Oncology nurses are critical to the delivery of high-quality cancer care and, as such, they are frequently introduced to patients immediately following a diagnosis. Indeed, nurses often spend more time with survivors with newly diagnosed cancer than any other health care professional. This early access provides a perfect opportunity for them to not only provide education and moral support, but also administer assessments to determine how cancer prehabilitation could be used to improve patients’ health outcomes.
The future of high-quality cancer treatment will increasingly focus on patient-centered care, supported by a strong evidence base and highly skilled providers. Nurses, particularly navigators, are uniquely positioned to deliver efficacious prehabilitation services. With this unique opportunity comes the responsibility to understand the evidence-based research and incorporate it into a best practices clinical approach to improving cancer care. Because research in this area of medicine is rapidly evolving, nurses should consider pursuing formal training and continuing education in cancer prehabilitation and collaborate more closely with rehabilitation health care professionals.
PREHABILITATION: A BRIEF HISTORY
Prehabilitation is not a new concept, nor is it specific to cancer. At its core, prehabilitation is designed to improve a person’s physical and psychological health in anticipation of an upcoming stressor. Furthermore, prehabilitation is part of the rehabilitation care continuum and is defined temporally as those assessments and interventions that occur after diagnosis but before acute treatment begins. In a 2013 review, prehabilitation, as it relates to oncology care, was specifically defined as
[A] process on the cancer continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment and includes physical and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments.1
Many of the early studies on cancer prehabilitation typically focused exclusively on building strength and stamina through an appropriate exercise regimen; however, more recent research has supported a multimodal approach that encompasses more than one intervention (ie, a combination of exercise, nutrition, and psychological strategies) to better prepare patients for the challenges associated with upcoming cancer treatments.2
A ROLE FOR ONCOLOGY NURSES
Nurses have long been on the front lines of oncology care, and nearly every oncology nurse is an expert at providing patient and caregiver education that begins at diagnosis and continues throughout the cancer care continuum. This includes informally explaining procedures to patients, helping patients figure out how to navigate a complicated health care system, and offering general advice and reassurance. As oncologists and others witnessed the positive impact these informal interactions had on patients, they started to support more formal nursing interventions. For example, many patients with newly diagnosed cancer receive some form of nursing-directed preoperative counseling, and having nurses lead a chemo class (a chemotherapy education class) prior to the start of chemotherapy is commonplace at cancer centers.
Navigation, which ideally begins at diagnosis, may now involve assessments, patient and caregiver education, recognition and removal of barriers to care, and coordination of other interventions. In fact, nurse navigation has become so much more formalized that it is now included as a patient-centered standard in the American College of Surgeons’ Commission on Cancer (CoC) accreditation process.
However, there is a distinct difference between what many nurses are currently doing prior to the start of cancer treatment and what would be considered prehabilitation (Figure 1). One of the most important factors in prehabilitation is the ability to formally assess patients and then implement specific interventions that improve outcomes through objective measures.