Liverpool University Hospitals NHS Foundation Trust is helping to get pancreatic cancer patients fit enough for surgery using a model that enables those that previously wouldn’t have been well enough to undergo potentially lifesaving operations, the chance of curative surgery.
Preoperative exercise, nutritional and wellbeing intervention, or prehabilitation, is where multidisciplinary teams come together prior to cancer surgery to improve the health of patients who are due to have surgery, or were earlier too sick to have surgery.
Aintree University Hospital were leaders in further developing the concept of prehabilitation in 2012, becoming one of the first hospitals to popularise its use and conduct trials to see patient benefits. The therapy led service has been offered since 2017, and is now a leading service in the UK and offers intervention to all major cancer surgical patients.
Following the merger of Aintree University Hospital and the Royal Liverpool University Hospital in October 2019, the newly formed Liverpool University Hospitals NHS Foundation Trust is looking at piloting the scheme at the Royal Liverpool University Hospital site where they are currently trialling it with pancreatic cancer patients.
The Royal is one of the biggest pancreatic cancer units in the country and currently has over 1,700 cases discussed at pancreas specialist multidisciplinary team meetings each year to diagnose and plan courses of treatment, be it surgery, oncology or palliative care for patients.
The award winning team are internationally recognised for their innovative work into a disease which is often late to diagnose due to its hidden symptoms. Because of this, the survival rates for those with pancreatic cancer are slim, with 20% of patients passing away within a month of diagnosis and only 7% having curative surgery.
“Half of our pancreatic cancer patients that are potentially suitable for surgery cannot have it as they are not fit enough. However by using prehab on these patients, we are increasing the percentage of those who can go on to be eligible for lifesaving operations,” said Declan Dunne, consultant pancreatic surgeon at Royal Liverpool University Hospital. Declan was one of the clinicians who helped develop the prehab service at Aintree, before he took up a consultant post at the Royal.
"With prehab you are getting better results for those who were initially too sick to have surgery. The patient benefits are huge – their quality of life improves and there are reduced risks of complications."
"The length of stay for patients undergoing major cancer surgery at Aintree has been cut two days because of it.”
Many of these patients will also be supported by the Royal Liverpool University Hospital’s Hepato-pancreato-biliary (HPB) support group, which was created by Macmillan pancreatic clinical nurse specialist, Phil Whelan, in 2017. The patient and carer support group host regular patient-led meetings with guest speakers and professional support.
From this, a HPB buddy group has also formed, consisting of former patients who have experienced medical conditions of the pancreas and now support others during their pre-op, prehab, operation and chemotherapy. Some of the patients in this group, whose work was recognised at the Royal’s 2019 Make a Difference Awards, have also gone through an element of prehab, so know all too well how it can be beneficial.
Dr Tristan Cope, medical director at Liverpool University Hospitals NHS Foundation Trust, said: “We’re confident that this model will help to transform the outcomes available to some of our cancer patients and we look forward to seeing how it will shape the future and enhance patient care.”
Georgia Papacleovoulou, senior policy and intelligence manager at Pancreatic Cancer UK, said: “The progress made by the dedicated health professionals across Liverpool University Hospitals NHS Foundation Trust in making treatment a reality for more patients is extremely encouraging. Tragically, 70 per cent of people with pancreatic cancer do not receive active treatment – either lifesaving surgery or chemotherapy that could allow them more precious time with their loved ones. The pain, malnutrition, and debilitating impact on a person’s fitness this devastating disease can cause is often a significant factor.”
“The innovative model of prehabilitation has significant potential, not only for patients to receive treatment, but also for improving post-treatment recovery and ensuring the best quality of life for those living with and beyond the deadliest common cancer.”