The Feasibility of Prehabilitation as Part of the Breast Cancer Treatment Pathway

Abstract

Background: There is compelling support for implementing prehabilitation to optimize perioperative risk factors and to improve postoperative outcomes. However, there is limited evidence studying the application of multimodal prehabilitation for patients with breast cancer. Objective: To determine the feasibility of multimodal prehabilitation as part of the breast cancer treatment pathway. Design: This was a prospective, cohort observational study. Breast cancer patients undergoing surgery were recruited. They were assigned to an intervention or control group according to patient preference. Setting: UK prehabilitation center. Participants: A total of 75 patients were referred during the study period. Forty eight patients (64%) did not participate; 20 of those opted to be in the control group. Twenty four patients engaged with prehabilitation and returned completed questionnaires. In total, 44 patients were included in the analysis. Interventions: The program consisted of supervised exercise, nutritional advice, smoking cessation, and psychosocial support. Outcome Measures: Feasibility was determined by the center's ability to deliver the program. This was measured by the number of patients who wanted to access the service, compared with those able to. Service uptake, patient satisfaction, and project costs were recorded. Patient-reported outcomes (PROs) and the use of healthcare resources were also evaluated. Results: A total of 61 patients (81%) wanted to participate; 24 (32%) were able to partake and return questionnaires. Reasons for nonparticipation included surgery within weeks, full-time commitments, and transportation difficulties. A total of 25 (93%) prehabilitation patients recorded high satisfaction with the program. There was a significant reduction in anxiety among prehabilitation patients. There were no significant improvements in the other PROs. There were no changes to hospital length of stay, readmissions, and complications. Conclusions: Multimodal prehabilitation is a feasible intervention. Logistical challenges need to be addressed to improve engagement. These results are limited and would require a larger sample to confirm the findings. Work on a thorough cost-benefit analysis is also required.

The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

“…There are several reasons to account for our feasibility outcomes. We have been able to improve on some of the recruitment problems highlighted in previous studies [ 5 , 27 ]. By offering a home-based format, we have been able to address key concerns relating to hospital transport, in-person supervised session availability and timings (e.g., availability of exercise equipment and space), and the need to accommodate our interventional recommendations around medical and/or personal commitments.…”

“…Our intervention was modelled on our existing in-person supervised prehabilitation program [ 4 , 5 ]. We were able to adopt a multi-modal telehealth-delivered home-based program.…”

“…Prior to the pandemic, we were able to provide our cancer patients with center-based, or face-to-face, prehabilitation interventions [ 4 , 5 ]. Prehabilitation (“prehab”) involves identifying and promoting health-optimizing behaviors to mitigate the unwanted consequences of cancer treatment, often in the pre-operative setting to improve post-operative outcomes [ 6 , 7 ].…”

Understanding Patients’ Experiences and Perspectives of Tele-Prehabilitation: A Qualitative Study to Inform Service Design and Delivery

“…Despite the advertised potential benefits of prehabilitation, not all patients offered our service choose to engage [ 14 , 15 ]. Gaining a better understanding of the actions that underline and influence cancer patients’ behaviours is an important step to developing an effective and evidence-based prehabilitation programme.…”

Clinical Exercise Prescription for Cardiovascular Health in Breast Cancer Survivors

“…27 . Within the literature of breast cancer prehabilitation, previous studies-which were conducted as pilot studies-explored potential improvements in patient-reported outcomes (e.g., physical function, fatigue, range of motion, and quality of life) and mainly addressed the feasibility of implementing exercise before breast cancer surgery28 .Only one study has reported cardiovascular-related outcomes before cancer therapy for this patient population.…”