Developing the Prehab Pathway for Lung Cancer Patients by Dr. Louise Brown

 
Developing the Prehab Pathway
for Lung Cancer Patients
 
Dr Louise Brown
North Manchester General Hospital
Clinical Lead for Lung Cancer, NE Sector
What is Prehab ?
What is Prehab ?
 
 
Lung Surgical Pathway
Lung Surgical Pathway
 
Surgical risk
2% 
mortality rate 
at 90 day
30 day 
complication rate 
is 30%
More frail 50-60% 
complications
 
Levels of support
Universal
Targeted
Model
 
Local challenges for NE Sector:
deprivation, frailty
Unemployment
lack of transport
No access to shuttlewalk or 6 minute walk
assessments
Cultural and language barriers
Lung Prehab Subgroup
North Manchester pilot
 
Patients confirmed lung
cancer = 24:
 
Referred for surgery: 10
 
Range: 130 – 260m
Mean: 175m
1 patient >250m
 
Referred for radical
intent oncology
treatment: 6
 
Range: 40 – 380m
Mean: 182m
1 patient > 250m
 
(January – March 2019)
 
 
 
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
Embedding a new service
 
 
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
Current practice:
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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.

  • Prehab Pathway
  • Lung Cancer Patients
  • Dr. Louise Brown
  • North Manchester Hospital
  • Surgical Preparation

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  1. Developing the Prehab Pathway for Lung Cancer Patients Dr Louise Brown North Manchester General Hospital Clinical Lead for Lung Cancer, NE Sector

  2. What is Prehab ?

  3. What is Prehab ?

  4. Lung Surgical Pathway

  5. Lung Surgical Pathway

  6. Surgical risk 2% mortality rate at 90 day 30 day complication rate is 30% More frail 50-60% complications High Medium Low

  7. Levels of support Specialised Universal Targeted Model Targeted Universal

  8. 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

  9. 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)

  10. 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

  11. 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

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