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

Abstract

Background: Breast cancer surgery results in numerous acute and long-term adverse outcomes; the degree to which these can be mitigated or prevented through prehabilitation is unknown. Methods: We conducted a longitudinal, single-arm, mixed-methods study to examine the feasibility of prehabilitation in 22 women undergoing breast cancer surgery. All participants received an individualized exercise prescription including upper quadrantspecific resistance and mobility training and aerobic exercise for the duration of their surgical wait time. Feasibility was assessed by recruitment, adherence, attrition, and intervention-related adverse event rates. An exploratory investigation of intervention efficacy was conducted via a 6-min walk test, upper-quadrant strength and range of motion, volumetric chances associated with lymphedema, and participant-reported quality of life, fatigue, pain, and disability. Outcome assessments were conducted at baseline, prior to surgery, and at six and 12 weeks after surgery. Semi-structured interviews with a subset of participants (n = 5) and health-care providers (H; n = 2) were conducted to provide further insights about intervention feasibility. Qualitative data were analyzed using a hybrid inductive and deductive thematic analysis approach. Results: Recruitment and attrition rates were 62 and 36%, respectively. Average prehabilitation duration was 31 days (range = 7-69 days). Seventy six percent of participants complied with at least 70% of their prehabilitation prescription. There was a clinically significant increase in the 6-min walk distance from baseline to the preoperative assessment (57 m, 95% CI = −7.52, 121.7). The interviews revealed that the intervention was favorably received by participants and HCPs and included suggestions that prehabilitation (i) should be offered to all surgical candidates, (ii) is an avenue to regain control in the preoperative period, (iii) is a facilitator of postoperative recovery, and (iv) is an opportunity to provide education regarding postoperative rehabilitation protocols. A preference for multimodal prehabilitation (including dietetic and psychological counseling) was also highlighted.

The Role of Behavioral Science in Personalized Multimodal Prehabilitation in Cancer

“…Importantly, some of the aforementioned studies also include qualitative process evaluations (Macleod et al, 2018 ; Brahmbhatt et al, 2020 ; McCourt et al, 2020 ). Brahmbhatt et al ( 2020 ) present findings from interviews with participants who had participated in a home-based exercise prehabilitation program prior to breast cancer surgery. They appreciated the personalized exercise prescription which they could complete with ease, irrespective of pervious activity levels.…”

Adverse Events Reporting of Clinical Trials in Exercise Oncology Research (ADVANCE): Protocol for a Scoping Review

“…Exercise is emerging as a therapy in supportive oncology care for people living with and beyond cancer (1). There is substantial evidence that exercise can provide an abundance of benefits, including improving physical structure and function, cancerrelated fatigue, psychological distress and quality of life (2)(3)(4)(5), increasing resilience prior to surgery and rehabilitation after surgery, as well as reducing disease specific and overall mortality risk (6,7). In this context, accurate knowledge of safety profiles of exercise interventions is crucial for health policy makers and healthcare providers to critically appraise the utility of an exercise intervention and can facilitate informed decision making for cancer patients and survivors considering exercise therapy.…”

Neoadjuvant Chemotherapy in Breast Cancer: An Advanced Personalized Multidisciplinary Prehabilitation Model (APMP-M) to Optimize Outcomes

“…The benefits of a multimodal prehabilitation model are still emerging in recent studies, particularly during the preoperative period. During this window of opportunity, patients may be more receptive to health behavior changes in a structured support network [ 6 ].…”