Feasibility and Acceptability of a Co-Designed Model of Prehabilitation for Head and Neck Cancer Patients Undergoing Radiotherapy.

Abstract

Radiotherapy for head and neck cancer (HNC) has significant physical and emotional effects. This study investigated the feasibility of delivering "Prep-4-Radiotherapy (RT)", a multi-modal, risk-stratified approach to prehabilitation for people with HNC. HNC patients planned for radiotherapy were screened for psychological distress, malnutrition, sarcopenia, dysphagia, and reduced physical function using self-report measures. Low-risk patients were provided access to self-management resources. High-risk patients were additionally referred to relevant allied health disciplines for specialist prehabilitation and provided access to self-management resources. The feasibility of Prep-4-RT was judged against a priori criteria. Primary feasibility outcomes included patient adoption (uptake: ≥ 70% of eligible patients consent to screening; intention to try: ≥ 60% of patients utilize self-management resources and ≥ 70% of high-risk patient participants verbally accept referrals to specialist prehabilitation) and fidelity (adherence to specialist pathway: ≥ 70% of high-risk patients receive specialist prehabilitation and attend ≥ 70% of scheduled prehabilitation appointments). Point estimates for four of five primary outcomes indicated acceptable feasibility. The point estimate for the fifth primary outcome, adherence as assessed by the percentage of high-risk patients assigned to specialist prehabilitation who received care from required clinicians before radiotherapy, indicated feasibility with further revision. Prep-4-RT appears to offer a feasible risk-stratified program to provide prehabilitation to HNC patients prior to radiotherapy, though results for some criteria were characterized by notable missing data. Further evaluation is required to determine its effect on clinical and health service outcomes. ANZCTA (Australian New Zealand Clinical Trials Registry) ACTRN12623000770662.