Prehabilitation for older patients with colorectal cancer: patient selection, targets and effectiveness

Abstract

Prehabilitation aims to enhance a patient’s physical condition before surgery in order to improve postoperative outcomes.

In recent years, prehabilitation has increasingly been implemented in clinical practice, particularly for older patients with colorectal cancer (CRC). This older population is characterized by a variety of physical, functional, cognitive and/or psychosocial impairments, which increases the risk of functional decline, postoperative complications or mortality.

Current evidence shows promising effects of prehabilitation, although the impact on postoperative outcome is still inconclusive. As prehabilitation research is challenging, a structured program is essential. Therefore, the aim of this thesis is to shape and concretize the concept of prehabilitation towards clinical practice by identifying frail or vulnerable patients, identifying relevant outcomes and by further describing the impact of prehabilitation.

The thesis shows that frailty has limited value for the selection of patients who will benefit from prehabilitation and that physical capacity, non-surgical complications and cost-effectiveness are relevant postoperative outcomes. Furthermore, we found that prehabilitation potentially prevents postoperative complications in older and frail patients and we found interesting effects on long-term outcomes. This thesis contributes to the further development of prehabilitation. Hopefully, this potential care improvement will eventually turn into standard care.