"Prehabilitate" patients with cancer prior to treatment

Persons who have just learned that they have cancer can benefit from cancer prehabilitation, interventions that take place between diagnosis and treatment initiation.

“There is a growing body of scientific evidence that supports preparing newly diagnosed patients for[,] and optimizing their health before[,] starting acute treatments,” wrote Julie K. Silver, MD, and Jennifer Baima, MD, both of the Department of Physical Medicine and Rehabilitation at Harvard Medical School in Boston, Massachusetts, in what they describe as the first review of cancer prehabilitation. Their work is published in American Journal of Physical Medicine & Rehabilitation (2013;92[8]:715-727).

Silver and Baima cite the primary goal of prehabilitation as preventing or reducing the severity of anticipated treatment-related impairments that may cause significant disability. Physical and psychological assessments are used to establish a baseline functional level, identify impairments, and provide targeted interventions.

Prehabilitation is not a new concept, nor is it exclusively used for persons with cancer. However, more evidence is showing the appropriateness of this approach for this specific patient population, wrote the authors. For example, one study demonstrated that a 2-week prehabilitation program comprising inspiratory spirometry, breathing and coughing exercises with bronchodilator nebulizers, and exercise shortened length of stay by 28% in a group of patients with lung cancer and chronic obstructive pulmonary disease who underwent surgery after the prehabilitation intervention. The need for tracheostomy and prolonged oxygen inhalation was also reduced for those patients.

According to Silver and Baima, cancer prehabilitation interventions can decrease morbidity, hospital readmissions, and direct and indirect cancer-related health care costs while increasing the number of potential treatment options and improving physical and psychological health outcomes for patients. They advised that pairing targeted psychological and physical prehabilitation interventions in a multimodal approach will likely offer the best overall outcomes. Identifying the most effective interventions—those that improve patient outcomes and reduce direct and indirect health care costs—is an important area of future research.

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