Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes

Abstract

Objective Prehabilitation is increasingly being used to mitigate treatment‐related complications and enhance recovery. An individual's state of health at diagnosis, including obesity, physical fitness and comorbidities, are influencing factors for the occurrence of adverse effects. This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post‐treatment and considers the utility of prehabilitation before cancer treatment. Methods A database search was conducted for articles published with prehabilitation as a pre‐cancer treatment intervention between 2009 and 2017. Studies with no 30 days post‐treatment data were excluded. Outcomes post‐prehabilitation were extracted for physical function, nutrition and patient‐reported outcomes. Results Sixteen randomised controlled trials with a combined 2017 participants and six observational studies with 289 participants were included. Prehabilitation interventions provided multi‐modality components including exercise, nutrition and psychoeducational aspects. Prehabilitation improved gait, cardiopulmonary function, urinary continence, lung function and mood 30 days post‐treatment but was not consistent across studies. Conclusion When combined with rehabilitation, greater benefits were seen in 30‐day gait and physical functioning compared to prehabilitation alone. Large‐scale randomised studies are required to translate what is already known from feasibility studies to improve overall health and increase long‐term cancer patient outcomes.

Prehabilitation

“…However, fitness improvements can be made in as little as 2 weeks. 44 Recognition of the clear challenges and potential benefits of prehabilitation is detailed in recent national guidance. 16…”

Prehabilitation to Improve outcomes afteR Autologous sTem cEll transplantation (PIRATE): A pilot randomised controlled trial protocol

“…As people undergoing autologous stem cell transplant are at high risk of malnutrition and loss of muscle mass, the inclusion of nutrition intervention is of upmost importance. A recent systematic review identi ed ve studies where prehabilitation included a nutrition intervention prior to surgery for cancer [18]. Three of these studies included nutrition only interventions [38][39][40], while a combined exercise/nutrition intervention was integral to two studies [38,41].…”

“…Nutrition interventions provided before and after autologous stem cell transplant reduce weight-loss and hospital length of stay [14][15][16][17]. A multidisciplinary approach comprising exercise and nutrition could further optimise recovery from autologous stem cell transplant as shown in previous studies combining nutrition and exercise interventions during prehabilitation for other cancers [18].…”

“…Prehabilitation aims to build functional reserve to prepare people to cope with the physical and psychological demands of treatment. Systematic reviews have shown prehabilitation to be effective in people with other cancers receiving surgery [18].…”

“…Patients receiving prehabilitation required a shorter length of stay and earlier recovery of blood counts than the control group [21]. Previous studies on prehabilitation for autologous stem cell transplant have only focused on exercise, and did not consider other interventions such as nutrition support [18]. No trials have evaluated the impact of multidisciplinary prehabilitation for people preparing for autologous stem cell transplant.…”