What is Cancer Prehabilitation?

Cancer prehabilitation is concerned with the period of time between a person receiving a cancer diagnosis and the beginning of his or her anti-cancer treatments, which may involve surgery, radiation, chemotherapy and/or immunotherapy, among other options.

Specifically, cancer prehabilitation involves interventions given or carried out in that period of time that are designed to:

• Reduce treatment complications
• Improve physical and mental health

All with a view toward improving treatment outcomes. Not only can these steps reduce complications, but they can also boost outcomes – by encouraging a patient to finish treatments for instance – they can broaden treatment options for some patients, and they can reduce health care costs.

According to Dr. Julie K. Silver and Dr. Jennifer Baima of Harvard Medical School, authors of a recent paper on the subject published in the American Journal of Physical Medicine & Rehabilitation:

A growing body of evidence supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments.

Silver and Baima's paper, "Cancer Prehabilitation: An Opportunity to Decrease Treatment-Related Morbidity, Increase Cancer Treatment Options, and Improve Physical and Psychological Health Outcomes," is believed to be the first comprehensive review published on the topic.

Silver adds:

There is a rather long and impressive history of using prehabilitation to improve orthopedic surgical outcomes. Our new review shows that there is a unique opportunity to help many people who have been newly diagnosed with cancer to improve their physical and emotional outcomes.

Cancer Prehabilitation Goals

In cancer prehabilitation, cancer patients are assessed both physically and psychologically in order to:

• Determine their baseline level of function
• Identify impairments
• Implement targeted interventions to lower risk/severity of post-treatment impairments

This is a shift away from generalized conditioning prehabilitation programs toward more targeted interventions that can directly make a difference in the life of a patient.

Examples

1. Developing exercises on swallowing for patients about to undergo before surgery for head or neck cancer
2. Smoking cessation to boost breathing function prior to lung cancer surgery or any radiation therapy to the chest
3. Exercises to build up the pelvic floor for prostate cancer patients who might have problems with post-op urinary incontinence

In order to be effective, cancer prehabilitation must be individualized. According to Silver and Baima:

Newly diagnosed cancer patients are often seeking ways to become immediately involved in their care that might go beyond decision making about upcoming treatments.

Cancer prehabilitation may be one of those areas in which a patient can get involved.