Better preparing cancer patients for surgery and the rigors of treatment regimens can improve patient outcomes and generate cost savings through shorter hospital stays and fewer readmissions, researchers say.
A study published in the August issue of the American Journal of Physical Medicine & Rehabilitation points to the results of several recent pilot programs involving cancer patients that show prehabilitation programs helped patients recover more quickly from surgeries and pursue follow-up care. The study suggests that taking advantage of a small "window of opportunity" before surgery can "improve patient outcomes and reduce direct and indirect healthcare costs."
"There's a long history of using prehabilitation in other settings such orthopedic surgeries and heart bypass surgeries," said Julie K. Silver, MD, an associate professor at Harvard Medical School and co-author of the study titled Cancer Prehabilitation: An Opportunity to Decrease Treatment-Related Morbidity, Increase Cancer Treatment Options, and Improve Physical and Psychological Health Outcomes. "And our review shows there's a great opportunity to use prehabilitation to improve health outcomes for cancer patients as well."
Silver says the concept of prehabilitation has been around for decades, dating back to a 1946 pilot program in which 85% of 12,000 formerly substandard military recruits were able to pass recruitment exams after a two-month improvement program. More recently, a study of patients undergoing knee replacement surgery showed patients who exercised before their surgery recovered more quickly and had fewer complications than those who didn't exercise.
In 2013, a study of lung cancer patients showed that patients who followed an exercise program before surgery had better post-operative results. It concluded that "preoperative exercise and short-term, intense physical therapy has been demonstrated to increase oxygen saturation, improve exercise capacity, and reduce hospital stays."
Another study involved 22 lung cancer patients who followed a two-week program before surgery that included breathing exercises, coughing exercises, and walking a minimum of 5,000 steps per day. Patients who followed the program spent 28% less time recovering in post-surgery rehabilitation facilities than patients who underwent a similar surgery without prehabilitation.
"For the most part, the studies on prehabilitative care have involved patients diagnosed with lung cancer and colon cancer," said Silver. "But we think there's a great opportunity to study how targeted interventions can help patients with all types of cancer recover faster and spend less time in the hospital."
One of the key challenges for cancer patients is the time available for prehabilitation. Unlike patients undergoing elective surgeries such as knee replacements, many cancer patients must undergo surgery or other procedures quickly to treat the cancer before it spreads.
"It depends on the type of cancer and also the wishes of the patient, who may choose to have a second or even third opinion before making a decision," said Silver. "But even though the window of opportunity in many cases is small, a lot can be done with even a few weeks."
Smoking cessation programs are one example. "People who stop smoking even for just a short period of time have better recovery times from all types of surgery and shorter hospital stays that result in cost savings," said Silver. Other programs that focus on swallowing exercises have helped patients recover quicker from cancers affecting the neck or throat.
Silver says the most effective approach in cancer patient prehabilitation is to conduct a physical assessment at the time a patient is diagnosed. Based on that information, and the type of surgery the patient plans to undergo, a targeted plan can be created to strengthen specific areas of the body.
"For patients undergoing surgery for prostate cancer, we've shown that exercises that strengthen areas around the pelvis and abdomen can help reduce the incidence of urinary incontinence after surgery," said Silver.
In the study, Silver also suggests that programs to improve the mental state of cancer patients are important. "The need for psychosocial support in some patients may be greatest at the time of diagnosis, as they work to acclimate to the changes this will mean in their lives and rally for the challenges ahead," the report stated.
"Providing support and instruction in coping skills during this waiting period, when survivors are in limbo, may be beneficial in alleviating some of the stress and anxiety." The report noted that "prehabilitative psychosocial interventions may also help patients move ahead with treatment decisions, further avoiding treatment delays."
Silver said a "multimodal" approach that includes various exercise and wellness programs along with psychological counseling could help patients complete their prescribed regimes of radiation and chemotherapy and, in the long-term, help them live longer. "People who complete their recommended treatment for cancer have a better chance at long-term survival than people who don't," said Silver. "And we believe prehabilitation can help people with all types of different cancers complete their treatment and improve their chances of living cancer-free."