MEDIA RELEASE CGH's home-based prehabilitation programme provides cancer patients a head-start in recovery - Singapore General ...

MEDIA RELEASE

    CGH’s home-based prehabilitation programme provides cancer patients
                         a head-start in recovery
Singapore, 15 February 2022 –Patients with newly diagnosed cancers who require prehabilitation
before embarking on their cancer treatment at Changi General Hospital (CGH) can now have a head-
start in optimising their physical and mental health in the comfort of their homes. Initiated by CGH
rehabilitation medicine specialists, this one-stop screen-and-intervene initiative cuts down time spent
in the hospital, and allows patients to focus fully on the prehabilitation to reap its benefits before
treatment starts – be it for surgery, chemotherapy or radiotherapy.

Comprising a series of assessment tests and clinical interventions, CGH’s prehabilitation programme
has since benefited close to 200 patients. In a pilot study of some 60 colorectal cancer patients1, the
patients showed significant improvement in physical tests measuring their functional capabilities after
undergoing prehabilitation, which also translated to better functional recovery after surgery. They also
had a significant improvement in their mental health, and went home earlier by an average of 1.5 days
after the surgery, with reduced readmission and mortality rates.

Clinical Assistant Professor Kwok Kah Meng, Consultant, Department of Rehabilitation
Medicine, said, “The involvement of a rehabilitation specialist doctor within CGH’s prehabilitation
programme allows us to holistically assess and intervene across medical, physical and mental
domains, and improve our cancer patients’ capacity to better withstand their upcoming surgery or anti-
cancer therapies. Beyond that, we also aim to help them regain their functional independence post-
treatment as soon as possible, facilitate their recovery journey from hospital to home, and empower
them to develop long-term beneficial health habits including exercise.”

Clinical Assistant Professor Dr Tay San San, Chief and Senior Consultant, Department of
Rehabilitation Medicine, said, “Despite the pandemic, our cancer patients have been able to
undergo cancer prehabilitation in the safety and comfort of their homes with minimal disruption due to
the home-based model of this programme. This ‘window of opportunity’ is crucial in empowering our
patients to play a part in improving their post-surgery outcomes. With the prehabilitation framework
set up by CGH, more cancer patient groups are able to benefit from the one-stop initiative.”

Typically, in other models of care, patients are referred to various allied health specialties by the
surgeons for prehabilitation. These appointments may occur on different days, and take time
However, under the new framework, most patients will need only two appointments – one for the first
consultation and the other before treatment starts.

Patients are mostly seen on the same day for their prehabilitation consultation, after their surgical
consultation. They will undergo a holistic health assessment comprising frailty, functional and mental
wellness tests by a prehabilitation coordinator. Based on the results and their medical conditions, the
rehabilitation doctors will draw up a personalised intervention plan in four areas, including optimisation

1Reference: Setting Up A Cancer Prehabilitation Framework in Singapore
Tay San San, Kwok Kah Meng
Journal of Cancer Rehabilitation 2021;4:1-6. DOI: 10.48252/JCR5

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of pre-existing chronic conditions, an exercise prescription, and specific advice relating to nutrition
and mental wellness. (Refer to Annex A)

Patients are then empowered to carry out these exercises and relaxation techniques at home that are
taught by the doctors. Family members and caregivers who are present during the consultation can
also learn these exercises to provide further reinforcement and supervision. These curated exercises
are available to the cancer prehabilitation patients under the HealthBuddy mobile app for them to re-
watch and follow the exercise video demonstrations developed by CGH. The prehabilitation
coordinator also checks in on patients’ progress regularly. (Refer to Annex B)

During the consultation, the doctors may also prescribe or titrate medication to improve patients’ body
conditions and in some instances, recommend additional supplements to promote recovery post-
treatment.

At the second consultation, prior to their cancer treatment, patients will undergo the same set of
assessment tests to measure their progress. The CGH prehabilitation team will continue to monitor
their recovery after their surgery, chemotherapy or radiotherapy sessions.

The prehabilitation programme has been expanded to include prostate, bladder, liver, biliary,
pancreatic, oesophagus and gastric cancer patients planned for surgery at CGH. (Refer to Annex C
for patient profile)

 Click here or scan the QR code below to watch the YouTube video of the patient journey for cancer
                             prehabilitation (Internet access required)

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CGH prehabilitation coordinator conducting the     CGH prehabilitation coordinator conducting the
 sit-to-stand assessment                            hand grip test using the hand dynamometer

   CGH rehabilitation specialist demonstrating an exercise for a patient undergoing prehabilitation

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About Changi General Hospital
Changi General Hospital (CGH) is an academic medical institution caring for more than 1 million people
in Singapore. A tertiary referral centre with over 1,000 beds, CGH is committed to medical research
and education, clinical innovation and care for patients through a comprehensive range of medical
specialties and services. Helmed by a multi-disciplinary, dedicated team of healthcare professionals,
CGH consistently delivers positive health outcomes for patients. For more information, visit
www.cgh.com.sg

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ANNEX A: 4 KEY AREAS IN PERSONALISED INTERVENTION PLAN

ANNEX B: EXERCISES DEMONSTRATION

     Warm up exercises
     How to do a cross punch
     How to do a dig & flex
     How to do a tap & punch
     How to do a sit to stand
     How to do a squat chop
     How to do a march & twist
     How to do an ice skater?
     Cool down exercises

Click below or scan QR codes to view videos:

               English Videos                     Chinese Videos

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ANNEX C: PATIENT PROFILE

64-year old Goh Tong Nang did his first colonoscopy at CGH in March 2021 on the prompting of his
friends. He had not done one before even though he was in the high-risk age group. Following the
screening, the colorectal surgeon detected polyps which were removed and sent for testing. Mr Goh
was diagnosed to have Stage 1 colorectal cancer.

The colorectal surgeon subsequently recommended surgery to remove the part of the colon. As soon
as Mr Goh was listed for surgery, he was concurrently referred to a rehabilitation physician to undergo
cancer prehabilitation, to help optimise his state of health and also to prepare him physically and
mentally for the surgery.

During his first cancer prehabilitation appointment, Mr Goh remembers undergoing physical
assessments and being taught physical exercises by a rehabilitation specialist to strengthen his legs
and abdomen. The rehabilitation specialist also advised him to include more protein in his diet and
shared anxiety reduction strategies. Mr Goh did not take the preparation for his surgery lightly. He
followed the physical exercise regime strictly, carrying out the prescribed exercises up to four times
daily in addition to his daily jogging regimen and golfing sessions.

Close to the date of his surgery, he went through the same series of physical assessments. The
rehabilitation specialist observed an improvement from his baseline scores. Mr Goh subsequently had
his surgery which went well, and was only warded for two days. To keep up his health, he continued
with the exercises for two months after his surgery.

Three months on, not only was Mr Goh recovering well, his post-operation scores were much better
than the baseline scores achieved during the first assessment. Mr Goh continues to enjoy his active
lifestyle and golfing sessions with his friends.

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