STTARRS protocol plans telehealth prehabilitation trial before major cancer surgery

A multicentre randomised controlled trial will test whether a single telehealth education session can reduce postoperative pulmonary complications in adults awaiting major cancer surgery. The STTARRS study plans to recruit 480 participants across nine Australian hospitals and compare a remotely delivered “Surgery School” intervention with usual care. Its primary outcome is the incidence of pulmonary complications during the first seven days after lung or major abdominal cancer surgery. The published paper is a study protocol: it describes the trial’s design, intervention, assessments and planned analyses but does not report whether the intervention improves outcomes.

Postoperative complications occur in 25–50% of patients undergoing major cancer surgery, and the protocol states that they can delay recovery and adversely affect cancer-free and overall survival. The trial focuses on prehabilitation intended to optimise physical and psychological wellbeing before surgery. Although patient education is recommended for inclusion in “universal prehabilitation” for all patients, the inclusion and content of this component are not frequently reported. The investigators say that minimal research has examined the effectiveness of Surgery School as part of universal prehabilitation, creating the evidence gap addressed by the planned trial.

STTARRS is a two-arm, parallel-group, assessor-blinded randomised controlled trial with a hybrid type 1 design that combines effectiveness and feasibility evaluation. Adults scheduled for lung cancer resection or open or minimally invasive major abdominal cancer surgery will be assigned to tele-Surgery School or usual care. The intervention is one 90-minute live online session delivered by a clinician within four weeks of planned surgery. It combines patient education and behaviour change through eight specifically developed educational videos. The education covers deep breathing, exercise and healthy eating, drawing on the content identified in the broader Surgery School approach. A nested exploratory sub study will examine additional research questions alongside the main trial.

The primary endpoint is the incidence of postoperative pulmonary complications during the first seven days following surgery. Secondary aims are to assess the feasibility of the intervention and compare acute hospital length of stay, pneumonia incidence, the trajectory of postoperative surgical recovery, physical function, physical activity, patient activation for self-management and health-related quality of life. Outcomes will be assessed at enrolment, before surgery and at 30 days, six months and 12 months after surgery. The protocol also includes an embedded health economic analysis. Quality-adjusted life years are listed among the study’s abbreviations, but the supplied trial description does not specify how that measure will be used in the economic analysis.

The protocol is powered for superiority and is intended to provide evidence on the clinical effects and feasibility of the Surgery School complex intervention for people undergoing major abdominal or thoracic cancer surgery in Australia. Its multicentre scope is intended to test the intervention across nine hospitals rather than at a single centre. The trial was prospectively registered on ClinicalTrials.gov on 7 October 2024 under the identifier NCT06631872. As a protocol, the paper establishes how effectiveness, feasibility and economic outcomes will be evaluated; it provides no clinical-effect estimate, feasibility result or evidence that telehealth Surgery School is superior to usual care. Those findings will depend on completion of the study and analysis of the enrolled population.

Subject of Research: Evaluation of a telehealth Surgery School intervention before major lung or abdominal cancer surgery

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

Article References: Denehy, L., Waterland, J. L., Riedel, B., Ismail, H., Boden, I., Spelman, T., Granger, C. L., Hackett, C., Laing, E., Heriot, A., Frawley, H., Sinton, C., Berney, S., Deij, S., Chen, G., Cavalheri, V., Mackney, J., O’Shea, H., Rollinson, T., … Slattery, C. (2026). Implementing univerSal TeleprehabiliTation into cAnceR caRe pathwayS (STTARRS Trial): protocol for a hybrid type 1 multi-centre randomised controlled trial and nested sub study. BMC Cancer. https://doi.org/10.1186/s12885-026-16906-2

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16906-2

Keywords: STTARRS trial, telehealth, prehabilitation, Surgery School, cancer surgery, postoperative complications, randomised controlled trial, lung cancer, abdominal surgery, Australia, Implementing, univerSal