An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

Abstract

Purpose The purpose of the study is to systematically review and synthesise randomised controlled trials investigating the effectiveness of prehabilitation compared to usual care for newly diagnosed, adult-onset cancer patients. Methods MEDLINE, EMBASE, PsycINFO, CINAHL and SSCI were searched up to April 2017. Studies were included if disease-related, treatment-related, patient-reported and health service utilisation outcomes were assessed. Two reviewers independently reviewed and appraised the risk of bias of each study. Results Eighteen studies were included. Interventions comprised one or more of the following components: psychological support, education and exercise. Meta-analyses found that pelvic floor muscle training (PFMT) significantly increased odds of continence at 3 months (OR = 3.29, 95% CI = 1.57-6.91), but did not significantly reduce daily pad use at 6 months post-surgery Mean Difference (MD)= ( = − 0.96, 95% CI = − 2.04-0.12) for prostate cancer patients. Although quality of life improved due to PFMT, functional ability or distress did not. Further meta-analyses indicated that presurgical exercise significantly reduced length of hospital stay (MD = − 4.18, 95% CI = − 5.43-− 2.93) and significantly lowered odds of post-surgery complications (OR = 0.25, 95% CI = 0.10-0.66) for lung cancer patients. Psychology-based prehabilitation significantly improved mood, physical wellbeing and immune function for prostate cancer patients and improved fatigue and psychological outcomes and a trend for better quality of life among breast cancer patients. Risk of bias was high for most studies. Conclusions Prehabilitation appears to benefit cancer patients. Rigorous trials are needed to investigate the effectiveness of prehabilitation among other cancer sites and other related effects. The cost-effectiveness of prehabilitation remains unanswered. Implications for cancer survivors Providing interventions earlier in the care pathway may lead to better outcomes for patients during survivorship.

Psychological factors, prehabilitation and surgical outcomes: evidence and future directions

“…The authors suggest stress management training may be more effective in improving quality of life than psychotherapeutic approaches; however, as there is considerable variation in outcome measures, such conclusions may be premature. A more recent review of 18 prehabilitation interventions in cancer patients identified some additional studies that included a psychological component . Both reviews note that the included studies tend to be small, at risk of bias and use a variety of outcome measures, making synthesis of the evidence difficult.…”

High-intensity interval training in the prehabilitation of cancer patients—a systematic review and meta-analysis

“…In this context, a recent meta-analysis on 3257 patients with cancer indicated that moderate aerobic exercise performed at 70-80% of maximum heart rate not only was feasible and safe but also showed beneficial effects in QoL and physical functioning and maintained or at least improved fitness during concomitant chemotherapy [18]. Although not without bearing a considerably risk of bias, pooled data from another recent metaanalysis revealed that prehabilitation significantly improved mood, physical well-being, and immune function for prostate cancer patients and improved fatigue and psychological outcomes with a trend indicating better QoL among breast cancer patients [19].…”

Feasibility of Prehabilitation Prior to Breast Cancer Surgery: A Mixed-Methods Study

“…A burgeoning body of research is investigating the utility of preoperative interventions, known as prehabilitation, to optimize posttreatment health outcomes. Numerous reviews of the prehabilitation literature in cancer populations demonstrate several important benefits, including improved preoperative and postoperative physical function, reduced hospital length of stay, and fewer postoperative complications (18)(19)(20)(21)(22)(23)(24). However, this literature exists almost exclusively in people undergoing tumor resection for thoracoabdominal malignancies, with breast cancer prehabilitation remaining largely unexamined.…”