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A prehabilitation coordinator conducts a sit-to-stand assessment on a patient to assess their suitability for the hospital's home-based prehabilitation program. PHOTO: CHANGI GENERAL HOSPITAL
SINGAPORE - Newly diagnosed cancer patients awaiting surgery can now do their pre-operation prehabilitation at home, thanks to a new programme by Changi General Hospital (CGH).
Prehabilitation is a process of care initiated before a patient receives cancer treatment or surgery. This is done in order to facilitate and optimise the patient's return to health following treatment.
After consultation with the surgeon, patients undergo frailty, functional, and mental wellness tests performed by a prehabilitation coordinator, who then draws up a personalised intervention plan that includes exercise prescriptions as well as advice relating to nutrition and mental wellness.
In the case of CGH's home-based programme, the hospital offers a one-stop solution in order to reduce the number of patient visits for pre-operation assessment and subsequently to allow patients to do their prehabilitation in the comfort of their homes.
This eliminates the need for patients to make multiple visits to the hospital as, typically, they are referred to various allied health practitioners by surgeons for prehabilitation, which may occur on different days, and takes time.
However, under the new framework, most patients will need only two appointments - one for the first consultation and the other before treatment starts.
According to clinical assistant professor Tay San San, chief of CGH's department of rehabilitation, prehabilition offers several benefits to patients undergoing surgery for cancer.
"Prehabilitation reduces the risk of post operative complications, re-admissions and dying and also improves the recovery of their daily function and fitness.
"In patients who need chemotherapy after their surgery, we have increased their ability to tolerate the side effects," said Dr Tay.
Started as a pilot study in January 2020 before the onset of the Covid-19 pandemic, 59 patients were enrolled over a period of 18 months.
The pilot was only open to patients who were suffering colorectal cancer.
As at mid-January this year, close to 200 patients have undergone CGH's home-based prehabilitation.
One such patient was 64-year old Goh Tong Nang, who was diagnosed with stage 1 colorectal cancer in March last year and underwent surgery in April.
"When I was diagnosed with cancer, I was worried and scared. I used to run 5km several times a week and I did not think I'd be doing it after my surgery," said the retiree who used to work in the manufacturing industry.
During his first cancer prehabilitation appointment, Mr Goh remembers undergoing physical assessments and being taught physical exercises by a rehabilitation specialist, who also advised him to include more protein in his diet and shared anxiety reduction strategies.
Dr Tay said that the home-based programme was especially useful over the course of the pandemic.
She added: "Despite the pandemic, our cancer patients have been able to undergo cancer prehabilitation in the safety and comfort of their homes with minimal disruption due to the home-based model of this programme."
Dr Navin Kuthiah, a medical consultant at Woodlands Health who specialises in perioperative medicine - the care of patients before and after surgery - said that there were pros and cons to home-based prehabilitation.
"Non-compliance is a challenge because patients might not adhere to the advice as they are unsupervised.
"While centre-based prehab provides a more conducive environment with the necessary equipment, patients who are accessed to be fit for home-based prehab help to reduce costs and the strain on medical resources," said Dr Kuthiah.
Dr Tay said that following the success of the prehabilitation pilot, the service has been expanded to include patients suffering from other forms of cancer, such as pancreatic cancer, oesophagal cancer and liver cancer.
"We put this expansion of care under a cancer prehabitilation framework by adopting the same core workflow but also looking at the specific needs of this different groups of patients," she said.