Promoting a culture of prehabilitation for the surgical cancer patient

Abstract

Background: Traditional rehabilitative approaches to perioperative cancer care have focused on the postoperative period to facilitate the return to presurgical baseline conditions. However, there is some realization that the preoperative period can be a very effective time for intervention as the patients are more amenable to target their physiological condition to prepare to overcome the metabolic cost of the surgical stress. Methods: We undertook a narrative review of the current literature on surgical prehabilitation and discussed the current evidence of preoperative interventions before cancer surgery in order to increase physiological reserve before surgery and accelerate postoperative recovery. Results: Published data indicate the positive impact of prehabilitation on postoperative functional capacity and return to daily activities. However, the current evidence on the impact on short-and long-term clinical outcome is limited, and more research needs to be conducted. Conclusion: Preliminary findings indicate that a group of interventions such as exercise, nutrition and anxiety reduction in the preoperative period can complement the enhanced recovery program and facilitate the return to baseline activities of daily living. It is not clear at this stage whether the preoperative increase in functional capacity mitigates the burden of postoperative morbidities and subsequent cancer therapies. Therefore, more research is warranted.

Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery

“…For example, evidence‐based multimodal prehabilitation programs have demonstrated some efficacy in contributing to improved patient outcomes within ERAS programs . Prehabilitation offers individualized nutrition (eg, counseling and supplemental protein, n‐3 fatty acids), function (exercise program), and anxiety reduction to promote metabolic preparation and optimization of health status beginning preoperatively and extending into recovery . AHS is working toward a standardized perioperative nutrition care pathway within the ERAS paradigm.…”

Enhanced recovery after thoracic surgery reduces discharge on highly dependent narcotics

“…We found that this significantly improves the patient's preparation for surgery and encourages them to take responsibility for their recovery. Studies have shown that an exercise program prior to surgery can improve function after surgery (12,13). This has helped patients to recover faster with fewer complications.…”

A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation

“…[10][11][12] There has also been emerging research in prehabilitation, for multimodal programs involving exercise, nutrition, smoking cessation, and psychologic support. 13,14 Nevertheless, it is unclear if this interest has translated into the clinical domain. This evidence-to-practice gap in healthcare is typically 17 years 15 ; implementation science in the field of perioperative care is only an emerging field.…”