On our site, we often discuss the benefits of prehabilitation before orthopedic, abdominal, and women’s health surgeries. When patients have elective surgeries, they often have at least a few weeks to prepare, by performing exercises, becoming educated about their post-op precautions, and setting their homes up for hospital discharge.
Very little has been discussed about prehab before another type of trauma: radiation and chemotherapy utilized to treat patients diagnosed with cancer. The American Journal of Physical Medicine and Rehabilitation has published a fascinating study about this very topic, and we’re excited to share some of the highlights.
Faul et al.61 questioned 192 patients with cancer of various diagnoses and stages about their level of independent exercise and their quality-of-life 1 wk before their first chemotherapy infusion. Two-thirds of the patients, all of whom were exercising the week before chemotherapy began (43% at a mild level and 57% at a moderate to strenuous level), had lower levels of anxiety and depression and better overall mental and physical quality-of-life than those who did not exercise. These results consequently emphasize the need to document baseline exercise levels and understand how these may affect quality-of-life outcomes when designing a patient-centered prehabilitation program.
Cancer prehab is not that different from any other prehabilitation. After the initial diagnosis, patients’ physical impairments and physical/psychological co-morbidities are identified, so that interventions may be initiated before the actual cancer treatment begins.
In the case of impending radiation therapy, urea cream has been successfully used as a prehabilitation intervention to ward off dermatitis:
Another area where prehabilitation might promote better health outcome is in radiation therapy. Pardo Masferrer et al.67 investigated the use of a urea-based cream before radiation therapy. Ninety-eight patients used the lotion three times per day for 2–3 wks before therapy. Compared with historical controls who began cream application concurrent with radiation therapy, these patients demonstrated that consistent application of urea-based cream before radiation therapy made the development of radiation dermatitis less likely and reduced skin toxicity.
Since a diagnosis of cancer typically implies the need for immediate action, it is normal to wonder if patients would even have time for prehab, in the scurry to initiate treatment. This segment beautifully summarizes how I would reply:
The reduced survival outcomes in patients who delay therapy support what some cancer survivors fear: that any delay in starting treatment may contribute to a worse outcome. However, it is the exception rather than the rule that someone who is diagnosed with cancer immediately begins treatment. The duration of the waiting period between diagnosis and the start of treatment may depend on many factors, including second opinions; surgical schedules; further testing; and, sometimes, a patient’s psychological state—the patient may simply feel overwhelmed and unable to readily deal with a new cancer diagnosis and the anticipated treatment. Therefore, the period between diagnosis and the start of acute cancer treatments may provide an opportunity for prehabilitation interventions that address both physical and psychological issues.
If you’d like to read more, the full text is available here.