Summary of Program
Preoperative optimisation is the process of enhancing general health before surgery. This concept encompasses many components of care including medical, physical exercise, nutritional support and psychological support. There are multiple projects being undertaken within this research program at SOuRCe, including the areas of mental health, nutrition and exercise.
SOuRCe was able to obtain a large NHMRC grant to develop the PRIORITY Trial and a MRFF grant to develop the PRIORITY-CONNECT 2 Trial. The PRIORITY Trial is a multi-centre randomised controlled trial investigating the effectiveness of a preoperative exercise and education program on patients undergoing surgery for advanced primary or recurrent gastrointestinal cancers compared to usual care. The clinical trial is being conducted at RPAH and COBLH in Sydney and Peter MacCallum Cancer Centre (PMCC), in Melbourne. The PRIORITY Trial commenced patient recruitment in November 2021. The PRIORITY-CONNECT 2 Trial will be a multi-centre randomised controlled trial investigating the effectiveness of incorporating a virtual multimodal program for patients undergoing major gastrointestinal cancer surgery compared to usual care.. This trial is currently in the pre-recruitment stage.
Highlights
- The PRIORITY Trial received ethical approval with the Human Research Ethics Committee at Concord Repatriation General Hospital in March 2020 and governance authorisation in May 2021. A research officer has been appointed since December 2020 to assist in the coordination of the trial. The trial was prospectively registered within the Australian New Zealand Clinical Trial Registry (ANZCTR) in May 2021 (ACTRN12621000617864), with a detailed protocol published in BMC Cancer in April 2022. The first participant was recruited in November 2021.
- The PRIORITY-CONNECT 2 Trial received ethical approval with the Human Research Ethics Committee at Royal Prince Alfred Hospital in December 2023 and governance authorisation within the same month. Given the size and potential impact of this trial, further recruitment of staff are underway. The pilot trial has been prospectively registered with the Clinical Trials Registry (clinicatrials.gov) in January 2024 (NCT06212700).
- To faciliate collaboration and development of knowledge in this area, the Global (P)rehabilitation Initiative was established. This is an innovative, international collaboration that brings together over 1000 multidisciplinary experts from 6 continents. As a connection hub for high-quality collaborative research, this initiative hopes to continue to build national and international networks of professionals committed to enhancing patient outcomes. To register your interest, please register HERE.
During the last 3 years, a number of studies have also been established:
- Preoperative technology-driven multimodal intervention for patients undergoing cancer surgery (app study): The study is looking at the barriers, facilitators and adoption of a preoperative program by surveying cancer patients undergoing surgery, their carers and treating clinicians. The study received ethical and governance approval and commenced recruitment in 2021. A total of 12 cancer patients and 7 clinicians have been recruited to date.
- Research priorities in prehabilitation for patients undergoing cancer surgery (international Delphi study): The investigators are conducting a Delphi study with international multidisciplinary experts to identify key research priorities in prehabilitation for patients undergoing cancer surgery. Almost 200 international prehabilitation experts have currently completed the first round survey.
- Mechanistic understanding of how preoperative exercise improves outcomes: A substudy of the NHMRC-funded PRIORITY randomised controlled trial (biomarker study): This project received funding from the Australian and New Zealand College of Anaesthetists Foundation. The study received ethics approval in November 2021 and governance approval in March 2022. All patients recruited into PRIORITY are invited to participate in this study. Currently 12 participants have been recruited.
- Safety, feasibility and validity of remote physical assessments during the covid-19 pandemic (validation/reliability study): The study is being conducted at RPAH and Neuroscience Research Australia (NeuRA) and is investigating the validity and reliability of conducting online physical assessments in patients presenting with cancer and older people. The study received ethics and governance approval in June 2022 and will commence participant recruitment in July 2022.
- Comparative efficacy of preoperative interventions to improve postoperative outcomes in cancer patients (network meta-analysis): This network meta-analysis is being conducted at RPAH and is looking at the comparative effectiveness of preoperative interventions in cancer patients on postoperative complications and length of hospital stay. The study is currently in the data analysis phase.
- The role of physical, nutritional and/or psychological statuses on surgical outcomes, patients outcomes and survival following major cancer surgery: This retrospective cohort study is looking at patients who had undergone cytoreductive surgery or pelvic exenteration surgery for locally advanced or recurrent pelvic cancers. The paper is currently under review at Annals of Surgical Oncology.
- Reference values for the Six Minute Walking test in cancer patients: This international multicentre study, involves individual patient data form RPAH, PMCC and from another 24 sites in Canada, New Zealand and the UK. The main aim of this study is to provide reference values of the Six Minute Walking Test for cancer patients undergoing gastrointestinal surgery.
If you would like to get involved with our Preoperative Optimisation Research Program, submit an expression of interest HERE.