Prehabilitation in oncology rehabilitation refers to the proactive approach of preparing cancer patients for their treatment journey before they undergo surgery, chemotherapy, radiation, or other cancer treatments. The goal of prehabilitation is to optimise physical, psychological, and nutritional health prior to treatment, which can help improve treatment outcomes, minimise side effects, and enhance recovery. Essentially, prehabilitation equips patients with the tools and support they need to better tolerate treatment and recover faster and more effectively afterward.

Why Prehabilitation Matters in Oncology:

Cancer treatments can be physically demanding and have a range of side effects, including fatigue, muscle weakness, pain, loss of mobility, and impaired cardiovascular function. Prehabilitation can mitigate these effects by improving the patient’s physical fitness and mental resilience before treatment begins. It’s often a personalised, comprehensive program that may involve exercise, education, nutritional counseling, and psychological support.

Benefits of Prehabilitation in Oncology:

1. Enhanced Physical Resilience:
   • Prehabilitation helps patients increase their strength, endurance, and flexibility before cancer treatment starts, making them better able to handle the physical demands of surgery, chemotherapy, or radiation.
   • Exercise improves cardiovascular health, muscle mass, and lung function, reducing the likelihood of treatment-related fatigue, weakness, and functional decline.
2. Reduction in Treatment-Related Side Effects:
   
   • By improving baseline physical fitness, prehabilitation may help reduce the severity of common side effects such as fatigue, muscle wasting, joint stiffness, and reduced mobility.
   • Regular physical activity and strengthening exercises can help prevent complications such as post-surgical pneumonia, deep vein thrombosis (DVT), and lymphedema.
3. Faster Recovery Post-Treatment:
   
   • Patients who undergo prehabilitation often recover more quickly after surgery or treatment because their bodies are better prepared to handle the stress and demands of the recovery process.
   • Prehabilitation programs may help reduce hospital stays, speed up wound healing, and increase overall functional capacity.
4. Improved Emotional and Psychological Health:
   
   • Cancer treatment can take a heavy emotional toll. Prehabilitation often incorporates psychological support, such as counseling or stress management, which can reduce anxiety and depression, increase emotional resilience, and improve overall well-being.
   • Mind-body techniques like mindfulness, relaxation exercises, and breathing techniques can help patients manage stress and improve their coping abilities during treatment.
5. Better Nutritional Status:
   
   • Prehabilitation can address potential nutritional deficits that may affect treatment tolerance and recovery. A focus on a balanced diet rich in essential nutrients ensures patients are better prepared for the metabolic challenges of cancer treatments.
   • Nutritional guidance helps prevent weight loss, malnutrition, and dehydration, which are common concerns for patients undergoing cancer treatments.
6. Increased Treatment Tolerance:
   
   • Prehabilitation can enhance a patient’s ability to tolerate the rigors of cancer treatments. By improving physical health, patients may be less likely to experience severe side effects, need to delay treatments, or have to reduce doses.
   • Better functional status before treatment helps patients adhere to prescribed treatment regimens without interruption.
7. Empowerment and Control:
   
   • Prehabilitation gives cancer patients a sense of empowerment and control over their treatment journey. This proactive approach can help patients feel more prepared and confident as they approach their cancer treatment, reducing fear and uncertainty.
   • The comprehensive nature of prehabilitation helps patients be more actively involved in their own care, contributing to better long-term outcomes.

Key Components of Prehabilitation in Oncology:

1. Physical Exercise Programs:
   • Aerobic Exercise: Activities like walking, cycling, or swimming improve cardiovascular health and stamina, preparing the body to handle the strain of cancer treatments.
   • Strengthening Exercises: Resistance training helps increase muscle mass and strength, reducing the risk of muscle wasting (a common side effect of cancer treatments).
   • Flexibility and Mobility Training: Stretching and mobility exercises can improve joint function, reduce stiffness, and enhance overall flexibility.
   • Balance and Coordination: Prehabilitation may include balance exercises to help prevent falls, especially if cancer treatments affect muscle strength or coordination.

1. Psychological Support:
   • Stress Management: Techniques like mindfulness, meditation, relaxation exercises, and guided imagery can help reduce pre-treatment anxiety and stress.
   • Counseling and Support Groups: Prehabilitation often includes access to mental health professionals or cancer support groups, where patients can discuss their fears and concerns, and share experiences.
   • Cognitive Behavioral Therapy (CBT): CBT may be used to address issues like depression or anxiety and provide strategies for managing negative thoughts during cancer treatment.
2. Education and Empowerment:
   
   • Pre-treatment Education: Patients are educated about the treatment process, what to expect, and how to manage potential side effects. This empowers them to make informed decisions and reduces feelings of uncertainty.
   • Self-Care Techniques: Patients are taught how to monitor and manage their own symptoms, and how to implement energy-saving techniques during treatment.
3. Lifestyle Modifications:
   
   • Sleep Hygiene: Ensuring proper rest is crucial, as cancer treatments can disrupt sleep patterns. Prehabilitation includes advice on improving sleep quality to enhance recovery.
   • Smoking Cessation and Alcohol Reduction: Prehabilitation programs often encourage patients to stop smoking or reduce alcohol intake, as these can interfere with healing and treatment efficacy.

When to Start Prehabilitation:

• Before Treatment Begins: Ideally, prehabilitation should start as soon as cancer is diagnosed or before treatment begins, but it can also be beneficial at any point during the treatment journey.
• During Treatment: While some aspects of prehabilitation may be easier to implement before treatment begins, certain components, such as exercise and psychological support, can continue throughout treatment to help manage side effects and improve overall outcomes.

Who Can Benefit from Prehabilitation:

Prehabilitation is beneficial for all cancer patients, regardless of the type of cancer, treatment plan, or stage of cancer. It is particularly important for patients who:

• Are undergoing surgery (e.g., mastectomies, prostatectomies, etc.)
• Are receiving chemotherapy or radiation
• Have a high risk of treatment-related complications
• Are dealing with coexisting health conditions (e.g., heart disease, diabetes, etc.)
• Want to improve their overall well-being during treatment

Conclusion:

Prehabilitation is a powerful and proactive approach in oncology rehabilitation that helps cancer patients optimise their physical, emotional, and nutritional health before beginning treatment. By incorporating exercise, nutrition, psychological support, and education, prehabilitation enhances the patient’s resilience, improves treatment outcomes, and facilitates faster recovery. It provides cancer patients with a sense of control and empowerment, equipping them with the tools to better manage their treatment journey and improve their long-term quality of life.

Fiona Collins, MISCP, CORU PT066610

Fiona earned her degree in Physiotherapy from the Amsterdam University of Applied Sciences and further specialised in lymphoedema management, becoming certified in complete decongestive therapy. She has worked extensively with individuals managing lymphatic disorders, offering manual lymphatic drainage, compression therapy, and personalised exercise programs to reduce swelling, improve mobility, and enhance overall well-being.
Fiona expanded her practice to include oncology rehabilitation (PINC therapist), supporting cancer survivors through prehabilitation, treatment and recovery.