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Faye Dickinson
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OA08 - Putting the Patient at the Center: Holistic Patient Care (ID 156)
- Event: WCLC 2020
- Type: Oral
- Track: Nursing and Allied Health Professionals
- Presentations: 1
- Moderators:
- Coordinates: 1/30/2021, 11:45 - 12:45, Scientific Program Auditorium
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OA08.04 - Providing Thoracic Prehabilitation during COVID-19: Review of a Virtual Model (ID 3614)
11:45 - 12:45 | Author(s): Faye Dickinson
- Abstract
- Presentation
Introduction
Prehabilitation in lung cancer surgery has shown to improve exercise capacity and reduce post-operative complication rates, morbidity and hospital length of stay (Rosero et al, 2019; Boujibar et al, 2018; Steffens et al, 2018). Prehabilitation is predominantly delivered via supervised exercise programmes, however since the COVID-19 pandemic, capacity to deliver face-to-face hospital appointments has significantly reduced. Therefore, we present preliminary data from a new, virtual prehabilitation service for patients undergoing lung surgery at a busy National Health Service Trust in London.
Methods
20 patients were prospectively recruited from surgical lists over six weeks (15th June-30th July 2020). Each patient was offered a virtual prehabilitation assessment over video or phone. Assessment included outcomes that could be completed virtually: MRC Dyspnoea scale, physical activity levels (Godwin Leisure Time Exercise Questionnaire (GLTEQ), dietary needs, mood (Hospital Anxiety and Depression Scale (HADS) and fatigue (FACIT-fatigue). Exercise capacity was measured using the one minute sit to stand (STS) test.
Following assessment, each patient received a personalised home-based exercise programme and a diary to monitor compliance. Written advice and counselling for specific symptom management was also provided. Virtual follow-up occurred weekly or fortnightly. An ‘end of prehabilitation’ (EOP) assessment was completed approximately three days before surgery to repeat outcome measures. Due to local policy changes during this pilot, some patients were permitted a one-off, face-to-face prehabilitation assessment, however intervention and follow-up continued virtually.
Results
Baseline characteristics: 65% of the cohort were female, with an average: age 68 years; MRC Dyspnoea scale: 2; FEV1 %predicted: 87.9 and performance status: 1. 45% had ≥5 comorbidities, 70% had a smoking history and 15% were classified as ‘vulnerable-mildly frail’ using the Rockwood Clinical Frailty Score. A walking exercise tolerance ≥500m was present in 80% of the cohort, yet only 40% were classified as ‘sufficiently active’ on the GLTEQ.
Uptake and technology: 35% of participants received a virtual prehabilitation assessment, whilst 65% had this delivered face-to-face. The uptake rates for patients approached for virtual or face-to-face assessments were 64% and 100% respectively. 75% of participants had access to email and video technology, whilst 25% could only receive telephone calls and written handouts. Inability to access emails and video was noted in all patients ≥80 years of age, yet there was no association between lack of technology and higher comorbidities or frailty.
At EOP there was no change in average MRC-Dyspnoea scale, HADS or fatigue levels. However, GLTEQ scores changed by an average of +45.9 points, with 100% of the cohort meeting recommended levels of physical activity. We observed an average change in one minute STS test scores of +5.1, exceeding the minimum clinically important difference of +3 (Vaidya et al, 2016).
Conclusion
Our findings demonstrate that virtual, home-based prehabilitation is feasible and may improve patients’ pre-surgical physical activity levels and exercise capacity. This is pertinent given ongoing uncertainty surrounding COVID-19 and its impact on face-to-face healthcare delivery. Further consideration regarding the delivery of safe and effective virtual prehabilitation to more elderly or vulnerable patients may be required.
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P27 - Nursing and Allied Health Professionals - Symptom Management (ID 158)
- Event: WCLC 2020
- Type: Posters
- Track: Nursing and Allied Health Professionals
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P27.02 - Symptom Burden and Referral to Allied Health Professionals at time of Diagnosis for Patients with Malignant Pleural Mesothelioma. (ID 2371)
00:00 - 00:00 | Presenting Author(s): Faye Dickinson
- Abstract
Introduction
Malignant pleural mesothelioma (MPM) patients often present with a high symptom burden. Current guidelines in the management of MPM highlight the importance of early symptom control 1-2.
There is little research into the impact of Allied Health Professionals (AHPs) intervention on symptom management or outcomes for this patient cohort. However, current practice for cancer supports early intervention from AHPs for proactive rehabilitation programmes to reduce the impact of the disease, improve adherence to treatment regimes, improve daily physical activity, promote independence and improve quality of life.
At Guy's And St Thomas' NHS Foundation Trust (GSTT) there is a well-established team of AHPs present within the thoracic oncology outpatient consultant lead clinics. These AHPs are well positioned to address the rehabilitation and supportive care needs of all thoracic oncology patients including those with a diagnosis of MPM.
The aim of this retrospective analysis was to record the symptom profile of MPM patients at the point of diagnosis, their AHP intervention needs and the onwards referrals made to members of the AHP team.
Methods
A retrospective notes review was completed over a one year period at GSTT which is a regional centre for MPM. All patients with a diagnosis of MPM who attended either the medical or clinical thoracic oncology clinics were included.
All patients were offered a comprehensive screening assessment within 3 months of their initial oncology appointment.
Symptoms and AHP clinical needs were identified through a review of the screening assessment and patient’s notes.
Results
Symptom Profile:
A total of 46 patients were included in the review. At least one symptom at point of diagnosis was reported by 78% (n=36) of the patients. The most prevalent symptoms at point of diagnosis were shortness of breath (n=21), fatigue (n=16), weight loss (n=15), low mood/ anxiety (n=15), reduced mobility (n=15) and pain (n=15). 22% (n=10) reported no symptoms requiring support at the time of diagnosis.
Onwards referrals to AHP team:
57% of patients (n=27) were referred to at least one AHP speciality at time of diagnosis. 4% (n=2) declined referral to AHP, and 15% (n=7) were not referred to AHP despite reporting symptoms.
Conclusion
MPM is associated with high levels of symptom burden and specialist AHP intervention to assist with its management is thought to be beneficial, however at present the supporting guidelines into this are limited.
This retrospective analysis of the symptom burden and AHP needs of this patient group has identified that most patients report one or more symptoms that would benefit from AHP intervention at time of diagnosis.
Early rehabilitation has been identified as being key to reducing the impact of cancer related symptoms and therefore should be offered to this patient group.
Future research should be completed to determine specific intervention pathways and guidelines to ensure that all patients are receiving appropriate intervention.
1. Van Zandwik et al 2013. Guidelines for the diagnosis and treatment of malignant plaura; mesothelioma. J Thoracic Dis.
2. Woodhouse et al 2018. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax
