Psychological factors, prehabilitation and surgical outcomes: evidence and future directions.

The pre-operative optimisation of comorbidities is increasingly recognised as an important element of the pre-operative pathway. These efforts have primarily focused on physical comorbidities such as anaemia and the optimisation of exercise and nutrition. However, there is a growing recognition of the importance of psychological morbidity. Increasingly, evidence suggests that psychological factors have an impact on surgical outcomes in both the short and long term. Pre-operative anxiety, depression and low self-efficacy are consistently associated with worse physiological surgical outcomes and postoperative quality of life. This has led to the emergence of psychological prehabilitation and the trimodal approach to prehabilitation, incorporating psychological intervention as well as exercise and nutritional optimisation. However, there is currently insufficient evidence to be sure that pre-operative psychological interventions are of benefit, or which interventions are most effective, because their impact has been mixed. There is an urgent need for high quality, contemporaneous prospective trials with baseline psychological evaluation, well-described interventions and agreement on the most appropriate psychological, quality of life and physiological outcomes measures.

Managing fatigue after cancer treatment: development of RESTORE, a web-based resource to support self-management.

OBJECTIVE: The aim of this study is to co-create an evidence-based and theoretically informed web-based intervention (RESTORE) designed to enhance self-efficacy to live with cancer-related fatigue (CRF) following primary cancer treatment. METHODS: A nine-step process informed the development of the intervention: (1) review of empirical literature; (2) review of existing patient resources; (3) establish theoretical framework; (4) establish design team with expertise in web-based interventions, CRF and people affected by cancer; (5) develop prototype intervention; (6) user testing phase 1; (7) refinement of prototype; (8) user testing phase 2; and (9) develop final intervention. RESULTS: Key stakeholders made a critical contribution at every step of intervention development, and user testing, which involved an iterative process and resulted in the final intervention. The RESTORE intervention has five sessions; sessions 1 and 2 include an introduction to CRF and goal setting. Sessions 3-5 can be tailored to user preference and are designed to cover areas of life where CRF may have an impact: home and work life, personal relationships and emotional adjustment. CONCLUSIONS: It is feasible to systematically 'co-create' an evidence-based and theory-driven web-based self-management intervention to support cancer survivors living with the consequences of cancer and its treatment. This is the first account of the development of a web-based intervention to support self-efficacy to manage CRF. An exploratory trial to test the feasibility and acceptability of RESTORE is now warranted.