The Case for Prehabilitation Prior to Breast Cancer Treatment

Abstract

Cancer rehabilitation in breast cancer survivors is well established, and there are many studies that focus on interventions to treat impairments as well as therapeutic exercise. However, very little is known about the role of prehabilitation for people with breast cancer. In this narrative review, we describe contemporary clinical management of breast cancer and associated treatment-related morbidity and mortality considerations. Knowing the common short- and long-term sequelae, as well as less frequent but serious sequelae, informs our rationale for multimodal breast cancer prehabilitation. We suggest 5 core components that may help to mitigate short- and long-term sequelae that align with consensus opinion of prehabilitation experts: total body exercise; locoregional exercise pertinent to treatment-related deficits; nutritional optimization; stress reduction/psychosocial support; and smoking cessation. In each of these categories, we review the literature and discuss how they may affect outcomes for women with breast cancer.

Feasibility of Prehabilitation Prior to Breast Cancer Surgery: A Mixed-Methods Study

“…An important theme that was identified in the interviews was the need for a multimodal intervention, including exercise, dietetic support, and stress management counseling delivered by the appropriate professionals. This need for multimodal prehabilitation has been repeatedly identified in the literature (50,51). Advocacy from researchers and clinicians alike has resulted in a shift toward multimodal interventions in research and practice given that these different modalities likely were synergistically and provide greater benefit than either modality alone might (52,53).…”

Multiphasic Prehabilitation Across the Cancer Continuum: A Narrative Review and Conceptual Framework

“…Multimodal prehabilitation interventions have often comprised a combination of the following: i) aerobic and resistance training to attenuate cardiorespiratory and musculoskeletal deconditioning, respectively; ii) dietary interventions to counteract disease and/or treatment-related malnutrition and to support anabolism and the metabolic cost of exercise; iii) psychological interventions to reduce stress and associated morbidity; iv) cessation of adverse health behaviors ( e.g ., alcohol abuse, smoking); v) medical optimization ( e.g. , assessing/treating anemia; medication corrections); and vi) behavioral counseling to support intervention initiation and adherence in the pre-treatment setting and establish self-management skills for long-term health behavior maintenance ( 28 – 30 ). While these recommendations are largely driven by expert consensus, recent qualitative findings from patient interviews also support the need for an integrated multimodal approach to prehabilitation ( 31 ).…”

Integrating Rehabilitation Into the Cancer Care Continuum

“…In 2015, a group of subject matter experts in surgical cancer prehabilitation convened in Canada to reach consensus regarding recommendations for future research [40]. Prehabilitation is a fascinating and evolving field that, in the future, may prove to help with physical and functional outcomes, adherence to adjuvant treatment, value‐based care, and even survival [41,42].…”