The impact of prehabilitation interventions on affective and functional outcomes for young to midlife adult cancer patients: A systematic review

Abstract

Objective: Cancer remains one of the most enduring health crises of the modern world. Prehabilitation is a relatively new intervention aimed at preparing individuals for the stresses associated with treatment from diagnosis. Prehabilitation can include exercise, psychological and nutrition-based interventions. The present systematic review aimed to assess the efficacy of prehabilitation on affective and functional outcomes for young to midlife adult cancer patients (18-55 years). Outcomes of interest included prehabilitation programme composition, duration, mode of delivery and measures used to determine impact on affective and functional outcomes. Methods: The following databases were searched with controlled and free text vocabulary; Psychological Information database (PsychINFO), Culmunated Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE) andPublic MEDLINE (PubMed). Abstract and full-text screening was conducted with a secondary reviewer and final texts were subject to risk of bias analysis.Results: Thirteen texts were included at full-text. These included data of 797 prehabilitation participants (mean age 53 years) and a large representation of female participants (71% average). Evidence was found for the efficacy of psychological prehabilitation for anxiety reduction. Prehabilitation did not significantly affect health related quality of life. Findings moderately supported the therapeutic validity of exercise prehabilitation for functional outcomes, both in terms of clinical and experimental improvement with respect to the quality of evidence. Variation between all prehabilitation types was observed. There was insufficient evidence to support the efficacy of psychological prehabilitation on stress, distress or depression. Conclusion:Implications for future research are highlighted and then discussed with respect to this young to midlife age group.

Patients’ and carers’ views on research priorities in prehabilitation for cancer surgery

“…These findings support the direction of prehabilitation research towards enhancing the evidence base in these areas. Previous studies have sought to address these areas; however, the strength of evidence remains relatively weak [ 1 – 4 , 23 – 25 ]. The pursuit of future high-quality trials to advance these areas is supported by the findings of this study.…”

“…Prehabilitation is the preparation of patients for surgery with the aim to enhance resilience and functional capacity for optimal postoperative recovery and expedited return to baseline daily activities [ 1 – 4 ]. It encompasses the use of physical, nutritional, and psychosocial interventions to address modifiable risk factors and thereby improve preoperative functional capacity [ 5 , 6 ].…”

Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study

“…improve postoperative outcomes in surgical patients. [1][2][3] Prehabilitation in cancer care occurs in the time between diagnosis and surgical management, identifying impairments and delivering targeted interventions to improve health with the goal of preventing adverse effects of treatment. 4,5 Preoperative interventions encompass optimisation of physical, nutritional, and/or psychosocial health.…”

“…There is growing evidence that prehabilitation may improve preoperative functional capacity, promote recovery, reduce complications, and reduce healthcare costs. 1,2,7,9 Currently, most of the literature in this field is from small, underpowered trials, employing a heterogenous mix of interventions and protocols. 10 While recent trials and systematic reviews demonstrate the significant benefits of prehabilitation in improving preoperative functional capacity and postoperative outcomes, including in-hospital complications and length of hospital stay, this field remains in its infancy.…”

“…There is growing evidence that prehabilitation may improve preoperative functional capacity, promote recovery, reduce complications, and reduce healthcare costs. 1 , 2 , 7 , 9 …”