A pioneering project that requires cancer patients to get fit and lose weight before surgery has delivered significant improvements in care.
Patients spend far less time recovering in hospital, are less prone to post-operative infections such as pneumonia and “get their life back” more quickly.
They are given FitBit-style devices to monitor their activity and advice on how to change their diet and lifestyle, including help to quit smoking. Surgery can be postponed if patients fail to respond.
The project at Imperial College Healthcare has won multiple awards and is set to be rolled out to other NHS trusts and a hospital in the Netherlands.
The PREPARE for Surgery project was set up by clinical nurse specialist Venetia Wynter-Blyth, a RCNi nurse of the year, for gastro-oesophagael cancer after a grant of almost £100,000 from Imperial Health Charity. It is due to expand to liver, pancreatic and lung cancers.
About 70 patients have completed the scheme, which aims to “train” patients for surgery that lasts 10 to 12 hours. Ms Wynter-Blyth said patients were required to sign up to four to six weeks of “pre-hab”. She said: “It’s non-negotiable. Whether they adhere to the programme is a different matter.
“We try to address some lifestyle changes people need to make. The point someone is told they have a deteriorating health condition such as cancer would ordinarily act as a barrier, but it can facilitate change. That is when your mortality is threatened.
“We are seeing people take responsibility. They are becoming more active. They recognise if they don’t do something it will preclude them from having surgery in the first place.”
Post-operative complications fell from 70 per cent to 30 per cent. Pneumonia rates halved to 29 per cent. Patients are discharged seven or eight days after surgery, down from 17 days. Imperial has saved about £300,000 as a result.
Dr Helgi Johannsson, clinical director of theatres and anaesthesia at Imperial, said one patient who failed to follow the advice was refused surgery.
“He hadn’t stopped smoking, he looked dreadful, he really wasn’t motivated,” Dr Johannsson said. “I said to him: ‘Today is not the day for your operation.’ We sent him away for four weeks. He stopped smoking, he did exercises every day. He came back four weeks later looking like a different man and absolutely sailed through surgery.”
One patient, Rashmi Chauhan, 61, marked the first anniversary of his operation for oesophageal cancer at St Mary’s hospital by climbing Mount Snowdon with the PREPARE team in June, helping to raise £10,000 for the project.
He had his oesophagus, or food pipe, removed and his stomach remodelled. “The operation is one of the hardest operations on the body,” he said. “I feel I’m fitter now than before the operation. I feel like I’ve had a new lease of life.
“It wasn’t put like I had to lose weight. I wasn’t negative – it was positive. It was: ‘Let’s see if you can do this.’ If my body is going to have 10 hours of surgery, the only way to make sure everything goes smoothly is to get as physically fit as you can.”
PREPARE stands for: Physical activity; Removal of bad habits; Eat well; Psychological wellbeing; Ask about medicines; Respiratory exercises; Enhanced recovery.
- An edited version of this article appears in tonight’s Evening Standard