Prehabilitation

Prehabilitation

Cancer ‘prehabilitation’ can reduce complications and improve treatment outcomes.

Prehabilitation” is any interventions given between the time of diagnosis and the start of cancer treatment. According to a report in the American Journal of Physical Medicine & Rehabilitation, prehabilitation is aimed at reducing complications from treatments and improving physical and mental health outcomes.

Examples of cancer prehabilitation areas of focus
Stress/distress/coping

Pain
Swallowing
Sleep
Fatigue
Cardiovascular function

Goals and benefits of cancer prehabilitation
Prevent or reduce treatment related impairments
Reduce unnecessary testing
Reduce time to recovery milestones
Reduce hospital lengths of stay
Reduce visits to Rehabilitation clinics
Reduce hospital re-admissions
Reduce risk of second primary cancer
Reduce risk of cancer recurrence
Decrease disability
Decrease death
Improve health-related quality-of-life.
This is not a full list

“We need to focus on survivorship care beginning at the time of diagnosis. Our institution embraced this concept some time ago. It works. Patients value it.
Lillie D. Shockney, RN, BS, MAS, a University Distinguished Service associate professor of breast cancer at Johns Hopkins University School of Medicine and director of the Johns Hopkins Cancer Survivorship Program


This study includes the following:
Examples of Multimodal Prehabilitation Interventions in Cancer Patients

Lung Cancer
Breathing exercises
Balance exercises
Total body strengthening and cardiovascular exercises
Psychosocial support with specific stress reduction strategies
Nutrition
Smoking cessation

Head and Neck Cancer
Swallowing exercises
Balance exercises
Cervical range of motion exercises
Total body strengthening and cardiovascular exercises
Psychosocial support with specific stress reduction strategies
Nutrition
Smoking cessation

Prostate Cancer
Pelvic floor exercises
Balance exercises
Total body strengthening and cardiovascular exercises
Psychosocial support with specific stress reduction strategies
Nutrition
Smoking cessation

Breast Cancer
Shoulder and cervical range of motion exercises
Upper body strengthening exercises
Balance exercises
Total body strengthening and cardiovascular exercises
Psychosocial support with specific stress reduction strategies
Nutrition
Smoking cessation

The study also says:
One of the most intriguing questions yet to be fully considered in the prehabilitationresearch is whether these types of interventions can influence the options for oncology treatment. That is to say, can prehabilitation make surgery a viable option for a newly diagnosed lung cancer patient who is initially deemed to be too high of a risk for surgical resection?
The significant risks associated with this type of major surgical procedure (i.e., thoracotomy) combined with a population profile that typically reflects pre-existing health conditions that increase surgical morbidity and even mortality, often make surgical treatment a nonviable option.
However, this is a population in which prehabilitation interventions should be strongly considered, because the research to date suggests that preoperative interventions may significantly improve physical outcomes, decrease surgical risk factors, and reduce hospital lengths of stay.
Although this question of whether prehabilitation can sufficiently reduce the surgical risk in some patients such that they are qualified to safely undergo resection of their cancer needs further study, there is early evidence that it may.

Major surgery is like running a marathon—and both require training

Source: BMJ
The impact of surgery leads to significant homeostatic disturbance. The surgical stress response is characterised by catabolism and increased oxygen demand. The extent and duration of the stress response is proportionate to the magnitude of surgery and the associated risk of developing postoperative complications.

Patients who experience postoperative complications within 30 days of surgery have a reduced long term survival rate. Even in the absence of complications there is a 20-40% reduction in postoperative physical function and a significant deterioration in quality of life after major surgery.


Writing in The Journal of Hematology Oncology Pharmacy, Julie Silva MD says:
One cancer survivor wrote a blog that included this question in the title: Are we doing too much in oncology backwards? In his blog post he said, “I was reviewing my blood work after my recent stem cell transplant and noticed that my hemoglobin and red blood cells had dropped 47% from my normal health to their lowest values two weeks after my transplant. I then checked what altitude a 50% drop in oxygen would correspond to. A 50% drop in oxygen represents an altitude of over 19,000 feet. Mt. Everest south base camp is 16,700 feet.” The survivor continued, “It would be irresponsible to send someone to Mt. Everest base camp without training them first, but it is common practice in oncology to physically challenge patients in a similar manner without training them for the difficulty to come. Instead, we nurse patients through the treatment challenge, cheer them when they are finished, then send them off to physical therapy to address injuries.” Then, in bold and italics for emphasis, he admonished, “This is not a success story, this is poor survivorship planning.”


 

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