Cancers (Mar 2022)

Feasibility of a Multimodal Prehabilitation Programme in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: A Pilot Study

  • Berta Diaz-Feijoo,
  • Nuria Agusti-Garcia,
  • Raquel Sebio,
  • Antonio López-Hernández,
  • Marina Sisó,
  • Ariel Glickman,
  • Nuria Carreras-Dieguez,
  • Pere Fuste,
  • Tiermes Marina,
  • Judit Martínez-Egea,
  • Laura Aguilera,
  • Juan Perdomo,
  • Amaia Pelaez,
  • Manuel López-Baamonde,
  • Ricard Navarro-Ripoll,
  • Elena Gimeno,
  • Betina Campero,
  • Aureli Torné,
  • Graciela Martinez-Palli,
  • María J. Arguis

DOI
https://doi.org/10.3390/cancers14071635
Journal volume & issue
Vol. 14, no. 7
p. 1635

Abstract

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Introduction: Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We aimed to evaluate the feasibility and postoperative impact of a multimodal prehabilitation programme in AOC patients undergoing surgery. Methods: This single-centre, before-and-after intervention pilot study included 34 patients in two cohorts: the prehabilitation cohort prospectively included 15 patients receiving supervised exercise, nutritional optimisation, and psychological preparation from December 2019 to January 2021; the control cohort included 19 consecutive patients between January 2018 and November 2019. Enhanced Recovery After Surgery guidelines were followed. Results: The overall adherence to the multimodal prehabilitation programme was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimisation, and 80% adherence to psychological preparation. The median hospital stay was shorter in the prehabilitation cohort (5 (IQR, 4–6) vs. 7 days (IQR, 5–9) in the control cohort, p = 0.04). Differences in postoperative complications using the comprehensive complication index (CCI) were not significant (CCI score: 9.3 (SD 12.12) in the prehabilitation cohort vs. 16.61 (SD 16.89) in the control cohort, p = 0.08). The median time to starting chemotherapy was shorter in the prehabilitation cohort (25 (IQR, 23–25) vs. 35 days (IQR, 28–45) in the control cohort, p = 0.03). Conclusions: A multimodal prehabilitation programme before cytoreductive surgery is feasible in AOC patients with no major adverse effects, and results in significantly shorter hospital stays and time to starting chemotherapy.

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