P60 Establishing access to prehabilitation services within the hepatocellular carcinoma (HCC) setting

<h3>Introduction</h3> Frailty in oncology is increasingly relevant to our aging population, but frailty is not just about age alone. In the HCC clinic, addressing frailty by endeavouring to improve nutrition and physical status can increase a patient’s ability to cope with, and recover from, locoregional treatments, which are often needed in repeated cycles. In some cases, it may enable patients to improve to a point where they are fit enough for treatment, when their fitness was previously considered borderline. Until recently, prehabilitation services were only available to patients being considered for surgery. This has now changed to encompass non-surgical patients, giving them access to a 12 week individualised programme of specialist dietetic, physio and occupational therapy input. <h3>Project</h3> All patients attending the regional HCC clinic are now assessed for liver frailty (using liver frailty index, LFI), offered a Macmillan health needs assessment (HNA) and considered for prehabilitation (prehab). <h3>Findings</h3> So far 40 patients have been accepted for prehab (4 patients declined). Average age 71.3 years, median performance status 2, median clinical frailty score 3, LFI range 3.02 to 5.4 (28 pre-frail, 11 frail, 1 robust), 27 HNA’s completed so far. Within this group, 26 patients have a definite treatment plan (awaiting TACE, SBRT etc); 5 have no definite plan, continuing active surveillance but likely to require a further locoregional therapy imminently; 6 patients need to continue recompensating before considering treatment; 2 patients are already on systemic therapy; and one patient is being worked up for transplantation. 4 main concerns from HNA’s; breathlessness, fatigue, appetite and sleeping. Patient feedback regarding prehab has been very positive. <h3>Conclusion/Future Plans</h3> All patients referred to prehab had clinical signs of frailty which were previously not addressed, and under reported. We plan to continue auditing our referrals over a longer time frame, including gathering post-treatment frailty measurements, and can see there is a lot more work to do in addressing patient needs, improving patient experience, and promoting patient centred care.