Impact of an Allied Health Prehabilitation Service for Haematologic Patients Receiving High Dose Chemotherapy in A Large Cancer Centre

Purpose To evaluate the impact of routine multidisciplinary allied health prehabilitation care in haematologic cancer patients receiving high-dose chemotherapy with autologous stem cell transplant (AuSCT). Methods In a tertiary cancer centre, 12-months of prospectively collected data was retrospectively analysed. Patients were referred to the service for individualised exercise prescription, nutrition intervention and, if indicated through screening, psychological intervention. Impact and operational success were investigated based on the RE-AIM framework: patient uptake of the service and sample representativeness (Reach); Effectiveness in terms of changes in outcomes from initial to pre-transplant assessment; Adoption of the service by key stakeholders; fidelity of the prescribed exercise program (Implementation); and the extent to which the service had become part of routine standard care (Maintenance). Results 183 patients were referred to the AuSCT service, of whom 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Significant improvements were demonstrated between initial and pre-transplant assessments particularly six-minute walk distance (n = 45); mean difference (95% CI) 39.9m (18.8 to 61.0, p = < 0.005). Missing data were an issue for assessment of effectiveness. Fidelity of exercise prescription was moderate with 72% of eligible patients receiving the intended aerobic and resistance exercise interventions. Conclusion The prehabilitation service was well adopted by clinicians. Clinically relevant improvements in outcomes were demonstrated. Recommendations, including development of well-integrated discipline-specific assessment intervention and measurement protocols, are highlighted to improve the service. Prehabilitation should be routinely considered to support the care of patients undergoing AuSCT.