29 November 2023

Austin Health has introduced the Strong for Oesophago-gastric Cancer Surgery (SOCS) program, a comprehensive prehabilitation initiative designed to enhance the well-being of patients before they undergo oesophageal and gastric cancer surgery.

The SOCS program was developed in recognition of mounting evidence that suggests enhanced prehabilitation programs are effective in reducing surgical morbidity and mortality. It delivers physical, nutritional, psychological and preoperative medical support, with the goal of improving patient experience and fitness levels, making them 'stronger,' and better prepared for surgery.

“By bolstering our patients' fitness through the SOCS program, we ensure they are better able to withstand and overcome surgical complications. This program is a proactive response, designed to reduce post-surgical morbidity and mortality and improve the overall quality of life for patients post-surgery,” says Dr. David Liu, co-lead for the SOCS program.

In the year since the program’s implementation, it has demonstrated significant positive outcomes. Respiratory complication rates for patients undergoing surgery have dropped by 50%, cardiac complication rates have dropped by 86%, the number of days spent in ICU post-surgery has reduced by one and a half, the overall length of stay in hospital has decreased by two days, and the number of patients fit enough to receive additional chemotherapy after surgery has doubled.

What started as a trial of a service has now turned into a multi-disciplinary clinic. The SOCS program turned clinic stands out for its patient-centric design, incorporating consumer input and adopting a resource-conscious, evidence-informed strategy. This program is fully integrated into the patient’s pre-existing clinical care pathway, and as such does not interrupt anti-cancer treatments nor does it extend wait time to surgery.

The SOCS program involves a series of comprehensive assessments conducted by a multidisciplinary team, including dieticians, exercise physiologists, clinical psychologists, perioperative physicians and surgeons. These assessments establish baseline fitness levels across nutritional, physical, psychological, and medical aspects. A personalised four or 12-week intervention program is then designed and delivered while the patient is undergoing chemo/radiotherapy, in the lead-up to surgery. The program seeks to optimise medical comorbidities, alleviate anxiety, restore self-control and improve nutritional and physical fitness of participants, ensuring each patient is ready (‘strong’) for oesophago-gastric cancer surgery.

A cornerstone of the SOCS Clinic is our dedicated Cancer Care Coordinator, Ms Linda Watson, who enables seamless delivery of this service by fostering ongoing communication and collaboration among patients, GPs (general practitioners), allied health and medical teams.

Beyond the direct benefits to patients, the SOCS program also positively impacts medical and allied health clinicians. Since implementation it has elevated performance in areas, including medical expertise, clinical decision-making, health education and advocacy, leadership, and cultural competency and safety. The SOCS program has also led to the implementation of an updated cancer database and establishment of additional infrastructure for research, exemplifying Austin Health’s commitment to innovation in cancer care.

The SOCS program is coordinated by our Cancer CNC, Linda Watson, and integrates the expertise of anaesthetics (Leads: Dr Marissa Ferguson, Prof Laurence Weinberg), Upper GI surgery (Leads: Dr David Liu, A/Prof Ahmad Aly, Amanda Dalyell), gastroenterology (Lead: Dr Darren Wong), dietetics (Leads: Jaimee Cacic, Brooke Chapman), exercise oncology (Lead: Dr Ashley Bigaran), respiratory medicine (Leads: Dr Celia Lanteri, Danny Brazzale), psycho-oncology (Lead: Prof Carlene Wilson), clinical costing (Lead: A/Prof Ronald Ma), and the General and Gastrointestinal Surgery Trials Group (Leads: Dr David Liu, Kat Hall).

This program led by Dr David Liu and Dr Ashley Bigaran is supported by North East Melbourne Integrated Cancer Service, the Austin Medical Research Foundation, Austin Health, and the Olivia Newton-John Cancer Centre. The first of its kind at Austin Health, the SOCS program has been funded through the NEMICS Service Improvement Grant (2022) and Grants-in-Aid (2023) from the Austin Medical Research Foundation.

By addressing the holistic needs of patients and by fostering collaboration among healthcare professionals, the SOCS program aims to revolutionise the landscape of prehabilitation in cancer treatment. This unique model of care can be implemented for all types of cancer services. As the program continues to evolve, its impact on patient outcomes and the efficiency of healthcare delivery is expected to reach far beyond the confines of Austin Health, setting a new standard for cancer care preparation.

If you are interested in referring your patients or would like further information, please contact Dr David Liu or Dr Ashley Bigaran via email or at (03) 9496 3296.