CareinCancer(2021)29:551–554/10.1007/s00520-020-05768-
4 COMMENTARY TeleprehabilitationduringCOVID-19pandemic:theessentialsof“what”and“how” GenevieveLambert1,2&hDrummond1,2&VanessaFerreira1,3&FrancescoCarli1,
2 Received:16June2020/epted:8September2020/Publishedonline:12September2020#Springer-VerlagGmbHGermany,partofSpringerNature2020 AbstractInviewoftheCOVID-19pandemicandrecentglobalevents,thehealthcaresystemanditsserviceshavebeennegativelyaffected,contributingtowardsextensivesurgicalbacklogs.Oncologicalsurgicalcandidateshavebeenthemostimpactedbythesechangesandmendedself-isolationpractices,whichcouldresultinemotionaldistress,sedentarybehavior,andpoorlifestylehabits.Preoperativesupportiveintervention,prehabilitation,hasbeenproventoimprovepatients’functionalstatusandclinicaltrajectories.Presently,thereisacriticalneedforprehabilitationtooptimizepatienthealth,astheyexperienceextendedwaittimes.However,in-hospitaldeliverymaynotbeanidealapproachduetopublichealthandsafetymeasures.Telehealthisafieldofresearchandpractice,whichhasgrownandevolvedsignificantlyinthelasttwodecades,allowingfortheremotedeliveryofhealthservices.Therefore,thementaryaddressesthedifferentmodalitiesoftelehealthdeliveryinperspectiveoftheirknownfeasibilityandpotentialapplicationinprehabilitation. KeywordsPrehabilitation.Telehealth.Videoconferencing.Teleprehabilitation.Isolation.Inactivity.Elderly.Frail.Exercise.Nutrition.Behavioralcounseling TheCOVID-19pandemichasimmenselyimpactedpublichealthandthedeliveryofhealthcareservicesaroundtheworld.Inanefforttoincreasepublicsafety,hospitaltraffichasbeenrestrictedbylimitingnon-essentialmedicalvisitsandprocedures.Consequently,alargemajorityofelectivesurgerieshavebeenpostponedindefinitely,imposingastrainonbothpatientsandhealthcaresystems.Allthewhile,patientsarecontinuouslyplacedonsurgicalwaitlistsresultinginextensiveandgrowingsurgicalbacklogs[1].Theoncologicalsurgicalcandidatesarehighpriorityandoftenorbidities,makingthemincreasinglysusceptibletoplications[2].Inadditiontoextendedwaittimes,oncologicalpatients *FrancescoCarlifranco.carli@mcgill.ca 1DepartmentofAnesthesia,MontrealGeneralHospital,McGillUniversityHealthCentre,Montreal,Quebec,Canada 2DepartmentofExperimentalSurgery,McGillUniversity,Montreal,Quebec,Canada 3DepartmentofKinesiology,McGillUniversity,Montreal,Quebec,Canada mustself-isolatefortheirsafety,whichmayhaveseriousrepercussionsonlifestylehabits,negativelyaffectingphysicalcondition,nutrition,andmentalstatus[3].Predictably,assurgeriesbegintoslowlyresume,patientsarelikelytomanifestcumulativehealthimpairments,therebyaggravatingprognosisandriskoferativemorbidityandmortality[3].Inlightofthegrowingsurgicalbacklogsandanticipatedhealth-relatedaftereffectsofisolation,preoperativelifestyleinterventionsaremorecrucialnowthanever. Prehabilitation,definedaslifestyleinterventionsaimedtopreparepatientsforthephysiologicalstressassociatedwithmajorsurgeries,hasdemonstratedtohaveclinicalimportanceinenhancingperioperativefunctionandrecovery[4].Prehabilitationinterventionsarepersonalizedtopatients’needsandtypicallyincludeexercise,nutrition,andpsychologicalsupport.Additionally,itprovidesanopportunitytoempowerpatientsintheircarecontinuumandincreasetheirresilienceinviewoffutureimpairments.Naturally,theimpactofprehabilitationonpatientesislargelydependentontheiradherence.Supervisionduringexerciseinterventionshasbeendemonstratedtobethepreferredapproach,asitisassociatedwithasuperiorimpactonadherencewithsustainedimprovementsinfunctionalcapacity[5]. 552 SupportCareCancer(2021)29:551–554 Atthepresenttime,wearefacingahealthparadigm;althoughprehabilitationisincreasinglypertinentduringthesechallengingtimes,in-hospital-supervisedprogramsmaynotbewidelyeptedbypatients[6].Thus,manypatientsmaynotesstherequiredsupportivecare.Otherauthorshaveelaboratedonthepossibilityofusingtelehealthfordistanceddeliveryofpatientservicesintimesofpandemic[6,7].Telehealthreferstoalargevarietyofinterventionmodalities,eitherasynchronousorreal-timeapplications,thatcanbeusedplementandenhancethequalityofcare[8].Telehealthincludesallhealthservicesdeliveredusingtechnologiesandcouldbeassimpleashavinghealthcareproviderscallpatients.Understandably,supportprovidedviatelephonehaslimitationsinthecontextofprehabilitation,sinceobjectivefunctionalassessmentsandpersonalizedprogramprescriptionsarenotfeasible. ArecentstudybyCheridetal.[9]reportedthatelderlypopulationsareingincreasinglyknowledgeablewiththeuseoftechnologies,whichhaspromptedsignificantsatisfactionfrompatientsandcliniciansinthedeliveryoftelehealthservices[10].Othertelehealthapproaches,likeasynchronousinterventionsandremotemonitoring,haveeincreasinglyutilizedsincethebeginningofthepandemic[11].Thesewouldincludetheuseofwearabledevices(e.g.,elerometer,stepcounter,orheartratemonitor)andsendingvideo-basedexerciseprogramsthroughplatforms(e.g.,emails,websites,orapplications).However,thesetypesofinterventionsmaynotbemendedforhigh-riskpatients,astheyrequiremoresupervisionandspecificsupport.Also,theydonotprovidethementalwell-beingbenefitsofsocialinteractions.Furthermore,wearabledeviceshavealsofacedsomescrutinyastotheirclinicalandscientificvalidity.Thisisnotablyduetosomewearabledevices’uratedata,suchasestimationsofcaloricexpenditurewhichareweaklycorrelatedtostandardizedmetabolicassessmentsandhighinter-modelvariability.Modernwearabledevicesuseopticalsensor-basedheartratemonitorsandhaveparedwithelectrocardiogramstoassesstheiruracyandvalidity;theliteraturereportsstrongcorrelationsatrest,whichdecreaseswithincreasedexerciseintensity[12].Althoughnoteworthy,thisingisnotconcerningamongtheelderlyandoncologicsurgicalcandidatesasmostcannottoleratehighintensityexercise.Also,theelerometer-basedstepcountersincludedinwearabledevicescanlargelyunderestimatethenumberofstepsinslowerwalksspeedsandhavealotofinter-modeldisparities[13].Thelateremphasizesthatevenwithtechnologicaladvancements,appropriateproductselectionisimportanttoacquirehigh-qualitydata.Commercialwearabletechnologiesofferseveralbenefitsrelatedtoeaseofuseandremoteacquisitionofthedataformonitoring;however,thereisaneedforclinicianstofamiliarizethemselveswiththetechnologiesusedinordertointerpretthedatawithcriticalminds. Abetter-targeteduseoftechnologiestoprovideprehabilitationcouldbereal-timevideoconferencing.Thiswouldaddressmanyofthelimitationsofothertelehealthmethods,providingvisualinformationforthepatientsandreciprocalfeedbackforclinicians,furtherprovidingsafetyinadditiontothebenefitsofsocialinteractions.Videoconferencinghasproventobeeffectiveandbeneficialinthedeliveryofhealthservicesinavarietyofclinicalcontexts[14–16];however,duetothetimelynatureofprehabilitation,telehealthmaypromptdifferentbarrierstootherclinicalcontextsofintervention.Thechoiceofthesystemrequiresconsiderationoftechnologicalessibilityandintuitivenessoftheinterfaces:previousstudiesutilizedeitherinnovativedevicestobetakenhomeand/orinstallationservicesforthetechnologies.Introducingneworinnovativedevicesinpatients’dailylifemayimposealearningcurvebarrierthatcouldnegativelyimpactadherenceintheshort-livedprehabilitationprocess.Therefore,usagemercialdevices(e.g.,puters,tablets,smartphones)andapplications,respectinggovernmentalregulations,maybeadvantageous,aspatientsmayalreadyhaveesstosimilartechnologiesandwouldthereforefacilitatetheiradoption[17].Inasimilarvein,thecostoftelecaremaybedecreasedbytheusemercialdevices,ifpatientsareabletousetheirowntechnologies.Additionally,relatingtothecost-efficiencyoftelehealth,astudydemonstratedthatteleprehabilitationbecamecost-effectiveforthehealthcaresystemwhenpatientslivedfurtherawayfromthetertiaryhealthcarecenterthan30km[18]. Videoconferencingcannotreplaceessentialhospitalvisitsneverthelessplementthedeliveryofhealthservicesandislargelyeptedasaneffectiveandnon-inferioralternativetoface-to-facetherapyinthedeliveryofbothpostsurgicalrehabilitation[14,15]andprehabilitation[17,19–21].Ithasfurtherproventobefeasibleandeffectivetodelivernutritionalandpsychologicalcounseling[16,22].Notably,fromthepatientperspective,therelationshipwiththetherapistthroughvideoconferencingwasshowntofosterasenseofsafetyandsupport.Patientshavevoicedsatisfactionwithtelehealthprograms,reportingfeelingengagedintheircontinuityofcareandmoreresilientbothphysicallyandmentally[23].Anotherstudyreportedthatvideoconferencingallowedforvisualcues,helpingtoreducerisksofmunicationandincreasingfocusofbothpatientsandclinicians[24].Granted,theyreportedtheincidenceoftechnicalissues,inwhichcaseclinicianswouldresortbacktophoneappointments,whichhighlightstheneedforareliablesystem.Thelaterwouldbedefinedasasystemeasytoessforpatientsandclinicians,withsmoothvisualandmunicationandminimaltimelagassociatedwithusageonbothsidesofmunicationsystem[24].Therewouldbetwowaystoresolvethechallengesoflag:(a)havetheclinicianuseanconnectionasitismorestableandreliablethanWiFiand(b)providetechnologieswithdataincluded(i.e.,atabletwithasimcardin). SupportCareCancer(2021)29:551–554 Inprogramsusingaunimodalvideoconferencingsystem,itmaybechallengingtoquantifyfunctionalimprovementsifpatientsarenotseenin-hospital,asnotallassessmentsareappropriateandreproducibleinhome-basedsettings.Thiswouldsuggesttheneedbinesystemstoesspertinentinformation,whileprovidingsupport,usingtechnologiesthatwillnotbeoverbearingforthepatients.Withtheintegrationofvideoconferencing,mobileandwearabledevices,dataacquisition,andclinicalsupportcanbefacilitated,whileavoidingtheneedtointroduceforeigntechnologies.Withtechnologicaladvancements,trainingwatchesprovidemanytoolstohelpusersbemoreawareoftheirdailyhabitsinordertoimprovetheirlifestyle.Quantifyingtheirsleep[25],relaxationtime,physicalactivity[26],orinactivity[27]canhelppatientsattaintheirobjectives.Acquiringsuchdata,inadditiontoself-reportedquestionnaires,mayleadtoimprovementsinpersonalizedcounseling,patientmotivation,andengagement. binedtelehealthapproachmaybeanappropriatesetoftoolsforhealthcareproviderstoproperlysupportoncologicsurgicalcandidates,whilepromotingpatientsafetyandrespectinggovernmentalguidelinesinviewofthecurrentandfuturepandemics.Asthesetechnologiesemoreeptedandcontinuetoevolve,furtherresearchiscrucialtoaligntelehealthwitheffectiveperioperativehealthmanagementstrategies.Subjectssuchas(a)feasibilityandeffectivenessofremotefunctionalassessments,(b)theoptimaltechnologiesandmethodologiesformultimodaltele-interventions,and(c)theeptanceandadherencetointerventionprogramswouldneedtobeexploredpleteunderstandingofthefeasibilityandeffectivenessofteleprehabilitationinelderlyandadultoncologicpopulations.Compliancewithethicalstandards ConflictofinterestTheauthorsdeclarethattheyhavenoconflictofinterest. References
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2.SøgaardM,ThomsenRW,BossenKS,SørensenHT,NørgaardM(2013)Theimpactorbidityoncancersurvival:areview.ClinEpidemiol5(SUPP1):3–29
3.SilverJK(2020)PrehabilitationmayhelpmitigateanincreaseinCOVID-19peri-pandemicsurgicalmorbidityandmortality.AmJPhysMedRehabil99
(6):459
4.SimcockR(2019)Principlesandguidanceforprehabilitationwithinthemanagementandsupportofpeoplewithcancerinpartnershipwithacknowledgements[].Availablefrom:/publication/336617250.essed18Jun2019
5.AwasthiR,MinnellaEM,FerreiraV,RamanakumarAV,ScheedeBergdahlC,CarliF(2019)Supervisedexercisetrainingwithmultimodalpre-habilitationleadstoearlierfunctionalrecovery 553 followingcolorectalcancerresection.ActaAnaesthesiolScand63
(4):461–4676.SilverJK(2020)Prehabilitationcouldsavelivesinapandemic[].BMJ369:m1386Availablefrom:/lookup/doi/10.1136/bmj.m1386.essed6Apr20197.SellNM,SilverJK,RandoS,DraviamAC,SantaMinaD,QadanM,etalPrehabilitationtelemedicineinneoadjuvantsurgicaloncologypatientsduringthenovelCOVID-19coronaviruspandemic8.McCannL,McMillanKA,PughG(2019)Digitalinterventionstosupportadolescentsandyoungadultswithcancer:systematicreview.JMIRCancer5
(2):e120719.CheridC,BaghdadliA,WallM,MayoNE,BerryG,HarveyEJ,AlbersA,BergeronSG,MorinSN(2020)Currentleveloftechnologyuse,healthandeHealthliteracyinolderCanadianswitharecentfracture—asurveyinorthopedicclinics.OsteoporosInt31:1333–134010.ApplemanER,O’ConnorMK,RockefellerW,MorinP,MooLR(2020)Usingvideotelehealthtodeliverpatient-centeredcollaborativecare:theG-IMPACTpilot.ClinGerontol:1–1011.BettgerJP,ThoumiA,MarquevichV,DeGrooteW,RizzoBattistellaL,ImamuraMetal(2020)COVID-19:maintainingessentialrehabilitationservicesacrossthecarecontinuum.BMJGlobHealth5
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4 COMMENTARY TeleprehabilitationduringCOVID-19pandemic:theessentialsof“what”and“how” GenevieveLambert1,2&hDrummond1,2&VanessaFerreira1,3&FrancescoCarli1,
2 Received:16June2020/epted:8September2020/Publishedonline:12September2020#Springer-VerlagGmbHGermany,partofSpringerNature2020 AbstractInviewoftheCOVID-19pandemicandrecentglobalevents,thehealthcaresystemanditsserviceshavebeennegativelyaffected,contributingtowardsextensivesurgicalbacklogs.Oncologicalsurgicalcandidateshavebeenthemostimpactedbythesechangesandmendedself-isolationpractices,whichcouldresultinemotionaldistress,sedentarybehavior,andpoorlifestylehabits.Preoperativesupportiveintervention,prehabilitation,hasbeenproventoimprovepatients’functionalstatusandclinicaltrajectories.Presently,thereisacriticalneedforprehabilitationtooptimizepatienthealth,astheyexperienceextendedwaittimes.However,in-hospitaldeliverymaynotbeanidealapproachduetopublichealthandsafetymeasures.Telehealthisafieldofresearchandpractice,whichhasgrownandevolvedsignificantlyinthelasttwodecades,allowingfortheremotedeliveryofhealthservices.Therefore,thementaryaddressesthedifferentmodalitiesoftelehealthdeliveryinperspectiveoftheirknownfeasibilityandpotentialapplicationinprehabilitation. KeywordsPrehabilitation.Telehealth.Videoconferencing.Teleprehabilitation.Isolation.Inactivity.Elderly.Frail.Exercise.Nutrition.Behavioralcounseling TheCOVID-19pandemichasimmenselyimpactedpublichealthandthedeliveryofhealthcareservicesaroundtheworld.Inanefforttoincreasepublicsafety,hospitaltraffichasbeenrestrictedbylimitingnon-essentialmedicalvisitsandprocedures.Consequently,alargemajorityofelectivesurgerieshavebeenpostponedindefinitely,imposingastrainonbothpatientsandhealthcaresystems.Allthewhile,patientsarecontinuouslyplacedonsurgicalwaitlistsresultinginextensiveandgrowingsurgicalbacklogs[1].Theoncologicalsurgicalcandidatesarehighpriorityandoftenorbidities,makingthemincreasinglysusceptibletoplications[2].Inadditiontoextendedwaittimes,oncologicalpatients *FrancescoCarlifranco.carli@mcgill.ca 1DepartmentofAnesthesia,MontrealGeneralHospital,McGillUniversityHealthCentre,Montreal,Quebec,Canada 2DepartmentofExperimentalSurgery,McGillUniversity,Montreal,Quebec,Canada 3DepartmentofKinesiology,McGillUniversity,Montreal,Quebec,Canada mustself-isolatefortheirsafety,whichmayhaveseriousrepercussionsonlifestylehabits,negativelyaffectingphysicalcondition,nutrition,andmentalstatus[3].Predictably,assurgeriesbegintoslowlyresume,patientsarelikelytomanifestcumulativehealthimpairments,therebyaggravatingprognosisandriskoferativemorbidityandmortality[3].Inlightofthegrowingsurgicalbacklogsandanticipatedhealth-relatedaftereffectsofisolation,preoperativelifestyleinterventionsaremorecrucialnowthanever. Prehabilitation,definedaslifestyleinterventionsaimedtopreparepatientsforthephysiologicalstressassociatedwithmajorsurgeries,hasdemonstratedtohaveclinicalimportanceinenhancingperioperativefunctionandrecovery[4].Prehabilitationinterventionsarepersonalizedtopatients’needsandtypicallyincludeexercise,nutrition,andpsychologicalsupport.Additionally,itprovidesanopportunitytoempowerpatientsintheircarecontinuumandincreasetheirresilienceinviewoffutureimpairments.Naturally,theimpactofprehabilitationonpatientesislargelydependentontheiradherence.Supervisionduringexerciseinterventionshasbeendemonstratedtobethepreferredapproach,asitisassociatedwithasuperiorimpactonadherencewithsustainedimprovementsinfunctionalcapacity[5]. 552 SupportCareCancer(2021)29:551–554 Atthepresenttime,wearefacingahealthparadigm;althoughprehabilitationisincreasinglypertinentduringthesechallengingtimes,in-hospital-supervisedprogramsmaynotbewidelyeptedbypatients[6].Thus,manypatientsmaynotesstherequiredsupportivecare.Otherauthorshaveelaboratedonthepossibilityofusingtelehealthfordistanceddeliveryofpatientservicesintimesofpandemic[6,7].Telehealthreferstoalargevarietyofinterventionmodalities,eitherasynchronousorreal-timeapplications,thatcanbeusedplementandenhancethequalityofcare[8].Telehealthincludesallhealthservicesdeliveredusingtechnologiesandcouldbeassimpleashavinghealthcareproviderscallpatients.Understandably,supportprovidedviatelephonehaslimitationsinthecontextofprehabilitation,sinceobjectivefunctionalassessmentsandpersonalizedprogramprescriptionsarenotfeasible. ArecentstudybyCheridetal.[9]reportedthatelderlypopulationsareingincreasinglyknowledgeablewiththeuseoftechnologies,whichhaspromptedsignificantsatisfactionfrompatientsandcliniciansinthedeliveryoftelehealthservices[10].Othertelehealthapproaches,likeasynchronousinterventionsandremotemonitoring,haveeincreasinglyutilizedsincethebeginningofthepandemic[11].Thesewouldincludetheuseofwearabledevices(e.g.,elerometer,stepcounter,orheartratemonitor)andsendingvideo-basedexerciseprogramsthroughplatforms(e.g.,emails,websites,orapplications).However,thesetypesofinterventionsmaynotbemendedforhigh-riskpatients,astheyrequiremoresupervisionandspecificsupport.Also,theydonotprovidethementalwell-beingbenefitsofsocialinteractions.Furthermore,wearabledeviceshavealsofacedsomescrutinyastotheirclinicalandscientificvalidity.Thisisnotablyduetosomewearabledevices’uratedata,suchasestimationsofcaloricexpenditurewhichareweaklycorrelatedtostandardizedmetabolicassessmentsandhighinter-modelvariability.Modernwearabledevicesuseopticalsensor-basedheartratemonitorsandhaveparedwithelectrocardiogramstoassesstheiruracyandvalidity;theliteraturereportsstrongcorrelationsatrest,whichdecreaseswithincreasedexerciseintensity[12].Althoughnoteworthy,thisingisnotconcerningamongtheelderlyandoncologicsurgicalcandidatesasmostcannottoleratehighintensityexercise.Also,theelerometer-basedstepcountersincludedinwearabledevicescanlargelyunderestimatethenumberofstepsinslowerwalksspeedsandhavealotofinter-modeldisparities[13].Thelateremphasizesthatevenwithtechnologicaladvancements,appropriateproductselectionisimportanttoacquirehigh-qualitydata.Commercialwearabletechnologiesofferseveralbenefitsrelatedtoeaseofuseandremoteacquisitionofthedataformonitoring;however,thereisaneedforclinicianstofamiliarizethemselveswiththetechnologiesusedinordertointerpretthedatawithcriticalminds. Abetter-targeteduseoftechnologiestoprovideprehabilitationcouldbereal-timevideoconferencing.Thiswouldaddressmanyofthelimitationsofothertelehealthmethods,providingvisualinformationforthepatientsandreciprocalfeedbackforclinicians,furtherprovidingsafetyinadditiontothebenefitsofsocialinteractions.Videoconferencinghasproventobeeffectiveandbeneficialinthedeliveryofhealthservicesinavarietyofclinicalcontexts[14–16];however,duetothetimelynatureofprehabilitation,telehealthmaypromptdifferentbarrierstootherclinicalcontextsofintervention.Thechoiceofthesystemrequiresconsiderationoftechnologicalessibilityandintuitivenessoftheinterfaces:previousstudiesutilizedeitherinnovativedevicestobetakenhomeand/orinstallationservicesforthetechnologies.Introducingneworinnovativedevicesinpatients’dailylifemayimposealearningcurvebarrierthatcouldnegativelyimpactadherenceintheshort-livedprehabilitationprocess.Therefore,usagemercialdevices(e.g.,puters,tablets,smartphones)andapplications,respectinggovernmentalregulations,maybeadvantageous,aspatientsmayalreadyhaveesstosimilartechnologiesandwouldthereforefacilitatetheiradoption[17].Inasimilarvein,thecostoftelecaremaybedecreasedbytheusemercialdevices,ifpatientsareabletousetheirowntechnologies.Additionally,relatingtothecost-efficiencyoftelehealth,astudydemonstratedthatteleprehabilitationbecamecost-effectiveforthehealthcaresystemwhenpatientslivedfurtherawayfromthetertiaryhealthcarecenterthan30km[18]. Videoconferencingcannotreplaceessentialhospitalvisitsneverthelessplementthedeliveryofhealthservicesandislargelyeptedasaneffectiveandnon-inferioralternativetoface-to-facetherapyinthedeliveryofbothpostsurgicalrehabilitation[14,15]andprehabilitation[17,19–21].Ithasfurtherproventobefeasibleandeffectivetodelivernutritionalandpsychologicalcounseling[16,22].Notably,fromthepatientperspective,therelationshipwiththetherapistthroughvideoconferencingwasshowntofosterasenseofsafetyandsupport.Patientshavevoicedsatisfactionwithtelehealthprograms,reportingfeelingengagedintheircontinuityofcareandmoreresilientbothphysicallyandmentally[23].Anotherstudyreportedthatvideoconferencingallowedforvisualcues,helpingtoreducerisksofmunicationandincreasingfocusofbothpatientsandclinicians[24].Granted,theyreportedtheincidenceoftechnicalissues,inwhichcaseclinicianswouldresortbacktophoneappointments,whichhighlightstheneedforareliablesystem.Thelaterwouldbedefinedasasystemeasytoessforpatientsandclinicians,withsmoothvisualandmunicationandminimaltimelagassociatedwithusageonbothsidesofmunicationsystem[24].Therewouldbetwowaystoresolvethechallengesoflag:(a)havetheclinicianuseanconnectionasitismorestableandreliablethanWiFiand(b)providetechnologieswithdataincluded(i.e.,atabletwithasimcardin). SupportCareCancer(2021)29:551–554 Inprogramsusingaunimodalvideoconferencingsystem,itmaybechallengingtoquantifyfunctionalimprovementsifpatientsarenotseenin-hospital,asnotallassessmentsareappropriateandreproducibleinhome-basedsettings.Thiswouldsuggesttheneedbinesystemstoesspertinentinformation,whileprovidingsupport,usingtechnologiesthatwillnotbeoverbearingforthepatients.Withtheintegrationofvideoconferencing,mobileandwearabledevices,dataacquisition,andclinicalsupportcanbefacilitated,whileavoidingtheneedtointroduceforeigntechnologies.Withtechnologicaladvancements,trainingwatchesprovidemanytoolstohelpusersbemoreawareoftheirdailyhabitsinordertoimprovetheirlifestyle.Quantifyingtheirsleep[25],relaxationtime,physicalactivity[26],orinactivity[27]canhelppatientsattaintheirobjectives.Acquiringsuchdata,inadditiontoself-reportedquestionnaires,mayleadtoimprovementsinpersonalizedcounseling,patientmotivation,andengagement. binedtelehealthapproachmaybeanappropriatesetoftoolsforhealthcareproviderstoproperlysupportoncologicsurgicalcandidates,whilepromotingpatientsafetyandrespectinggovernmentalguidelinesinviewofthecurrentandfuturepandemics.Asthesetechnologiesemoreeptedandcontinuetoevolve,furtherresearchiscrucialtoaligntelehealthwitheffectiveperioperativehealthmanagementstrategies.Subjectssuchas(a)feasibilityandeffectivenessofremotefunctionalassessments,(b)theoptimaltechnologiesandmethodologiesformultimodaltele-interventions,and(c)theeptanceandadherencetointerventionprogramswouldneedtobeexploredpleteunderstandingofthefeasibilityandeffectivenessofteleprehabilitationinelderlyandadultoncologicpopulations.Compliancewithethicalstandards ConflictofinterestTheauthorsdeclarethattheyhavenoconflictofinterest. References
1.SchmunkR(2020)CatchinguponB.C.surgerybacklogwilltakeupto2years,provincesays
2.SøgaardM,ThomsenRW,BossenKS,SørensenHT,NørgaardM(2013)Theimpactorbidityoncancersurvival:areview.ClinEpidemiol5(SUPP1):3–29
3.SilverJK(2020)PrehabilitationmayhelpmitigateanincreaseinCOVID-19peri-pandemicsurgicalmorbidityandmortality.AmJPhysMedRehabil99
(6):459
4.SimcockR(2019)Principlesandguidanceforprehabilitationwithinthemanagementandsupportofpeoplewithcancerinpartnershipwithacknowledgements[].Availablefrom:/publication/336617250.essed18Jun2019
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