Cancer 'Prehabilitation' Can Reduce Complications and Improve Outcomes, Says Review in AJPMR
Thursday, July 18, 2013
Posted by: Bernadette Rensing
'Prehabilitation' Can Reduce Complications and Improve Treatment Outcomes, Says
Review in AJPM&R
between Diagnosis and Treatment Provides 'Window of Opportunity' to Optimize
Pa. (July 18, 2013) - For patients with cancer, "prehabilitation"—
interventions given between the time of diagnosis and the start of treatment—has
the potential to reduce complications from treatments and improve physical and
mental health outcomes, according to a report in the August American Journal of Physical Medicine & Rehabilitation (AJPM&R). AJPM&R, the official
journal of the Association of Academic Physiatrists, published by Lippincott
Williams & Wilkins, a
part of Wolters Kluwer Health.
View the review in AJPM&R.
"A growing body of
evidence supports preparing newly diagnosed cancer patients for and optimizing
their health before starting acute treatments," write Drs. Julie K. Silver
and Jennifer Baima of Harvard Medical School. Their article, titled Cancer
Prehabilitation: An Opportunity to Decrease Treatment-Related Morbidity,
Increase Cancer Treatment Options, and Improve Physical and Psychological
Health Outcomes, is the
first comprehensive review of the topic.
"There is a rather
long and impressive history of using prehabilitation to improve orthopedic
surgical outcomes," Dr. Silver comments. "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."
Prehabilitation—Getting Patients in Best Possible Shape for Treatment
The goal of cancer prehabilitation is to prevent or
lessen the severity of anticipated treatment-related problems that could lead
to later disability. Immediately after
diagnosis, patients undergo physical and psychological assessments to establish
their baseline level of function and identify any current impairment, and
provide targeted interventions to reduce the risk and severity of future impairments.
Traditionally, pretreatment interventions focused
on aerobic conditioning to build patients' general strength and stamina. But
recent studies have shown that more directed interventions can improve outcomes
in patients with specific cancers: for
example, swallowing exercises before surgery for head or neck cancer, smoking
cessation to improve breathing function before lung cancer surgery, or pelvic
floor exercises to reduce problems with urinary incontinence after surgery for
Some studies have shown that prehabilitation
interventions, individually or in combination, can increase the range of
treatment options, lower complication rates, and improve physical and mental
health outcomes. Benefits include a
reduced risk of hospital readmission and lower health care costs.
Cancer prehabilitation seems more effective when it
includes both physical and psychological interventions. Providing psychosocial support immediately
after diagnosis has improved treatment outcomes for patients with prostate,
breast, and ovarian cancer. Future
studies may show that prehabilitation can increase patients' ability to
complete their recommended treatment—thus improving their chances of survival.
Drs. Silver and Baima emphasize that cancer
prehabilitation should follow an individualized approach, "identifying
current and anticipating future impairments as a critical first step in
improving healthcare outcomes and decreasing costs." They liken cancer prehabilitation
to a puzzle, with individual approaches put together in combinations that best
meet the needs of the individual patient.
While patients may fear that delaying cancer
treatment may reduce their risk of survival, there's typically some waiting
period before treatment begins. This
time—whether it's a few days or a few weeks—may provide a "window of
opportunity" for prehabilitation interventions to address physical and psychological
issues. Drs. Silver and Baima write, "Newly diagnosed cancer patients are
often seeking ways to become immediately involved in their care that may go beyond
decision making about upcoming treatments."
Studies have begun to show that physical and
psychological prehabilitation interventions can reduce treatment-related
complications, decrease length of hospital stay and/or readmissions, increase
available treatment options for patients who would not otherwise be candidates,
and quickly facilitate return of patients to the highest level of function
possible. Drs. Silver and Baima highlight the need for further studies to
identify the most effective prehabilitation interventions: "those that improve patient health
outcomes and reduce direct and indirect healthcare costs."
"This review provides an exciting 'jumping-off
point' for cancer researchers to look more closely at how to improve outcomes
from the moment of diagnosis onward," Dr. Silver adds. "We hope it will serve to highlight this
exciting area of research and to show clinicians that there are key
opportunities right now to improve cancer care."