Optimizing physical recovery after oncological surgery: A blended physical activity and nutrition intervention

Major oncological surgery is frequently associated with substantial functional decline. To limit muscle mass loss and associated decline in physical functioning, it is crucial for patients to increase their physical activity levels and meet protein intake requirements following oncological surgery. However, post-discharge supportive care interventions focusing on functional recovery are limited. Digital health tools— such as smartphone apps and activity trackers— in combination with coaching by allied healthcare professionals may offer a promising solutions by providing accessible support and continuity of care in patients’ own environments. The aim of this thesis was to develop and evaluate a blended intervention designed to provide optimal physical recovery after hospitalization in patients who have undergone gastrointestinal or lung cancer surgery. Chapter 2 evaluates if self-monitoring of physical activity using an activity tracker and smartphone app after hospital discharge is feasible in patients after gastrointestinal or lung cancer surgery. Chapter 3 contains a systematic review and meta-analysis, evaluating the effectiveness of physical activity interventions using activity trackers during or after inpatient care. Based on the results of chapter 2 and 3, the Optimal Physical Recovery After Hospitalization (OPRAH) intervention was developed. The OPRAH intervention combines self-monitoring of physical activity and protein intake, with remote coaching by a physiotherapist and dietician after hospital discharge. Chapter 4 evaluates the feasibility of the OPRAH intervention and the associated study procedures as a prelude to performing a randomized controlled trial. In chapter 5 the protocol for the multicenter randomized controlled trial (RCT) to investigate the effectiveness of the OPRAH intervention compared to usual care is described and results of the multicenter RCT are presented in chapter 6. Chapter 7 presents qualitative data on patient’s experiences with the OPRAH intervention. Furthermore, chapter 8 evaluates the extent to which the OPRAH intervention is conducted as initially designed, by assessing the implementation fidelity. The findings of this thesis indicate that the OPRAH intervention can effectively enhance functional recovery following gastrointestinal and lung cancer surgery. However, further research is needed to determine the optimal patient selection criteria and coaching intensity to maximize patient benefit while ensuring cost-effectiveness. Moreover, targeted adaptations and greater personalization are crucial to address health inequities and improve accessibility for hard-to-reach populations.