Summary

Many people with cancer have surgery as part of their treatment.1 While these procedures are safe and effective, they do carry a risk of complications.2 3 In 2017, researchers at the University Hospital Southampton NHS Foundation Trust in England, UK, launched WesFit – a trial prehabilitation programme for people with cancer.4 The programme aims to reduce the impact of surgery through exercise and psychological support. It was found to improve people’s physical fitness ahead of surgery and shortened their post-operative hospital stays.5 6 The programme was initially delivered in community venues, but moved to remote delivery during the COVID-19 pandemic.6 7

 

Challenge

In the UK, 45% of people with cancer have surgery to remove a tumour.1 These procedures are safe and effective ways to treat cancer, following advances in surgical techniques, anaesthesia and care before and after operations.2 Still, people with cancer are at higher risk of post-surgery complications, such as breathing difficulties, heart issues, pain and reduced mobility.3 8

The physical toll of other cancer treatments, such as radiotherapy and chemotherapy, can impact a person’s recovery from surgery.3 In addition, people may experience anxiety and depression in the period around their procedure, which can also affect their recovery.9 10 People with higher levels of physical fitness and mental wellbeing tend to have better outcomes after their cancer surgery.11

 

Solution

In 2017, researchers at the University Hospital Southampton NHS Foundation Trust in England launched WesFit – a trial prehabilitation programme that aims to reduce the impact of surgery on people with cancer.4 It was developed based on research and patient feedback,6 12 and is available to people due to have surgery for oesophageal, gastric, colorectal, thoracic or urological cancer.4

WesFit combines physical exercise with psychological support, delivered in community venues close to people’s homes.4 6 Experienced personal trainers lead the exercise sessions, with programmes tailored to the participants’ needs and preferences.4 6 Programmes last up to 15 weeks and are suitable for people undergoing chemotherapy or radiotherapy. People can also access individual or group counselling at local cancer centres, which can help them prepare for surgery and improve their overall mental health.6 11

 

What has it achieved?

As of early 2020, WesFit has expanded to 21 sites across southern England.6 Between 2017 and 2020, 250 people took part, with 97% attending three sessions per week. The programme has:

  • improved the physical fitness of people due to have surgery for rectal cancer following chemotherapy and radiotherapy5
  • reduced the length of post-surgery hospital stays.6

WesFit was paused in March 2020 due to the COVID-19 pandemic, but the research team behind the programme developed an alternative called SafeFit.6 7 This programme:

  • provides exercise guidance and psychological support using telephone consultations and video calls7
  • allows people to self-refer for prehabilitation7
  • supported 800 people with their prehabilitation during the COVID-19 pandemic, when they were advised to ‘shield’ at home.6 13 14

The WesFit research team won the Health Services Journal award for Cancer Care Initiative of the Year in 2020.15 16

 

Next steps

The research team would like to continue delivering the SafeFit programme and advocates for its integration into the cancer care pathway across England.14 They are also planning to complete the initial WesFit trial and expand the programme to include nutritional advice.6 14

 

Further information

 

Contact

Fran Williams, Partnerships Manager, NHS Wessex Cancer Alliance

Email address: Fran.williams1@nhs.net

References:

  1. Cancer Research UK. 2017. Cancer treatment statistics. [Updated 01/09/17]. Available here: https://www.cancerresearchuk.org/health-professional/cancer-statistics/treatment#heading-Two [accessed: July 2021]
  2. American Cancer Society. 2014. Evolution of Cancer Treatments: Surgery. [Updated 12/06/14]. Available here: https://www.cancer.org/cancer/cancer-basics/history-of-cancer/cancer-treatment-surgery.html [accessed: July 2021]
  3. Simões CM, Carmona MJC, Hajjar LA, et al. 2018. Predictors of major complications after elective abdominal surgery in cancer patients. BMC Anesthesiology 18(1): 49
  4. Wesfit. 2015. Wessex Fit-4 Cancer Surgery Trial. Available here: http://www.wesfit.org.uk/index.html [accessed: July 2021]
  5. West MA, Astin R, Moyses HE, et al. 2019. Exercise prehabilitation may lead to augmented tumor regression following neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Acta Oncologica 58(5): 588-95
  6. NHS Wessex Cancer Alliance. 2020. WesFit. Available here: https://wessexcanceralliance.nhs.uk/wesfit-project/ [accessed: July 2021]
  7. NHS Wessex Cancer Alliance. 2021. Welcome to SafeFit. Available here: https://safefit.nhs.uk/ [accessed: July 2021]
  8. Carli F, Charlebois P, Stein B, et al. 2010. Randomized clinical trial of prehabilitation in colorectal surgery. British Journal of Surgery 97(8): 1187-97
  9. Hellstadius Y, Lagergren J, Zylstra J, et al. 2017. A longitudinal assessment of psychological distress after oesophageal cancer surgery. Acta Oncologica 56(5): 746-52
  10. Foster C, Haviland J, Winter J, et al. 2016. Pre-Surgery Depression and Confidence to Manage Problems Predict Recovery Trajectories of Health and Wellbeing in the First Two Years following Colorectal Cancer: Results from the CREW Cohort Study. PLOS ONE 11(5): e0155434
  11. Macmillan Cancer Support, National Institute of Health Research, Royal College of Anaesthetists. 2020. Principles and guidance for prehabilitation within the management and support of people with cancer. London: Macmillan Cancer Support
  12. Wessex Voices. 2017. Patients' experience of exercise and cancer. Southampton: Wessex Voices
  13. NHS. 2021. Who is at high risk from coronavirus (clinically extremely vulnerable). [Updated 08/07/21]. Available here: https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/who-is-at-high-risk-from-coronavirus-clinically-extremely-vulnerable/ [accessed: July 2021]
  14. Williams F. 2021. Interview with Catherine Hodge at The Health Policy Partnership [Video call]. 22/07/21
  15. University Hospital Southampton NHS Foundation Trust. 2020. WesFit trial wins Cancer Care Initiative of the Year. [Updated 04/09/20]. Available here: https://www.uhs.nhs.uk/ClinicalResearchinSouthampton/Research/Facilities/NIHR-Southampton-Biomedical-Research-Centre/News-and-updates/Articles/WesFit-trial-wins-Cancer-Care-Initiative-of-the-Year.aspx [accessed: July 2021]
  16. Health Services Journal. 2020. HSJ Value Awards 2020: Cancer Care Initiative of the Year. [Updated 04/09/20]. Available here: https://www.hsj.co.uk/hsj-value-awards/hsj-value-awards-2020-cancer-care-initiative-of-the-year/7028296.article [accessed: July 2021]