06 april 2023 – 00:27
Investing in fitness leads to faster recovery and fewer complications from colorectal cancer
A large international study, led by Máxima MC (MMC), proves that prehabilitation before surgery in patients with colorectal cancer leads to a faster recovery and a strong reduction in serious complications. The results of this PREHAB trial were recently published in JAMA–surgery, one of the leading US surgical journals. The expectation is that this revolution will soon be available to all patients in the Netherlands.
It is known that patients who go into surgery fit have a lower risk of complications. Unfortunately, the average Dutch patient who has to be operated on for colorectal cancer is not that fit. This is a sum of age and lifestyle in which overweight, too little exercise, unhealthy diet and smoking and alcohol play an important role.
Why prehabilitation?
Prehabilitation is a program in which patients are supported to become fit before major surgery. The program consists of 5 pillars and lasts four weeks. During the program we work on: 1 – strength and fitness training, 2 – dietary advice with extra proteins and vitamins, 3 – lifestyle (smoking), 4 – mental guidance and 5 – correction of anaemia. The results of this international PREHAB trial prove that this revolutionary approach works,” concludes Gerrit Slooter, surgeon at MMC. He is proud of Charlotte Molenaar, author of the publication, and the other physician-investigators who set up and conducted the PREHAB trial with him.
The international PREHAB trial proves effectiveness
The PREHAB trial involved 270 patients from Montreal, Barcelona, Copenhagen, Ferrara, Breda and Veldhoven. A program was tailor-made for each participant for maximum effect. The PREHAB trial now provides evidence that patients have fewer complications and recover faster. In particular, there are 40 percent fewer serious complications in patients who have been prehabilitated compared to the control group (patients who did not participate in the program). This is an important gain because it is precisely those complications that stand in the way of a full recovery. But the benefits lie in several factors, says Slooter: “Patients are more involved both before and after surgery. Due to the increased strength and condition, patients have confidence to actively work on their recovery the day after surgery. Patients from MMC who prehabilitated went home two days earlier.” The study was made possible by KWF Cancer Control.
Why is this study so important?
The favorable results from the PREHAB trial once again confirm that prehabilitation deserves to be rolled out more widely nationwide. But prehabilitation has no structural funding. Many hospitals are already in the starting blocks to offer prehabilitation but are struggling with financing. The Federation of Medical Specialists (FMS) and the Dutch Society for Surgery (NVvH) have calculated that the use of prehabilitation alone in operations for cancer of the colon may save 60 million euros in five years (ref. BIA). However, it appears almost unsolvable to fit the costs into the budget. Many hospitals use their own research funds or make use of incidental money from health insurers.
That is why Máxima MC, together with a number of other leading hospitals such as the UMC Groningen, Radboudumc and Reinier de Graaf Gasthuis, is united in the Prehabilitation Working Group of the NVvH and the Fit4Surgery Foundation. Together, as much evidence as possible is collected about the effectiveness of the program. In consultation with all disciplines involved, a ‘Standpunt Prehabilitatie’ was also drawn up, which was derived from the PREHAB trial. This is a national protocol that can ensure that prehabilitation is offered universally from all hospitals.
In MMC, it took us three years to set up the prehabilitation program. More than half of all hospitals in the Netherlands have already undergone training in MMC. “We see it as our task to share this knowledge with the NVvH and Fit4Surgery in order to make prehabilitation possible for as many patients as possible in as many hospitals as possible,” says Slooter.
In MMC, we are already expanding the special approach to prehabilitation
Since 2017, we have been focusing on prehabilitation to make patients fit before intestinal surgery. Prehabilitation is a good example of a health maintenance initiative. Because at MMC we strive for patients to stay as healthy as possible for as long as possible. So that our patients can get the most out of their lives. Prehabilitation is a good example of this. We therefore have great confidence in MMC’s special approach. Almost 400 patients have followed the prehabilitation program in recent years. Not only for colon cancer operations, but also for operations on the liver or lungs. Meanwhile, specific programs have also been drawn up for other major operations such as complex incisional hernias, open aneurysm surgery, stomach reductions and for gynecological or urological procedures.
Link to the PREHAB trial publication in JAMA-Surgery: Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery
Bron: Maxima MC
Editorial Medicalfacts/ Janine Budding
I studied physiotherapy and Health Care business administration. I am also a registered independent client support worker and informal care broker. I have a lot of experience in various positions in healthcare, the social domain and the medical, pharmaceutical industry, nationally and internationally. And have broad medical knowledge of most healthcare specialties. And of the care laws from which the care is regulated and financed. Every year I attend most of the leading medical conferences in Europe and America to keep my knowledge up-to-date and to keep up with the latest developments and innovations. Currently I am doing a Masters in Applied Psychology.
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