Rehab Before Chemo Improves Results


Rehab Before Chemo Improves Results


So you’ve just learned that you have a cancer of some sort. Colorectal, prostate, breast, uterine, esophageal, etc.

Perhaps it was caught early…perhaps you’re one of the lucky ones and it’s treatable.

But whether your treatment programs involves chemo, radiation, or surgery, there’s a good chance you’re going to endure substantial doses of pain and stress – cancer treatment is one of the most challenging experiences one can endure.

But there is a new field of research that just might make any cancer treatment program a little easier on the mind and the body.

What is prehabilitation?

Emerging research points to something so obvious that it shouldn’t need research: The more physically and emotionally prepared you are for the traumas of cancer treatment, the more effective and successful the treatment can be.

The relatively new field of pre-procedure preparation is called prehabilitation, or prehab. It is intended to prevent or reduce the severity of anticipated treatment-related challenges, some of which may lead to long-term disability. Along with improved physical and psychological health outcomes, cancer prehab can reduce morbidity, increase treatment options, prevent hospital readmissions, and lower the costs—both direct and indirect—for treatment.

Prehab is now somewhat of a no-brainer for people preparing for an orthopedic procedure. Your new knee or hip will depend on easily identified muscles—so let’s get them strong ahead of time.

It’s not so simple when you’re talking about the psychological and systemic physical stress that cancer patients face.

How prehab works

As with prehab for orthopedic procedures, cancer prehab usually involves exercise to improve endurance, strength, or cardiorespiratory health. You start with baseline measurements, for example, how far can you walk on a treadmill in X minutes? How can we increase that? Are there current physical problems? Radiation for breast cancer, for example, means holding your shoulder in an already awkward position—is the shoulder ready for that?

Some prehab protocols also provide psychological, nutritional, and other counseling services. It’s different for every patient. If the patient has been practicing “bad diet,” for example, he or she should start eating for optimal health as soon as possible. A patient preparing for neck surgery might be given prehab swallowing exercises and speech therapy to reduce post-procedure complications.

It only makes sense.

But insurance providers don’t cover concepts. Lacking sufficient hard data, it’s currently difficult for them to determine if prehab should be a covered expense.

Nor is it written in stone that prehab is the sole cause of the improved outcomes many specialists see. Other factors can come into play—overall health at the time of diagnosis and treatment, willingness to comply with every directive involved pre- and post-procedure, or some other reason.

But while the insurance providers and researchers wrestle with those legitimate issues, I firmly believe that prehab should be covered—for every cancer intervention. As with all best practices, it can prevent problems rather than treat existing ones.

So let’s bring on some of the research we do have.

Cancer prehab shows promise

A study of 77 people with colorectal cancer who were awaiting surgery began by dividing them into two groups. One group did targeted exercise and received relaxation and nutritional counseling in the four weeks before their surgery. The other group did the same in the eight weeks after surgery.

Eight weeks after surgery, 84 percent of the prehab patients had recovered to or exceeded their baseline measurements on a six-minute treadmill test. In the rehab group, 62 percent of the patients recovered that fully.

That’s a pretty healthy difference. Score one for prehab.

Another study indicates that patients who exercise before treatment had reduced length of hospital stay, lower readmission rates, and fewer cardiorespiratory complications.

Again—strong data, but more is required for prehab to become standard practice—as it is in my own practice.

When should prehab begin?

One specialist describes what she calls “the window of opportunity” for prehab. That’s the time between diagnosis and treatment. It’s common for people to take that time to absorb the impact of diagnosis, to get a second opinion, to get additional tests, or just to get an appointment for the procedure.

The window of opportunity can remain open for days or weeks. That’s the time to begin prehab. Especially given the enormous emotional stress involved in processing your situation, any positive activity you can undertake will do you a world of good. You prove to yourself that you’re not just a helpless victim awaiting an unknown fate. You have a positive role to play.

Use the window

If you’re facing or anticipating cancer, or any other major medical treatment, talk with your doctor about prehab. If he or she isn’t convinced that it works, find a doctor who’s a believer. There are plenty of us.

 

 

Last Updated: August 16, 2018
Originally Published: September 25, 2015