The goal of cancer prehabilitation is to maximise physical and psychological health prior to surgery. To achieve this, best practice care should include multimodal approaches to ‘address the complex interactions between the physiological and psychological health of a patient1‘.
In cancer prehabilitation, when exercise, nutrition and psychology interventions are combined, compared to no intervention, evidence demonstrates improvements in:
- Pre-operative cardiopulmonary fitness
- Pre-operative functional capacity
- Reduced anxiety pre- and post-operatively
- Reduced length of hospital stay (LOS)
- Reduced complications2-8.
Evidence in surgical populations, including colorectal and lung cancers, is predominately supportive of efficacy2,5,9,10. A recent systematic review with network meta-analyses examined the efficacy of individual and combinations (exercise, nutrition and psychosocial) of prehabilitation interventions in mixed surgical populations that included 45% with cancer. When comparing individual components, exercise and nutrition were most likely to improve all critical outcomes with the strongest level of evidence. Trimodal interventions that include exercise, may improve health related quality of life and physical recovery11. See below link to this article.
However, inconsistencies regarding benefits remain in the literature12-15. Due to varied study designs and heterogenous populations, questions remain about the most effective components of prehabilitation to include and how to best apply these.
Further work is needed to clearly define and recommend:
- Standardised and validated assessment tools/methods including outcome measures
- Interventions for each of the core components of prehabilitation i.e. exercise, nutrition and psychology
- Implementation strategies to improve clinical adoption16-17.
- The ideal timing for prehabilitation before cancer treatment. Emerging evidence indicates that engaging in prehabilitation for two weeks or longer is recommended18.
High-quality Australian and international randomised control trials (RCTs) with well defined interventions are underway and consensus guidelines for prehabilitation along with the best outcomes measures to include are also being studied.