A systematic review of multimodal prehabilitation in breast cancer

Abstract

Purpose Breast cancer is the most prevalent malignancy in women. Prehabilitation may offer improvements in physical and psychological wellbeing among participants prior to treatment. This systematic review aimed to determine the efficacy of prehabilitation in participants diagnosed with breast cancer. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the impact of prehabilitation in participants with breast cancer were included. Studies were assessed independently according to pre-eligibility criteria, with data extraction and methodological quality assessed in parallel. Results 3184 records were identified according to our search criteria, and 14 articles were included. Articles comprised of quantitative randomised controlled trials (n = 7), quantitative non-randomised studies (n = 5), a qualitative study (n = 1), and a mixed-method study (n = 1). The majority of selected studies completed exercise programs (n = 4) or had exercise components (n = 2), with two focusing on upper-limb exercise. Five articles reported complementary and alternative therapies (n = 5). Two articles reported smoking cessation (n = 2), with a single study reporting multi-modal prehabilitation (n = 1). Mostly, prehabilitation improved outcomes including physical function, quality of life, and psychosocial variables (P < 0.05). The qualitative data identified preferences for multimodal prehabilitation, compared to unimodal with an interest in receiving support for longer. Conclusions Prehabilitation for patients with breast cancer is an emerging research area that appears to improve outcomes, however, ensuring that adequate intervention timeframes, follow-up, and population groups should be considered for future investigations. Implications for Cancer Survivors The implementation of prehabilitation interventions for individuals diagnosed with breast cancer should be utilised by multidisciplinary teams to provide holistic care to patients as it has the potential to improve outcomes across the cancer care trajectory.

An Integrated Care Approach to Improve Well-Being in Breast Cancer Patients

“…A specific role is recognized in rehabilitation for women undergoing surgery, namely, “pre-habilitation” [ 86 ]. This approach should be implemented as soon as the surgical indication has been established to improve not only the short-medium term functional items but also the surgical outcomes in terms of clinical, functional, psychological, and post-operative complications [ 87 , 88 ]. Pre-habilitation has also a key role in women who will undergo radio- and/or CHT, which is known to lead to significant musculoskeletal impairments, including widespread pain (e.g., joint pain and myalgia), muscle wasting or cachexia, bone fragility, and cardiorespiratory deconditioning [ 89 , 90 ].…”

Bewegungstherapeutische Prähabilitation in der Onkologie

“…Die Autoren berichten, dass zwar Verbesserungen in der CRF und der Lebensqualität zu erwarten seien, jedoch keine Beeinflussung der Operationsparameter beobachtet werden konnte. Ebenso konnten Toohey et al bei der systematischen Betrachtung von Prähabilitationsstudien mit Brustkrebspatientinnen keine statistisch signifikante Überlegenheit der Interventionsgruppe hinsichtlich der postoperativen Komplikationsrate beobachten [20]. Dafür zeigten die Patient*innen in den Interventionsgruppen eine Verbesserung der körperlichen Funktionsfähigkeit der Lebensqualität sowie anderer psychosozialer Variablen.…”

Feasibility study of a multimodal prehabilitation programme in women receiving neoadjuvant therapy for breast cancer in a major cancer hospital: a protocol

“…However, side effects include fatigue, cardiotoxicity, neurotoxicity, anxiety, insomnia, vasomotor symptoms, gastrointestinal disturbance as well as a raft of immune-related AEs, which may impact treatment tolerance, long-term outcomes and quality of life 3–7. Providing early supportive care prior to surgery (typically termed ‘prehabilitation’) may mitigate these side effects and improve quality of life 8…”

“…The most effective prehabilitation programmes take a holistic, multimodal approach. These programmes may combine exercise with psychological and well-being support, fatigue management strategies, nutrition, lifestyle advice, supportive oncology symptom management, and complementary therapies 7 8 26–28. Comprehensive supportive care builds self-efficacy, reduces anxiety, prepares the patient for treatment and surgery, and facilitates post-treatment recovery.…”