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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Minnella EM, Ferri L, Carli F. Considerations in Prehabilitation for Esophagogastric Cancer Surgery—Reply. JAMA Surg. 2019;154(5):463–464. doi:10.1001/jamasurg.2018.5593
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