The implementation of a new peri-operative pathway and prehabilitation programme in upper gi cancer patients

Introduction: The Introduction of two pilot projects at the Royal Marsden for the Upper GI cancer group, are demonstrating promising benefits. Initiated from October 2019, a restructured perioperative pathway, termed SUMMIT (Systematic Multi-disciplinary Management of Investigation and intervention), moving anaesthetic assessment upstream, with integration of patients into the MILE (My Integrated Lifestyle Elooking at referral into prehabilitation pillars, and Length of Stay (LOS) outcomes. Results: Since MILE, the percentage of patients receiving iron infusions has increased, (from 14% to 50%), including post-operative infusion in the MILE group accounting for 20% of all iron infusions which was an adjustment to our anaemia service during COVID. Physiotherapy Assessment and referral to either home or group exercise classes also increased (from 40% to 70%). In addition, 100% of patients in MILE received advice and explanation of the importance of exercise and lifestyle change from an anaesthetist at the start of chemotherapy. The two other domains of MILE are Dietician and Psychological input. No change occurred in the referral to dieticians as this is established often upon patients initial clinic consultation so earlier in the pathway prior to SUMMIT. All patients are screened and offered wellbeing support, and in this time period 4 patients were referred for formal assessment. The improvement in LOS since the implementation of MILE is seen with Oesophagectomy patients, with a reduction in ICU stay (median 2 days) and a small reduction in overall hospital stay (median 1 day). Conclusion: Although these are small patient numbers, results are encouraging, and further assessment of postoperative complications may show us the real health benefits to an integrated Lifestyle &Exercise prehabilitation programme.