Implementing univerSal TeleprehabiliTation into cAnceR caRe pathwayS (STTARRS Trial): protocol for a hybrid type 1 multi-centre randomised controlled trial and nested sub study

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Abstract Background Postoperative complications are common after major cancer surgeries, occurring in 25–50% of patients. They delay recovery and adversely affect both cancer-free and overall survival. Intervention to optimise patients’ physical and psychological wellbeing before major cancer surgery to improve postoperative outcomes, or prehabilitation, is growing internationally. Patient education is recommended in guidelines to be included in ‘universal prehabilitation’ for all patients. “Surgery School” is a method to deliver patient education, including deep breathing, exercise and healthy eating, but the inclusion and content of this component of prehabilitation is not frequently reported. There is minimal research examining the effectiveness of Surgery School as part of universal prehabilitation. The Implementing universal teleprehabilitation into cancer care pathways (STTARRS) randomised controlled trial aims to evaluate the effectiveness of multidisciplinary prehabilitation education using telehealth (tele-Surgery School) compared to usual care on postoperative recovery in adults awaiting lung cancer or major abdominal cancer surgery, with an embedded health economic analysis. Methods In a two-arm, parallel group, multicentre, assessor blinded, randomised, controlled, hybrid trial (type one effectiveness and feasibility) powered for superiority with a nested exploratory sub study, the primary aim is to investigate the effectiveness of tele-Surgery School education in 480 participants in reducing the incidence of postoperative pulmonary complications in the first seven days following lung or major abdominal cancer resection surgery (open or minimally invasive). Secondary aims include feasibility of the intervention and to compare length of acute hospital stay, pneumonia incidence, trajectory of postoperative surgical recovery, level of physical function, physical activity, patient activation for self-management and health-related quality of life. Tele-Surgery School is a single 90 min live and online session of an education and behaviour change intervention using eight specifically developed educational videos and hosted by a clinician delivered within four weeks of planned surgery. Outcomes are assessed at enrolment, before surgery and at 30 days, six and 12 months postoperatively. Conclusion The STTARRS trial will provide evidence, from a rigorously designed and conducted study, on the clinical effects and feasibility of the Surgery School complex intervention in patients having major abdominal or thoracic cancer surgery across nine Australian hospitals. Trial registration Prospectively registered on Clinicaltrials.gov (NCT Number NCT06631872) (07/10/2024).

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