD - Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia. LA - eng PT - Journal Article DEP - 20230327 PL - Canada TA - JMIR Res Protoc JT - JMIR research protocols JID - 101599504 PMC - PMC10131732 OTO - NOTNLM OT - cancer OT - colorectal OT - exercise OT - gastrointestinal OT - nutrition OT - prehabilitation OT - psychological OT - surgery OT - telehealth COIS- Conflicts of Interest: The Concord Repatriation General Hospital Dietetics department and KLR discloses that funding was received for a part-time wage for 1 year from Fresenius Kabi to support the study. EDAT- 2023/03/28 06:00 MHDA- 2023/03/28 06:01 PMCR- 2023/03/27 CRDT- 2023/03/27 11:54 PHST- 2022/07/15 00:00 [received] PHST- 2022/11/18 00:00 [accepted] PHST- 2022/11/03 00:00 [revised] PHST- 2023/03/28 06:01 [medline] PHST- 2023/03/27 11:54 [entrez] PHST- 2023/03/28 06:00 [pubmed] PHST- 2023/03/27 00:00 [pmc-release] AID - v12i1e41101 [pii] AID - 10.2196/41101 [doi] PST - epublish SO - JMIR Res Protoc. 2023 Mar 27;12:e41101. doi: 10.2196/41101.