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Optimising health outcomes at work

A CGH programme allows cancer patients to fully reap the mental and physical benefits of prehabilitation.

For patients who have been diagnosed with cancer, the road to recovery can appear long and daunting. It therefore came as a pleasant surprise to Mr Goh Tong Nang that he found himself up and about walking shortly after his surgery. He was even able to shower independently the morning after. These fast gains in mobility were the fruits of his efforts under Changi General Hospital (CGH)’s cancer prehabilitation programme devised by its rehabilitation medicine specialists.

A one-stop screen-and-intervene initiative, the CGH cancer prehabilitation programme gives newly-diagnosed patients a head-start on recovery, even before their treatment or surgery. By adopting a home-based model and cutting down time spent in the hospital, patients can focus fully on their prehabilitation so as to achieve improved recovery outcomes.

Following a pilot study for newly-diagnosed colorectal cancer patients who had improved functional recovery outcomes after undergoing prehabilitation, CGH expanded the programme to include more patients with liver, pancreatic, gallbladder, prostate, bladder, oesophagal and stomach cancers.


PRIMING FOR THE FIGHT AGAINST CANCER

Patients under the cancer prehabilitation programme undergo a series of assessments to holistically evaluate their health across physical and mental domains during the first prehabilitation consultation, which takes place after their surgical consultation. The comprehensive evaluation — which involves frailty, functional and mental wellness tests — is conducted by a prehabilitation team.


“This ‘window of opportunity’ between diagnosis and treatment is crucial in empowering our patients to play a part in improving their post-surgery outcomes, even from home.”

Clinical Assistant Professor Tay San San
Chief and Senior Consultant, Department of Rehabilitation Medicine, CGH

Based on each patient’s results from the evaluative assessments and their medical conditions, the prehabilitation specialist doctor prescribes a personalised, integrated intervention plan. The plan incorporates the optimisation of any pre-existing medical or chronic conditions, an exercise prescription, as well as nutrition and mental wellness advice. Collectively, these interventions are targeted at improving the patient’s capacity to withstand upcoming surgeries or anti-cancer therapies.


Typically, patients are referred to various allied health specialties by the surgeons for prehabilitation. CGH’s rehabilitation physicians involved in this programme are not only certified in exercise prescriptions but are also cross-trained by dietitians and psychologists. This enables patients to have convenient access to a well-rounded care intervention plan. “Under the new cancer prehabilitation framework developed by CGH, most patients will need only two appointments — one for the first consultation, where a comprehensive health assessment is carried out and personalised interventions are prescribed; and another to assess the patient’s condition before treatment starts,” says Clinical Assistant Professor Kwok Kah Meng, Consultant, Department of Rehabilitation Medicine, Changi General Hospital. The CGH multi-disciplinary team’s collaborative approach also ensures that patients with more complex cases can be referred to physiotherapists, dietitians or social workers if required.


Clinical Assistant Professor Kwok Kah Meng (right) and prehabilitation coordinator Christopher Paul (middle) going through the cancer prehabilitation programme with a patient model.


CGH prehabilitation coordinator Christopher Paul administers a hand grip test using a hand dynamometer.


“We aim to help our patients regain their functional independence post-treatment as soon as possible, facilitate their recovery journey from hospital to home, and empower them to develop long-term beneficial health habits, including exercise.”

Clinical Assistant Professor Kwok Kah Meng
Consultant, Department of Rehabilitation Medicine, CGH


Changi General Hospital's prehabilitation programme has benefited about 200 patients since its pilot in January 2020.

The journey does not end here. In providing continuity of care from hospital to home, CGH’s care team follows up with patients on their recovery progress three months after surgery, and individualises further care plans where necessary.


 

 

ENCOURAGING SIGNS

A PILOT STUDY SHOWS IMPROVED HEALTH AND RECOVERY OUTCOMES FOR PATIENTS IN THE PROGRAMME

A pilot study by CGH on 59 colorectal patients who participated in the cancer prehabilitation programme showed a significant improvement in their mental health, psychological well-being and quality of life*. They also went home earlier by an average of 1.5 days after the surgery, with reduced post-operation complications, readmission and mortality rates.

Their resulting better physical capacity leads to improved ability to tolerate additional therapy given after the main treatment, reducing the chance of treatment disruption or termination. The pre-operation and additional therapy period presents a golden opportunity for lifestyle interventions, as adequate exercise, nutritional diet and the cessation of smoking are known to reduce the recurrence of cancer.

* 2021 Cancer Prehabilitation Framework Study by CGH

 


A look at some factors that make a big difference in putting patients back on the path of wellness.

 

Medical optimisation refers to the control of underlying chronic diseases such as hypertension and diabetes, relieving symptoms that can affect one’s ability to participate in the prehabilitation exercise programme. This includes the management and treatment of underlying causes of anemia; smoking cessation as well as the reduction of alcohol intake.


Strengthening and aerobic workouts are key, while flexibility exercises are part of warm-up and cool-down routines. Strengthening exercises help maintain and build strong muscles, increase muscle mass and improve balance. Aerobic exercises — also known as cardio — improve heart and lung function, helping patients feel less tired during and after treatment.


Nutritional prehabilitation interventions consist of two important aspects — a balanced calorie intake and sufficient protein supplementation; as well as ensuring having proper micronutrients supplementation for immunonutrition. Having good nutrition helps ensure patients have sufficient food and liquids that have vitamins, minerals, proteins, carbohydrates, fat and water that the body needs.


Mental health, or psychological interventions, focus on relief techniques and strategies to address stress and anxiety symptoms. These include deep breathing techniques, progressive muscle relaxation and mental imagery techniques. Possessing good mental health encourages positivity and builds one’s mental resilience.


优化居家护理成果

樟宜综合医院推出了一项计划,让癌症患者能够充分获得术前预康复带给他们心理上和生理上的好处。

对于被诊断出癌症的患者来说,康复之路似乎漫长而艰巨。因此,GohTongNang先生在手术后不久就能站起来行走,让他感到惊喜不已。他甚至可以在第二天早上自己独立冲凉。他能够快速恢复行动能力,得益于樟宜综合医院的康复医疗专科医生们制定的癌症术前预康复计划。

樟宜综合医院癌症术前预康复计划是一项一站式的筛查与干预计划,让被诊断出患有癌症的患者们在治疗或手术之前采用以居家模式为主的干预计划,减少到医院复诊的次数,更好地专注于术前的康复练习,从而获得更好的康复效果。

在一项针对新诊断结直肠癌症患者的试点研究中,这些患者在接受了术前预康复干预后身体机能恢复效果有所改善,因此樟宜综合医院将该计划推广至更多的肝癌、胰腺癌、胆囊癌、前列腺癌、膀胱癌、食道癌和胃癌患者。


 

为对抗癌症做准备

患者将在手术会诊之后参加其首次术前预康复会诊,在此期间,患者将接受一系列的检查,以全面评估他们的生理和心理健康状况。全面的评估包括虚弱度、机能和精神健康测试,由一名术前预康复协调医疗队完成。

根据每名患者的评估结果和他们的健康状况,术前预康复专科医生将为他们制定个性化的综合干预计划。该计划包括优化任何已有的医疗状况或慢性疾病、一份居家运动处方,以及营养和心理健康建议。这些干预措施能够共同作用,帮助提高患者承受来临的手术或抗癌治疗的能力。

通常情况下,患者会由外科医生转介到不同的专职健康专科接受康复治疗。参与这项计划的樟宜综合医院的康复医生不仅在运动处方领域获得认证,而且还接受了营养师和心理学家的交叉培训。这让患者能够方便地获得全面的护理干预计划。

樟宜综合医院的跨科室团队密切合作,确保病情更复杂的患者能在必要时被转介至物理治疗师、营养师或社会工作者。

这还不是康复之旅的终点。在提供从医院到家庭的连续性护理方面,樟宜综合医院的护理团队在手术后三个月将追踪患者的康复进展,并在必要时制定个性化的深入护理计划。


作为术前预康复计划的一部分,患者将接受全面的健康评估,以获得个性化的干预计划。


借助科技的定制方案

根据康复医生开出的运动处方,术前预康复协调员将在患者的智能手机上输入运动处方,以帮助他们在家里练习这些常规运动和放松技巧。我们鼓励患者家人和看护者一起参与会诊,为他们的亲人提供进一步的支持与监督。术前预康复协调员还会定期检查患者的进展,以确保他们完成所规定的运动。这些运动可以在HealthBuddy手机应用程序上找到




Optimising health outcomes at work