Cancer 'prehabilitation' can reduce complications and improve treatment outcomes

(Press-News.org) Philadelphia, Pa. (July 18, 2013) - For patients with cancer, "prehabilitation"— interventions given between the time of diagnosis and the start of treatment—has the potential to reduce complications from treatments and improve physical and mental health outcomes, according to a report in the August American Journal of Physical Medicine & Rehabilitation (AJPM&R). AJPM&R, the official journal of the Association of Academic Physiatrists, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"A growing body of evidence supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments," write Drs. Julie K. Silver and Jennifer Baima of Harvard Medical School. Their article, titled Cancer Prehabilitation: An Opportunity to Decrease Treatment-Related Morbidity, Increase Cancer Treatment Options, and Improve Physical and Psychological Health Outcomes, is the first comprehensive review of the topic.

"There is a rather long and impressive history of using prehabilitation to improve orthopedic surgical outcomes," Dr. Silver comments. "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."

Cancer Prehabilitation—Getting Patients in Best Possible Shape for Treatment 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 current impairment, and provide targeted interventions to reduce the risk and severity of future impairments.

Traditionally, pretreatment interventions focused on aerobic conditioning to build patients' general strength and stamina. But recent studies have shown that more directed interventions can improve outcomes in patients with specific cancers: for example, 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 that 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 health care costs.

Cancer prehabilitation seems more effective when it includes both physical and psychological interventions. Providing psychosocial support immediately after diagnosis has improved treatment outcomes for patients with prostate, breast, and ovarian cancer. Future studies may show that prehabilitation can increase patients' ability to complete their recommended treatment—thus improving their chances of survival.

Drs. Silver and Baima emphasize that cancer prehabilitation should follow an individualized approach, "identifying current and anticipating future impairments as a critical first step in improving healthcare outcomes and decreasing costs." They liken cancer prehabilitation to a puzzle, with individual approaches put together in combinations that best meet the needs of the individual patient.

While patients may fear that delaying cancer treatment may reduce their risk of survival, there's typically some waiting period before treatment begins. This time—whether it's a few days or a few weeks—may provide a "window of opportunity" for prehabilitation interventions to address physical and psychological issues. Drs. Silver and Baima write, "Newly diagnosed cancer patients are often seeking ways to become immediately involved in their care that may go beyond decision making about upcoming treatments."

Studies have begun to show that physical and psychological prehabilitation interventions can reduce treatment-related complications, decrease length of hospital stay and/or readmissions, increase available treatment options for patients who would not otherwise be candidates, and quickly facilitate return of patients to the highest level of function possible. Drs. Silver and Baima highlight the need for further studies to identify the most effective prehabilitation interventions: "those that improve patient health outcomes and reduce direct and indirect healthcare costs."

"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," Dr. Silver adds. "We hope it will serve to highlight this exciting area of research and to show clinicians that there are key opportunities right now to improve cancer care."

### About AJPM&R American Journal of Physical Medicine & Rehabilitation focuses on the practice, research and educational aspects of physical medicine and rehabilitation. Monthly issues keep physiatrists up-to-date on the optimal functional restoration of patients with disabilities, physical treatment of neuromuscular impairments, the development of new rehabilitative technologies, and the use of electrodiagnostic studies. The Journal publishes cutting-edge basic and clinical research, clinical case reports and in-depth topical reviews of interest to rehabilitation professionals. The Journal is published by LWW a part of Wolters Kluwer Health.

About the Association of Academic Physiatrists The AAP was founded in 1967 to serve as the national organization of physiatrists who are affiliated with medical schools. The AAP is a member organization of the Association of American Medical Colleges (AAMC). The objectives of the Association are to promote the advancement of teaching and research in Physical Medicine and Rehabilitation within an academic environment. The organization acts as a sounding board and forum for the exchange of ideas and information relative to all phases of the art and science of Physical Medicine and Rehabilitation.

About Wolters Kluwer Health Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health's customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical, and UpToDate®.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of €3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.