# Prehabilitation beyond the trimodal standard: occupational therapy in a quadrimodal cancer care model

## TL;DR

This paper introduces a new cancer prehabilitation model that adds occupational therapy to standard care, improving physical and psychological readiness for surgery in frail patients.

## Contribution

The novel quadrimodal prehabilitation model integrates occupational therapy to enhance outcomes for frail oncology patients.

## Key findings

- Significant improvements in physical fitness, psychological well-being, and nutritional status were observed.
- Three patients no longer met frailty criteria after the program.
- Nutritional risk was reduced, and spirometric parameters improved significantly.

## Abstract

Prehabilitation is an increasingly recognised strategy designed to optimise patients’ physical, nutritional, and psychological status before major surgery. While the benefits of trimodal prehabilitation have been documented, we developed and implemented a quadrimodal model that incorporates occupational therapy as a fourth component. This comprehensive intervention targets frail patients with advanced oncogynecologic disease, a population at high risk for postoperative complications.

The study recruited 40 patients, 32 of whom successfully completed an intensive 3-week prehabilitation programme. The programme comprised four modules: physiotherapy, nutritional support, psychological support, and occupational therapy. Patients completed 4 days of inpatient care and 3 days of home care per week. The effectiveness of the programme was assessed using a range of methods, including physical tests (6-min walk test, 5 × sit-to-stand test), psychological status questionnaires (perceived stress scale) and nutritional assessment using established questionnaires (MUST and PONS).

The results demonstrated statistically significant enhancements in physical fitness assessments, a decline in the frailty index, and an augmentation in psychological well-being. Notably, three patients no longer fulfilled the frailty criteria at the conclusion of the programme. Spirometric parameters, including FVC, FEV1, and PEF, exhibited substantial improvement. The nutritional intervention resulted in a reduction in the number of patients at high risk of malnutrition. Additionally, there was a notable improvement in the nutritional parameters.

This quadrimodal prehabilitation model, integrating occupational therapy, demonstrated effectiveness in preparing frail oncologic patients for radical surgery. The approach not only improved physical and psychological readiness but also allowed for patient stratification into responders and non-responders. Its implementation in clinical practice could enhance patient outcomes and reduce the burden of postoperative recovery.