Wearable-Supported Prehabilitation and Rehabilitation for Patients Undergoing Surgery for Pancreatic Cancer

POWR-PaC (Perioperative Optimisation and Wearable Remote monitoring of Pancreatic Cancer) is a prospective, single-centre study evaluating the integration of wearable technologies into an established perioperative prehabilitation and rehabilitation pathway for patients undergoing pancreatic surgery. The study is being conducted at Manchester University NHS Foundation Trust in partnership with the Greater Manchester Prehab4Cancer programme.

Major pancreatic surgery is associated with substantial morbidity, prolonged recovery, and significant variation in patient outcomes. Although prehabilitation programmes have demonstrated benefits for physical fitness and surgical preparedness, there is limited evidence regarding the role of continuous physiological monitoring and remote assessment throughout the perioperative pathway. Wearable technologies may provide objective, longitudinal measures of activity, sleep, cardiovascular function, recovery trajectories, and treatment tolerance that are not routinely captured during standard care.

Participants enrolled in the intervention arm will be prescribed the targeted Greater Manchester Prehab4Cancer pathway and will additionally receive a wearable monitoring package consisting of a Corsano CardioWatch device and supporting home monitoring equipment. Physiological and behavioural measures collected by the wearable system may include physical activity, heart rate, respiratory rate, oxygen saturation, skin temperature, sleep-related metrics, and other device-derived indicators. Weight and blood pressure measurements will also be collected using home monitoring equipment where applicable.

Data collection will occur across the perioperative pathway, including the pre-operative prehabilitation period, inpatient surgical admission, and post-operative rehabilitation phase. Clinical, functional, physiological, and patient-reported outcome measures will be collected alongside routinely recorded healthcare data. The study will evaluate data completeness, participant adherence, acceptability of remote monitoring, and the potential relationship between wearable-derived metrics and clinical outcomes.

A matched historical control cohort will be identified from electronic health records at Manchester University NHS Foundation Trust. Control participants will have undergone pancreatic surgery and standard perioperative care without participation in the wearable-enabled pathway. Matching methods will be used to minimise baseline differences between groups and support comparative analyses of clinical outcomes.

The primary clinical evaluation will focus on post-operative morbidity within 30 and 90 days of surgery. Secondary analyses will assess measures including mortality, hospital utilisation, days alive and out of hospital, functional recovery, quality of life, and engagement with prehabilitation and rehabilitation services. Exploratory analyses will investigate whether longitudinal wearable data can provide early indicators of recovery status, post-operative complications, or treatment response.

The study also incorporates a mixed-methods evaluation of implementation. Participants, healthcare professionals, and exercise specialists may be invited to take part in qualitative focus groups to explore experiences of wearable-supported care, barriers and facilitators to adoption, usability of the technology, and opportunities for future pathway optimisation. Qualitative findings will be used to inform the future design, implementation, and scale-up of digitally enabled perioperative pathways within NHS surgical services.

The findings from POWR-PaC will provide evidence regarding the feasibility, acceptability, and potential clinical value of integrating wearable technologies into perioperative cancer care and will inform the development of larger effectiveness studies and future digitally enabled surgical pathways.

Inclusion criteria

• Adult patients aged 18 years or older.
• Able to provide informed consent.
• Able to use the study devices independently or with support from a carer.
• Approved for pancreatic cancer surgery, including patients undergoing surgery for:

Pancreatic cancer Distal cholangiocarcinoma Ampullary carcinoma Duodenal carcinoma Premalignant pancreatic lesions, including Intraductal Papillary Mucinous Neoplasms (IPMNs).

• Clinically stable and considered suitable to participate in the prehabilitation and rehabilitation programme.
• Owns a smartphone or tablet device

Exclusion criteria

• Unable or unwilling to provide informed consent.
• Lacks capacity to provide informed consent.
• Unstable angina pectoris.
• Recent myocardial infarction.
• Recent cerebrovascular accident (stroke).
• New cardiac arrhythmia.
• Social, physical, mental health, or substance misuse issues that, in the opinion of the investigator, would jeopardise adherence to study procedures or study contact.
• No infrastructure for remote monitoring (no access to either mobile signal or Wi-Fi).
• Clinically unstable or likely to require hospital admission within the next 72 hours.
• Unable to use the study devices and no carer or support person is available to assist.