"Prehabilitation" for Cancer Patients May Lead to Faster Recovery

By Jane Farrell

Four weeks of getting cancer patients physically ready for surgery may help them recover more quickly , according to a new study from Canadian researchers.

That’s according to a recent study of nearly 120 colorectal cancer patients in Montreal who took part in a “prehabilitation” program.

“We don’t have a one size-fits-all prescription for how much exercise people need leading up to cancer surgery,” said Celena Scheede-Bergdahl, a kinesiologist who teaches at McGill University and is one of the authors of the study on the 4-week program.  “But we hope that by including a kinesiologist on the team along with oncologists and other specialized medical personnel, and by moving towards prehabilitation rather than rehabilitation, we can help patients recover more quickly so that they can get back to the daily activities they enjoy.”

The success of prehabilitation is important news for those over sixty years of age who make up the majority of colorectal cancer patients. According to the latest figures from the World Health Organization, colorectal cancer is now the third most common cancer in women around the globe and the second most common cancer in men. Although mortality from the disease is decreasing around the world, the recovery process from this kind of major abdominal surgery is often slow and difficult, partly because of the poor state of physical fitness that many patients have going into the operation. Typically, six months after surgery only one in five patients have regained their previous level of physical activity.

That’s where the growing trend towards prehabilitation – preparing patients for an operation rather than simply helping them to recover afterwards – comes in.

Scheede-Bergdahl started working with elderly cancer patients four years ago and understands the challenges facing patients when they are asked to change their exercise behaviors immediately after receiving a cancer diagnosis.

“When you get a cancer diagnosis, you’re likely to feel stressed out and not be thinking about exercise much. But becoming more physically active could make all the difference. Surgery places tremendous physical stress on the body in a very short period of time. So, over the past ten years, some doctors and kinesiologists have started getting their patients ready for surgery in the same way that you would prepare an athlete for an event – through individually tailored exercise programs that challenge the body and allow adaptations to occur before their operations. And we’re seeing that people have a better recovery as a result.”

To test the four-week prehabilitation program that they had developed, which combines exercise, relaxation techniques and whey protein supplements, the researchers randomly assigned 116 colorectal cancer patients to either a control group or a prehabilitation group. After four weeks of prehabilitation, 70 percent of the patients in the prehabilitation group had doubled the number of hours they spent exercising.

“In the past, physicians would often advise their patients to rest in bed prior to surgery in order to build up their strength. This is actually likely to cause more complications, since it means that patients lose muscle mass and are more tired and slower to recover after an operation. This means that it takes them longer to be ready for chemotherapy or radiation,” said Scheede-Bergdahl.

The concept of preparing the patients for surgery through prehabilitation programs has been gaining interest from those who work with cancer patients. Franco Carli, the McGill anesthesiologist who initiated prehabilitation at the MUHC, has been meeting with health care professionals from across the globe. “It is an exciting time for prehabilitation. Bringing together specialists from various backgrounds gives us the opportunity to best prepare cancer patients to meet the challenges of their upcoming surgery, recovery period and subsequent treatment.”

The findings appeared in Supportive Care in Cancer.