Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review

Abstract

Background: Prehabilitation aims to improve functional capacity prior to cancer treatment to achieve better psychosocial and clinical outcomes. Prehabilitation interventions vary considerably in design and delivery. In order to identify gaps in knowledge and facilitate the design of future studies, we undertook a scoping review of prehabilitation studies to map the range of work on prehabilitation being carried out in any cancer type and with a particular focus on diet or nutrition interventions.Objectives: Firstly, to describe the type of prehabilitation programs currently being conducted. Secondly, to describe the extent to which prehabilitation studies involved aspects of nutrition, including assessment, interventions, implementation, and outcomes.Eligibility Criteria: Any study of quantitative or qualitative design that employed a formal prehabilitation program before cancer treatment (“prehabilitation” listed in keywords, title, or abstract).Sources of Evidence: Search was conducted in July 2020 using MEDLINE, PubMed, EMBASE, EMCARE, CINAHL, and AMED.Charting Methods: Quantitative data were reported as frequencies. Qualitative nutrition data were charted using a framework analysis that reflects the Nutrition Care Process Model: assessment, intervention, and monitoring/evaluation of the nutrition intervention.Results: Five hundred fifty unique articles were identified: 110 studies met inclusion criteria of a formal prehabilitation study in oncology. prehabilitation studies were mostly cohort studies (41%) or randomized-controlled trials (38%) of multimodal (49%), or exercise-only (44%) interventions that were applied before surgery (94%). Nutrition assessment was inconsistently applied across these studies, and often conducted without validated tools (46%). Of the 110 studies, 37 (34%) included a nutrition treatment component. Half of these studies provided the goal for the nutrition component of their prehabilitation program; of these goals, less than half referenced accepted nutrition guidelines in surgery or oncology. Nutrition interventions largely consisted of counseling with dietary supplementation. The nutrition intervention was indiscernible in 24% of studies. Two-thirds of studies did not monitor the nutrition intervention nor evaluate nutrition outcomes.Conclusion: Prehabilitation literature lacks standardized and validated nutritional assessment, is frequently conducted without evidence-based nutrition interventions, and is typically implemented without monitoring the nutrition intervention or evaluating the intervention's contribution to outcomes. We suggest that the development of a core outcome set could improve the quality of the studies, enable pooling of evidence, and address some of the research gaps identified.

Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology

“…Importantly, the NCPM provides a framework to guide professional nutrition practice. Given the recent scoping review of nutrition within prehabilitation research ( 7 ), which indicated that many nutrition interventions are currently conducted without reference to best practice guidelines, we suggest that implementation of the systematic NCPM could enhance the contribution of nutrition to prehabilitation and improve patient outcomes.…”

“…A recent scoping review of nutrition within prehabilitation oncology research identified that nutrition assessment was inconsistently applied across these studies, interventions did not often meet reference standards, and two-thirds of these studies did not monitor the nutrition intervention nor evaluate nutrition outcomes ( 7 ). Given that NCPM represents a global standard for provision of nutrition care, we advocate for its use in prehabilitation and have applied this model to the pre-operative surgical patient to illustrate how nutrition care can be effectively implemented and optimized.…”

“…We have limited this list to general recommendations and guidelines in surgery and oncology, but the reader should be aware that many disease-specific standards also exist ( 75 ). Unfortunately, accepted nutrition guidelines are not often used in prehabilitation ( 7 ). A scoping review of 37 prehabilitation studies with a nutrition treatment component in oncology identified that only half of these studies ( n = 21) specified a goal for their nutrition intervention; of these, 67% ( n = 14) referenced the stated goals and only 43% ( n = 9) used a reference standard or accepted guideline, including ESPEN guidelines ( 7 ).…”

“…Unfortunately, accepted nutrition guidelines are not often used in prehabilitation ( 7 ). A scoping review of 37 prehabilitation studies with a nutrition treatment component in oncology identified that only half of these studies ( n = 21) specified a goal for their nutrition intervention; of these, 67% ( n = 14) referenced the stated goals and only 43% ( n = 9) used a reference standard or accepted guideline, including ESPEN guidelines ( 7 ). The potential to improve patient outcomes is limited unless clinical guidelines are followed ( 76 ).…”

Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care

“…Another multimodal approach implements a prehabilitation intervention that combines (1) personalized nutrition counseling and supplementation as needed, (2) individualized aerobic and weight resistance exercises, and (3) anxiety reduction and relaxation strategies to prepare patients for the anticipated detrimental effects of surgery. The majority of research has been conducted in surgery patients (94%), with several RCTs showing prehabilitation incorporating these three components facilitated earlier return to pre-surgery physical function levels and was associated with greater gains in muscle mass (compared to rehabilitation), and reduced hospital LOS and healthcare costs [61][62][63][64][65].…”