Surgical Prehabilitation in Patients with Cancer

Carli, Francesco; Silver, Julie K.; Feldman, Liane S.; McKee, Andrea B.; Gilman, Sean; Gillis, Chelsia; Scheede‐Bergdahl, Celena; Gamsa, Ann; Stout, Nicole L.; Hirsch, Bradford R.

doi:10.1016/j.pmr.2016.09.002

Cited by 177 publications

(59 citation statements)

References 72 publications

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“…Following the shock of diagnosis, participants trusted their provider to help them navigate the illness and treatment journey, consistent with observations from Leydon et al (). This highlights a potential role for providers in engaging patients in preparation for treatment, an area in which evidence of benefit is still emerging (Carli et al, ; Fearon, Jenkins, Carli, & Lassen, ; Moran et al, ).…”

Section: Discussionmentioning

confidence: 99%

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The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers

et al. 2019

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Objective Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation. Methods We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis. Results The overarching theme was “Getting back to normal.” Diagnosis of disease signified a disruption to the normal trajectory of patients’ lives and the post‐treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post‐treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre‐treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden. Conclusion A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.

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Section: Discussionmentioning

confidence: 99%

“…Rehabilitation and prehabilitation programs can help return people to an independent, full and productive life (Cancer Council Victoria, 2018). Prehabilitation aims to increase functional capacity before surgery in preparation for stress associated with surgery.…”

Section: Introductionmentioning

confidence: 99%

The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers

et al. 2019

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“…Prehabilitation exercise regimes aim to increase a patient's physiological reserve before surgery [14] and have been shown to improve functional fitness post operatively [15]. However, within urology most prehabilitation studies have focussed upon reducing specific urological complications (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…However, within urology most prehabilitation studies have focussed upon reducing specific urological complications (e.g. urinary incontinence) [16] and not on general physiological parameters known to be associated with improved post-operative outcomes and return to preoperative status such as CRF [14], skeletal muscle mass [17] and body composition [18]. One consideration for all cancer prehabilitation regimes largely regardless of endpoint is that in the UK, the National Cancer Action Team specifies that first treatment (including surgery) should start within 31 days of the decision to treat [19].…”

Section: Introductionmentioning

confidence: 99%

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial

Blackwell

Doleman

Boereboom

et al. 2020

Prostate Cancer Prostatic Dis

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Objectives To assess the efficacy of high-intensity interval training (HIIT) for improving cardiorespiratory fitness (CRF) in patients awaiting resection for urological malignancy within four weeks. Subjects/patients and methods A randomised control trial of consecutive patients aged (>65 years) scheduled for major urological surgery in a large secondary referral centre in a UK hospital. The primary outcome is change in anaerobic threshold (VO 2AT) following HIIT vs. standard care. Results Forty patients were recruited (mean age 72 years, male (39): female (1)) with 34 completing the protocol. Intention to treat analysis showed significant improvements in anaerobic threshold (VO 2AT ; mean difference (MD) 2.26 ml/kg/min (95% CI 1.25-3.26)) following HIIT. Blood pressure (BP) also significantly reduced in following: HIIT (SBP: −8.2 mmHg (95% CI −16.09 to −0.29) and DBP: −6.47 mmHg (95% CI −12.56 to −0.38)). No reportable adverse safety events occurred during HIIT and all participants achieved >85% predicted maximum heart rate during sessions, with protocol adherence of 84%. Conclusions HIIT can improve CRF and cardiovascular health, representing clinically meaningful and achievable preoperative improvements. Larger randomised trials are required to investigate the efficacy of prehabilitation HIIT upon different cancer types, post-operative complications, socioeconomic impact and long-term survival.

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“…Preparing patients prior to cancer therapy by improving their overall health status as in prehabilitation could optimise their response to treatment and has important implications for future service delivery (Silver & Baima, 2013). Prehabilitation has been espoused as a key component of early recovery in cancer patients and is a term that has been traditionally used to describe interventions for optimising cardiopulmonary reserve prior to cancer surgery, with the aim of improving post-operative recovery outcomes (Carli et al, 2017;Silver, 2015;Silver & Baima, 2013). However, prehabilitation programmes are also targeting this pre-treatment period to improve chemotherapy adherence (Le Roy et al, 2016), reduce anxiety (Tsimopoulou et al, 2015) and to provide a stronger platform for post-treatment rehabilitation aimed at reversing treatment-related side effects and symptoms, managing comorbidities and enhancing longer-term health-related quality of life (Alfano, Ganz, Rowland, & Hahn, 2012;Boereboom, Williams, Leighton, & Lund, 2015;Shun, 2016;Silver, 2014).…”

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confidence: 99%

Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes

et al. 2019

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Objective Prehabilitation is increasingly being used to mitigate treatment‐related complications and enhance recovery. An individual's state of health at diagnosis, including obesity, physical fitness and comorbidities, are influencing factors for the occurrence of adverse effects. This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post‐treatment and considers the utility of prehabilitation before cancer treatment. Methods A database search was conducted for articles published with prehabilitation as a pre‐cancer treatment intervention between 2009 and 2017. Studies with no 30 days post‐treatment data were excluded. Outcomes post‐prehabilitation were extracted for physical function, nutrition and patient‐reported outcomes. Results Sixteen randomised controlled trials with a combined 2017 participants and six observational studies with 289 participants were included. Prehabilitation interventions provided multi‐modality components including exercise, nutrition and psychoeducational aspects. Prehabilitation improved gait, cardiopulmonary function, urinary continence, lung function and mood 30 days post‐treatment but was not consistent across studies. Conclusion When combined with rehabilitation, greater benefits were seen in 30‐day gait and physical functioning compared to prehabilitation alone. Large‐scale randomised studies are required to translate what is already known from feasibility studies to improve overall health and increase long‐term cancer patient outcomes.

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Surgical Prehabilitation in Patients with Cancer

Cited by 177 publications

References 72 publications

The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers

The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial

Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes

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