Psychological Prehabilitation Before Cancer Surgery: A Systematic Review

Tsimopoulou, Ioanna; Pasquali, Sandro; Howard, Ruth; Desai, Anant; Gourevitch, David; Tolosa, Iñigo; Vohra, Ravinder

doi:10.1245/s10434-015-4550-z

Cited by 203 publications

(121 citation statements)

References 46 publications

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“…The treatment phase of the disease is associated with high rates of depression [35]. Depression in this population has been shown to be associated with higher levels of pain, non-compliance with medical treatment, diminished immune response and carries an elevated risk of mortality [36,37].…”

Section: The Anxiety State Of the Surgical Cancer Patientmentioning

confidence: 99%

Promoting a culture of prehabilitation for the surgical cancer patient

2017

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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.

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Section: The Anxiety State Of the Surgical Cancer Patientmentioning

confidence: 99%

Promoting a culture of prehabilitation for the surgical cancer patient

2017

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“…In selected cancers, rehabilitation services should be offered pretreatment to optimize tolerance to surgical intervention and adjuvant treatment in order to minimize toxicity and improve outcomes. 56,71,126,127 5. Conduct a thorough assessment of the content coverage and psychometric properties of existing clinical measurement tools and forge consensus regarding criterion standard functional measures specific to different cancer populations.…”

Section: Recommendationsmentioning

confidence: 99%

Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group

Stout

Silver

Raj

et al. 2016

Archives of Physical Medicine and Rehabilitation

161

120

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The health care delivery system in the United States is challenged to meet the needs of a growing population of cancer survivors. A pressing need is to optimize overall function and reduce disability in these individuals. Functional impairments and disability affect most patients during and after disease treatment. Rehabilitation health care providers can diagnose and treat patients' physical, psychological, and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population. However, few care delivery models integrate comprehensive cancer rehabilitation services into the oncology care continuum. The Rehabilitation Medicine Department of the Clinical Center at the National Institutes of Health with support from the National Cancer Institute and the National Center for Medical Rehabilitation Research convened a subject matter expert group to review current literature and practice patterns, identify opportunities and gaps regarding cancer rehabilitation and its support of oncology care, and make recommendations for future efforts that promote quality cancer rehabilitation care. The recommendations suggest stronger efforts toward integrating cancer rehabilitation care models into oncology care from the point of diagnosis, incorporating evidence-based rehabilitation clinical assessment tools, and including rehabilitation professionals in shared decision-making in order to provide comprehensive cancer care and maximize the functional capabilities of cancer

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“…The prehabilitation programs could enhance postoperative recovery using preoperative interventions tailored to the population of interest. [44][45][46][47] Because ambulatory surgical procedures are planned well in advance, a prehabilitation program could be considered to treat these vulnerable patients. Currently, however, there is a lack of prehabilitation programs for ambulatory surgery.…”

Section: Future Considerationsmentioning

confidence: 99%

Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making

Mijderwijk

Stolker

Duivenvoorden

et al. 2016

Can J Anesth/J Can Anesth

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Background Ambulatory surgery patients are at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated a clinical prediction model to identify patients who were vulnerable to these psychological outcome parameters. Methods We prospectively assessed 383 mixed ambulatory surgery patients for psychological vulnerability, defined as the presence of anxiety (state/trait), aggression (state/trait), fatigue, and depression seven days after surgery. Three psychological vulnerability categories were considered-i.e., none, one, or multiple poor scores, defined as a score exceeding one standard deviation above the mean for each single outcome according to normative data. The following determinants were assessed preoperatively: sociodemographic (age, sex, level of education, employment status, marital status, having children, religion, nationality), medical (heart rate and body mass index), and psychological variables (self-esteem and self-efficacy), in addition to anxiety, aggression, fatigue, and depression. A prediction model was constructed using ordinal polytomous logistic regression analysis, and bootstrapping was applied for internal validation. The ordinal c-index (ORC) quantified the discriminative ability of the model, in addition to measures for overall model performance (Nagelkerke's R 2 ). Results In this population, 137 (36%) patients were identified as being psychologically vulnerable after surgery for at least one of the psychological outcomes. The most parsimonious and optimal prediction model combined sociodemographic variables (level of education, having children, and nationality) with psychological variables (trait anxiety, state/trait aggression, fatigue, and depression). Model performance was promising: R 2 = 30% and ORC = 0.76 after correction for optimism.

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Psychological Prehabilitation Before Cancer Surgery: A Systematic Review

Abstract: Available data suggested that preoperative psychological prehabilitation may have a role for cancer patients undergoing surgery. Further evidence is needed to evaluate its role.

Cited by 203 publications

References 46 publications

Promoting a culture of prehabilitation for the surgical cancer patient

Promoting a culture of prehabilitation for the surgical cancer patient

Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group

Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making

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