Strong for Oesophago-gastric Cancer Surgery (SOCS) Project
Project description:
There is mounting evidence to suggest that pre-surgical patient optimisation through exercise, nutritional and psychological interventions, known as enhanced prehabilitation, is safe, feasible and effective at reducing surgical morbidity and mortality.
The Strong for Oesophago-gastric Cancer Surgery (SOCS) program is an enhanced prehabilitation package with the aim of improving patient experience and outcomes following oesophageal and gastric cancer surgery. This is achieved through delivering nutritional, physical, and psychological support to patients before their surgery at Austin Health. The SOCS program is coordinated by a dedicated Cancer Care Nurse Coordinator, and is fully integrated into the patient’s pre-existing clinical care pathway. This means that the SOCS program does not interrupt anti-cancer treatments nor extend wait time to surgery. Any patient who is scheduled for elective oesophageal or gastric cancer surgery is eligible to participate in our SOCS program.
The SOCS program involves a comprehensive series of assessments conducted by dieticians, exercise physiologists, clinical psychologists and perioperative physicians, with the aim of establishing the patient’s baseline nutritional, physical, mental and medical fitness. These assessments enable the design of a 12-week personalised intervention program, delivered during chemo/radiotherapy and in the lead-up to surgery. The SOCS program seeks to optimise medical comorbidities, alleviate anxiety, restore self-control, and improve nutritional as well as physical fitness to all participants. This ensures that each patient is ready (‘strong’) for oesophago-gastric cancer surgery.
The Award would support expansion of the program, allowing for training of another nurse liaison officer within our surgical unit to share the responsibilities of a Cancer Care Nurse Coordinator. This will ensure that our patients receive un-interrupted care in the foreseeable future, and therefore sustains the longevity of our prehabilitation program.
Outcomes
The Strong for Oesophago-gastric Cancer Surgery program, which delivers nutritional, physical, and psychological support to patients before their surgery, can lead to:
Improved physical fitness
Maintained nutrition during anti-cancer treatment
Reduced anxiety levels
Increased self-efficacy
Enhanced quality of life
Reduced surgical complications
Minimise overall morbidity and mortality after surgery
Decreased healthcare costs
Improve cancer-specific outcomes
Impact on the healthcare professional
The SOCS program delivers multiple benefits to both medical and allied health clinicians. The process of conceptualising, designing, implementing, and maintaining this program has improved our performance in areas of medical expertise, clinical decision making, professionalism, health advocacy, teamwork, leadership, management, education, cultural competency and cultural safety. These benefits have in turn been positively reflected in patient experiences and outcomes. Moreover, this program has really lifted team morale, particularly during the COVID pandemic, where social distancing and enforced furlough has significantly impaired traditional methods of team building and collaboration.
Impact on the healthcare institution
The SOCS program may benefit Austin Health in multiple ways. Firstly, reduced surgical morbidity drastically saves healthcare cost. Secondly, reduced complications decreases length of stay, particularly in intensive care and high-dependency bed utilisation. This in turn increases bed availability for other patients, which is invaluable during the current COVID pandemic. Thirdly, through streamlined clinical care pathways, we have improved our efficiency in delivering cancer care. Moreover, the implementation of an up-to-date cancer database for this program will improve accessibility and accuracy of auditing our own outcomes. Finally, our program has established additional infrastructure for research, which we hope will expand our reputation as a leading oesophago-gastric cancer centre in Australia.
Proposer
Austin Health
145 Studley Road
Heidelberg, Victoria
Project contact person:
Dr. David Liu
David.liu2@austin.org.au
Project team members:
Upper gastrointestinal surgeon: Dr. David Liu (Coordinating principal investigator)
Exercise physiologist: Ms. Ashley Bigaran (Coordinating principal investigator)
Cancer Care Nurse Coordinator: Ms. Linda Watson
Physiotherapists: Ms. Clare O’Donnell
Dieticians: Ms. Belinda Johnston, Ms. Jaimee Cacic, Ms. Brooke Chapman
Clinical psychologist: Prof. Carlene Wilson, Dr. Karalyn McDonald
Gastroenterologist: Dr. Darren Wong
Anaesthetists: Dr. Marissa Ferguson, A/Prof. Laurence Weinberg
Upper gastrointestinal surgeons: A/Prof. Ahmad Aly, Dr. Stephen Kunz
Upper gastrointestinal surgery research nurse: Ms. Amanda Dalyell
Respiratory laboratory scientist: Mr. Danny Brazzale
Respiratory physician: Dr. Celia Lanteri
Clinical costing analyst: Dr. Ronald Ma
Project coordinator: Ms. Kat Hall