Cancer Prehabilitation Improves Outcomes

Editor's Note:
Cancer prehabilitation is emerging as a method of better preparing patients for the often toxic and disabling effects of cancer treatment. Its place within the continuum of cancer care is rapidly being established. Medscape recently spoke with Julie K. Silver, MD, Associate Professor at Harvard Medical School and cofounder of Oncology Rehab Partners, who developed the STAR (Survivorship Training and Rehabilitation) Program®, about the new therapeutic strategy of cancer prehabilitation.

Prehabilitation: An Old Concept Made New

Medscape: What is prehabilitation?

Dr. Silver: Prehabilitation is one or more interventions performed in a newly diagnosed cancer patient that are designed to improve physical and mental health outcomes as the patient undergoes treatment and beyond. Cancer prehabilitation uses a multidisciplinary approach combining exercise, nutritional, and psychological strategies to prepare patients for the challenges of cancer treatment, such as surgery, chemotherapy, immunotherapy, and radiation therapy.

Medscape: How did the concept of prehabilitation come to be applied to cancer treatment?

Dr. Silver: Cancer prehabilitation has been studied for many years in selected cancer patient populations, primarily prostate, colorectal, and lung cancer patients. An interesting fact that we discovered along the way was that cancer prehabilitation interventions were already being widely implemented, without being called "prehabilitation" and without always being evidence-based.

For example, an infusion nurse told me that she and her colleagues realized that patients who were beginning chemotherapy were extremely anxious, so they wanted to implement something to reduce anxiety in their patients. The nurses began to teach the patients meditation and guided imagery. They weren't basing this on any particular research; they just recognized a need and wanted to help.

That is what we are finding has happened in many oncology settings. Healthcare professionals are trying to offer solutions to identified needs, although they aren't necessarily provided by people who are trained in that intervention. Cancer prehabilitation programs ensure that these efforts are more coordinated and evidence-based, and are provided by the right healthcare professionals.

Medscape: What are the potential benefits of cancer prehabilitation?

Dr. Silver: The goal of cancer prehabilitation is to prevent or lessen the severity of anticipated treatment-related problems that could lead to later disability. Cancer prehabilitation has many potential benefits. In addition to improved physical and psychological health outcomes for oncology patients, cancer prehabilitation can reduce morbidity, increase treatment options, prevent hospital readmissions, and lower both direct and indirect healthcare costs attributed to cancer treatment.

We don't have enough evidence yet to say whether the benefits of prehabilitation are derived because patients are more compliant with cancer treatments, whether their improved health makes them better candidates for surgery, or whether some other changes are responsible for the benefits that we are seeing.

Some of the benefits differ depending on the population of cancer patients. For instance, in a man with newly diagnosed prostate cancer, urinary incontinence is an anticipated treatment-related complication of surgery. A program of prehabilitation that focuses on pelvic floor strengthening can attenuate incontinence.

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