Life saving ‘pre-hab’ service for lung cancer patients

Consultants at Barts Health have trialled a potentially lifesaving ‘pre-hab’ programme to help patients become physically fit so that they can safely undergo lung cancer surgery, a new study published in the Perioperative Medicine Journal shows.

Lung cancer is the most common cause of cancer death in the UK with the North-East London region historically having amongst the highest lung cancer mortality rates in the country, according to Cancer Research UK and UKLCC data.

Surgery is the best proven treatment for lung cancer and the difference between being fit enough for surgery or not can be lifesaving, with higher surgical rates correlating with improved survival.

Respiratory function can be improved by optimising treatment for underlying comorbidities, such as chronic obstructive pulmonary disease (COPD), and tipping the balance between a patient being considered not fit enough for surgery and being considered a surgical candidate. This also reduces the risk of complications following surgery.

The preoperative physiotherapy ‘pre-hab’ programme, one of the first of its kind in the UK for lung cancer patients, focused on progressive muscle strength and aerobic fitness training.

Participants considered inoperable due to respiratory comorbidities were also treated using COPD management such as inhaled therapy, smoking cessation and pulmonary rehabilitation.

For those patients limited by cardiac comorbidities or combined respiratory and cardiac comorbidities, access to cardiac services was provided by the Barts Health cardio-oncology service.

In the study, consultants from Barts Thorax Centre at St Bartholomew’s Hospital outlined the feasibility of the programme and the findings from the trial’s first 50 patients. Out of the 50 patients to undergo the initial pre-hab programme, 74% went on to successfully undergo surgery with all those with cancer having some form of treatment, such as radiotherapy or chemotherapy.

Over the last five years the surgical rate at Barts Health has more than doubled from 12.8% to 29.8%, one of the highest in the country.

​Dr Will Ricketts, consultant chest physician at St Bartholomew’s Hospital, said:

“Surgery is proven to save lives in lung cancer and that was the aim of this project, to save lives and enable our patients to safely undergo surgery, where they would not have been able to before.

“Every patient who successfully goes through this pre-hab programme is a life saved and that is something we can be very proud of.

“Given the success of this programme I would recommend that this should be the standard of care for all lung cancer patients in the UK.”