Presentation Authors: Deborah R. Kaye*, Steven Thelen-Perry, Christine Schafer, Yongmei Qin, Heidi IglayReger, Christine Parker, Samuel Kaffenberg, Lindsey Herrel, Todd Morgan, Alon Weizer, Khaled Hafez, Jeffrey S. Montgomery, Ann Arbor, MI
Introduction: Cystectomy patients are often elderly and frail. As a result, they experience high complications rates, frequent readmissions, poor quality of life (QOL) and require substantial medical resources. Strategies to improve outcomes and expand patient eligibility for cystectomy are lacking. Herein, we prospectively evaluate the feasibility, safety and impact of a prehabilitation program for patients undergoing cystectomy for bladder cancer.
Methods: This phase I/II study accrued patients â‰¥60 years old from 03/2013-10/2017 with biopsy-proven bladder cancer, Karnofsky performance score â‰¥70 and a sedentary baseline lifestyle. All subjects were prescribed a 4 week (3 sessions per week) supervised, escalating pre-operative strength and cardiovascular exercise training program. Primary outcomes were feasibility and safety; secondary outcomes included changes in functional fitness, patient-reported QOL, peri-operative complications and readmissions.
Results: Fifty-four patients enrolled in the program, completing 85.7% (SD 20.7%) of the prescribed exercise sessions. There were no adverse events. Functional fitness and patient-reported QOL improved post-intervention, with sustained improvements in general and mental health 90-days post-surgery (Table 1, Figure 1). The 90-day complication rate was 43%; the readmission rate was 20% which is not statistically decreased when compared to our historic cohort (29%, p=0.14).
Conclusions: Prehabilitation prior to cystectomy is feasible, safe, and results in marked improvements in patient strength and sustained improvements in patient-reported QOL from baseline. There was an encouraging trend toward decreased readmissions but this did not reach statistical significance. Efforts to further evaluate the impact of prehabilitation in this population in an expanded and randomized fashion are warranted.â€ƒ
Source of Funding: Michigan Institute for Clinical & Health Research, National Cancer Institute