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Comment & Response
February 6, 2019

Considerations in Prehabilitation for Esophagogastric Cancer Surgery—Reply

Author Affiliations
  • 1Department of Anesthesia, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada
  • 2Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
JAMA Surg. 2019;154(5):463-464. doi:10.1001/jamasurg.2018.5593

In Reply We appreciate Wee’s interest and comments on our article,1 and we are grateful for the opportunity to provide a more detailed description of our work. All the points raised are addressed in detail below.

First, the key role of psychosocial well-being in cancer care was highlighted, and we were asked the reason why specific assessment and intervention were not added to the prehabilitation program. The nature of impaired functional capacity in patients undergoing cancer treatment is complex and multifactorial, and our research group has directed their interest in implementing a multimodal, multidisciplinary, and multiphasic intervention addressing this complexity. As main determinants of functional status, our prehabilitation model includes exercise, nutritional therapy, and psychosocial intervention.2 In this case, as specified in the article,1 psychological assessment and referral are part of the standard preoperative pathway for esophagectomy at McGill University Health Centre (Montreal, Quebec, Canada), and patients in both groups received it if a specific distress was detected.

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