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Cancer 'prehab’ reduces complications, improves outcomes

Wednesday July 31, 2013
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Interventions given between the time of cancer diagnosis and the start of treatment, or prehabilitation, can reduce complications from treatments and improve patients’ physical and mental health outcomes, according to an article.

"A growing body of evidence supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments," Julie K. Silver, MD, and Jennifer Baima, MD, of Harvard Medical School in Boston, wrote in an article appearing in the August issue of the American Journal of Physical Medicine & Rehabilitation.

"There is a rather long and impressive history of using prehabilitation to improve orthopedic surgical outcomes," Silver said in a news release. "Our new review shows that there is a unique opportunity to help many people who have been newly diagnosed with cancer to improve their physical and emotional outcomes."

Studies have started to show physical and psychological prehabilitation interventions can reduce treatment-related complications, decrease length of hospital stay and readmissions, increase available treatment options for patients, and help patients return to their highest possible level of function.

The goal of cancer prehabilitation is to prevent or lessen the severity of anticipated treatment-related problems that could lead to later disability. Immediately after diagnosis, patients undergo physical and psychological assessments to establish their baseline level of function and identify any existing impairments, and provide targeted interventions to reduce the risk and severity of future impairments.

Traditionally, pretreatment interventions focused on aerobic conditioning to build patients’ strength and stamina. But the authors cite recent studies that have shown directed interventions for patients with specific cancers can improve outcomes. These include swallowing exercises before surgery for head or neck cancer, smoking cessation to improve breathing function before lung cancer surgery or pelvic floor exercises to reduce problems with urinary incontinence after surgery for prostate cancer.

Some studies have shown prehabilitation interventions, individually or in combination, can increase the range of treatment options, lower complication rates and improve physical and mental health outcomes. Benefits include a reduced risk of hospital readmission and lower healthcare costs.

Cancer prehabilitation seems more effective when it includes both physical and psychological interventions, the authors wrote. Providing psychosocial support immediately after diagnosis has improved treatment outcomes for patients with prostate, breast and ovarian cancer. According to the article, prehabilitation should be tailored to each individual patient.

Patients typically have some type of waiting period before treatment begins, the authors point out. This may provide an opportunity for prehabilitation interventions.

"Newly diagnosed cancer patients are often seeking ways to become immediately involved in their care that may go beyond decision-making about upcoming treatments," Silver and Baima wrote in the article.

Further studies are needed to identify the most effective prehabilitation interventions to improve patient outcomes and reduce healthcare costs, the authors wrote.

"This review provides an exciting 'jumping-off point’ for cancer researchers to look more closely at how to improve outcomes from the moment of diagnosis onward," Silver said in the release.

To read the full article, visit http://bit.ly/1622mzp.


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