Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Implementation of a prehabilitation model of care using co-designed resources for head and neck cancer patients undergoing radiotherapy  (#59)

Ella Sexton 1 , Hannah Ray 2 , Jacqui Frowen 2 3 , Karla Gough 3 4 5 , Wendy Poon 6 , Shannon Turnbull 7 , Shaza Abo 8 , Michael Barton 9 , Jenelle Loeliger 2 10 , Maria Ftanou 1 3
  1. Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  3. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
  4. Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  5. Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
  6. Nurse Consultant Head & Neck Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  7. Consumer Register, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  8. Physiotherapy & Occupational Therapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  9. Western & Central Melbourne Integrated Cancer Services , Melbourne, VIC, Australia
  10. School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia

Aims: Radiotherapy for patients with head and neck cancer (HNC) is associated with significant physical impacts and high rates of distress. This study aimed to (1) develop a stepped model of prehabilitation care (Prep-4-RT) designed to prepare HNC patients for the physical and psychological impacts of radiotherapy, including the co-design of self-management prehabilitation resources; and (2) evaluate the feasibility and acceptability of Prep-4-RT in clinical practice.

Methods: The research team developed the Prep-4-RT model of care, including conducting three co-design workshops with consumers and health professionals to develop and assess acceptability of the prehabilitation self-management resources. Then, a single site feasibility study was conducted over 24-weeks with HNC patients scheduled for radiotherapy. All patients received self-management resources and were screened for malnutrition, dysphagia, sarcopenia, physical impairment and mental health concerns. At-risk patients were stepped-up/referred for specialist prehabilitation with relevant health professionals. Patients and health professionals completed program evaluation surveys. Feasibility outcomes included adoption (uptake and intention to try), acceptability and satisfaction.

Results: Twenty-one consumers and health professionals reached a consensus and developed and endorsed a suite of self-management resources on five priority areas. For the feasibility study, the majority of patients consented to screening (65/68, 96%; uptake), with 38 of those consented, assigned to specialist prehabilitation and 93% of valid specialist referrals accepted (intention to try), exceeding our feasibility criterion of 70%. Of those patients who completed the acceptability and satisfaction surveys (n=33 and n=29 respectively), 100% rated Prep-4-RT self-management and specialist prehabilitation pathways as acceptable/very acceptable and mostly/very satisfied. Nine of 10 health professionals rated Prep-4-RT as acceptable/very acceptable and rates of self-reported acceptability and satisfaction also exceeded pre-specified feasibility criterion (≥70%).

Conclusions: The Prep-4-RT stepped-care model is a feasible and acceptable model of prehabilitation for HNC patients prior to radiotherapy. Further evaluation is required to determine its impact on clinical and health service outcomes.