Developing the Prehab Pathway for Lung Cancer Patients by Dr. Louise Brown
Dr. Louise Brown from North Manchester General Hospital leads the development of a prehab pathway for lung cancer patients in the NE sector. The project aims to enhance patient outcomes through pre-surgical preparation, addressing challenges such as frailty, deprivation, and lack of access to assessments. The pathway involves specialized support, innovative assessments, and a pilot program that has shown promising results in patient assessments and referrals for surgery and treatment. Key strategies include embedding a new service, creating standardized policies, and incorporating diverse health assessments to mitigate risks.
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Developing the Prehab Pathway for Lung Cancer Patients Dr Louise Brown North Manchester General Hospital Clinical Lead for Lung Cancer, NE Sector
Surgical risk 2% mortality rate at 90 day 30 day complication rate is 30% More frail 50-60% complications High Medium Low
Levels of support Specialised Universal Targeted Model Targeted Universal
Lung Prehab Subgroup Local challenges for NE Sector: deprivation, frailty Unemployment lack of transport No access to shuttlewalk or 6 minute walk assessments Cultural and language barriers
North Manchester pilot Patients confirmed lung cancer = 24: Total Patients Assessed 71 Referred for surgery: 10 % ISWT Score Total Range: 130 260m Mean: 175m 1 patient >250m 52 73.2 ISWT < 250 8 11.3 ISWT 250-390 10 14.1 ISWT >= 400 7 9.9 Patients employed Referred for radical intent oncology treatment: 6 64 90.1 Patients not employed 8 11.3 Patients meeting AOT criteria Range: 40 380m Mean: 182m 1 patient > 250m (January March 2019)
Embedding a new service Creating a Standardised operating policy Competency assessments for Band 4 s Support from experienced respiratory physiotherapist Finding a suitable environment Sharing best practice Incorporating other health and well being assessments to ensure all modifiable risk factors are addressed
Current practice: All surgical referrals: Shuttlewalk assessment when they attend clinic Aim to refer all patients for prehab and actively encourage patients to engage with the teams (including surgery school) Patients with <250m are still referred as long as no cardiovascular risk factors and clinical teams agree appropriate Incorporate tobacco addiction and referral for treatment if needed Continuing to develop/improve the service
