Enhancing abdominal surgical outcomes for cancer patients through prehabilitation in a community setting

By NSW Regional Cancer Research Network (NSWRCRN) posted 13-12-2023 02:46 PM


Dr Jennifer Mackney, Clinical Specialist Physiotherapist (Perioperative medicine), respiratory scientist and honorary lecturer at the University of Newcastle, is based at John Hunter Hospital in Newcastle, New South Wales. Dr Mackney is the lead for prehabilitation services in the Hunter New England Local Health District (HNELHD) and is part of a clinical team that has advocated for and developed the exercise testing service to identify risk and facilitate optimisation for people preparing for major, high-risk surgeries in hospital.

Dr Mackney's research and clinical work has demonstrated that ‘prehabilitation’ – improving a patient’s function capability prior to surgery - significantly reduces the occurrence of complications after surgery and reduces hospital length of stay. Prehabilitation employs a holistic strategy that integrates exercise with psychological and nutritional support, increasing 'readiness’ and potentially yielding significant benefits for patients undergoing major surgery. These advantages include enhanced physical function and well-being, fewer complications after surgery, shorter hospital stays, and a reduction in the provision of unnecessary healthcare.

“The fitter individuals can be before they have surgery, the lower the risk of complications from their surgery. This highlights the importance of optimising fitness, nutrition, and psychological well-being in the lead-up to surgery,” Dr Mackney explains.

Although the benefits of prehabilitation are well-known, to date, prehabilitation is not available as a distinct program for patients through HNELHD, nor does Medicare cover the costs of prehabilitation activities. Components of prehabilitation like exercise, psychology, and nutrition are available in the community but are often disconnected, with many patients in NSW lacking equal access to prehabilitation services, particularly those in regional and rural areas.

Dr. Mackney seeks to bridge this knowledge and practice gap with her recent NSW Regional Cancer Research Network grant titled ‘Supported PRehabilitation – Improving fiTness, Ensuring well-being before Surgery in people living with cancer: acceptability and feasibility’ (C-SPRITES for short). The project is piloting a novel model for the delivery of a multi-modal prehabilitation programme for cancer patients in the lead up to their planned for abdominal surgery.

“Prehabilitation performed prior to abdominal surgery has been demonstrated to halve the risk of postoperative complications, hasten recovery and decrease hospital length of stay by 2 days. By avoiding complications one-year survival can also be improved” Dr Mackney highlights.

The foundation of Dr Mackney’s project stems from the transformative shift in surgical approaches that has taken place over the past two decades, which now emphasises the critical role of pre-surgery preparation in improving outcomes post-operatively.

Dr Mackney’s project targets the critical period between the end of chemotherapy and the surgical date, typically spanning 4 to 6 weeks. Her team is conducting an acceptability and a feasibility study, offering interventions to a small group to gather feedback, ensuring both manageability and for future refinement.

“Establishing a program that is accessible to all – no matter how close to health services they live – will improve cancer outcomes and increase survival. This type of intervention can be done anywhere, so is particularly relevant to those living in NSW regional communities, where there is limited access to certain health services,” Dr Mackney describes.

Leveraging the prehabilitation model developed by Dr Mackney and John Hunter Hospital's perioperative department, Dr Mackney’s project implements interventions using Fitbit devices and personalised physical activity goals. Additionally, the Kaden Centre at Warabrook plays a pivotal role, offering targeted exercise programs, including supervised high-intensity interval training for patients preparing for surgery.

Dr Mackney envisions her project as the inaugural step towards a translational research pathway, aiming to gather substantial evidence of its feasibility, acceptability, and impact to secure further funding for the next phase of this project.

The NSW Regional Cancer Research Network is funded by the Cancer Institute NSW through a Translational Cancer Research Capacity Building Grant and established through NSW Regional Health Partners.