Poster Presentation NSW State Cancer Conference 2023

Outcome heterogeneity in prehabilitation trials- should we be worried? (#310)

Wilson Jiang 1 , Kilian G.M. Brown 1 2 3 , Cherry Koh 1 2 3 4 , Sascha Karunaratne 1 2 , Michael Solomon 1 2 3 4 , Paula R. Beckenkamp 1 5 , Ruby Cole 1 2 , Daniel Steffens 1 2
  1. Royal Prince Alfred Hospital, Camperdown, NEW SOUTH WALES, Australia
  2. Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
  3. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  4. Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  5. Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia

Introduction

Prehabilitation is an innovative healthcare intervention designed to enhance patient fitness prior to surgery, with the goal of decreasing postoperative complications and improving recovery times. However, the existing literature on prehabilitation trials is constrained by the inconsistency in reported outcomes and a lack of standardised definitions. The objective of this review is to provide an overview of the outcomes documented in randomised controlled trials (RCTs) focused on prehabilitation in patients undergoing cancer surgery.

Methods

We conducted a comprehensive search in Embase, AMED, The Cochrane Library, PsycINFO, MEDLINE, and CINAHL from inception to July 2021. We included randomised controlled trials (RCTs) that evaluated preoperative interventions (exercise, nutrition, psychological interventions) in adult oncology patients undergoing thoracic and gastrointestinal surgery. Verbatim outcomes reported in each article were extracted and assessed for definition and measurement using a tool. These outcomes were then categorised into standardised outcomes and domains. The quality of outcome reporting in each article was evaluated using Harman et al.'s tool, which assigns a score from 0 to 6, where 0 indicated that none of the criteria in the tool were addressed (1).

Results

We included 74 RCTs and extracted 601 outcomes, which were merged into 119 standardised outcomes. Only 110 (18.3%) of the outcomes were defined, 270 (44.9%) were labelled as ‘primary’ or ‘secondary’, and 198 (32.9%) were measured with a validated tool. The outcome reporting quality score showed poor quality across studies with a median score of 2. Surgical outcomes were most commonly reported, with 71 (95.9%) studies reporting at least one outcome in this domain. In contrast, disease activity outcomes were reported in only eight (10.8%) studies. The most commonly reported standardised outcome was 'postoperative complications', reported in 38 (51.4%) trials.

Conclusion

RCTs exhibit significant heterogeneity in the reporting of outcomes and insufficient definitions for those outcomes. To enhance the quality of outcome reporting, it is crucial to establish and implement standardised core outcome sets. This approach would promote better interpretation and strengthen the evidence base for prehabilitation trials.

  1. 1. Harman NL, Bruce IA, Callery P, Tierney S, Sharif MO, O'Brien K, et al. MOMENT--Management of Otitis Media with Effusion in Cleft Palate: protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials. 2013;14:70.