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Building Resilience: Cancer Prehab and Rehab

Resilience

Resilience is the ability to recover quickly from difficulties such as the rigors of cancer treatment. Resilience is connected to higher quality of life and, in some cases, improved outcomes for people with cancer. Many factors contribute to your level of resilience:

• Your previous experiences in dealing with adversity
• Your coping skills
• Your social support systems
• Your resources
• Your general health

Some people may have innate strengths and qualities that support their resilience, while others must cultivate and enhance the ability to persist and recover during adverse times. These techniques may enhance resilience:

• Self-care practices that support physical, mental and emotional health
• Receiving information, guidance, support and therapies from others, such as enlisting a social worker to help you access resources for transportation, paying for your treatments and child care
• Learning mind-body skills to manage stress

Pretreatment Approaches ("Prehab")

After a cancer diagnosis and before treatment begins, you can prepare your body/mind/spirit so that you are in the best shape possible to meet the challenges of cancer treatment. This process is called cancer prehabilitation. Examples:

• Men preparing for radical prostatectomy can learn to do pelvic floor exercises to strengthen these muscles and reduce the risk of incontinence after surgery. These men can also learn stress management skills with the goal of improving mood both before and after surgery.
• The Society for Integrative Oncology 2013 clinical practice guidelines suggest supervised exercise-based pulmonary (p)rehabilitation in patients awaiting pulmonary resection for suspected lung cancer with compromised lung function, with a goal of improving cardiorespiratory fitness and functional capacity.¹

Centers and practices that offer cancer prehab generally begin with a baseline of patients’ physical and psychological health for these reasons:

• Assess functional level
• Identify any impairments
• Provide information and therapies which would promote physical and emotional health.

The goal is to reduce the occurrence and/or severity of future impairments from cancer treatment.² Preliminary evidence supports this goal: a 2019 analysis of preoperative multimodal exercise and nutritional programs found improved five-year disease-free survival in stage III colorectal cancer patients undergoing elective, biopsy-proven, primary non-metastatic colorectal cancer surgery. However, no improvement was seen in overall survival.³

Prehab Approaches in Clinics, Hospitals and Centers

The Block Center for Integrative Cancer Treatment is an example of an integrative oncology program that first helps a patient become as healthy as possible before conventional cancer treatment begins. Lifestyle changes, diet, nutritional supplements, psychosocial support, counseling, vitamins and exercise may begin before cancer treatment and continue throughout and after treatment. If you are looking into integrative cancer practices, ask about pretreatment services to “shore you up” before you begin your cancer treatment.

Some cancer treatment clinics and centers now formally offer cancer prehab, with some receiving the STAR (survivorship training and rehabilitation) program training and certification developed by a team of clinicians led by Julie Silver, MD. Dr. Silver is an associate professor at Harvard Medical School, a cancer survivor and the author of several books on oncology rehabilitation. Some healthcare facilities in Massachusetts, Rhode Island and Baltimore are using the STAR model of prehab.⁴ A network of hospitals in Pennsylvania also offers cancer prehab.⁵

Even if a cancer treatment center doesn’t formally advertise a prehab program, many offer services that are considered prehab. For example, most centers provide pre-surgery speech therapy for patients scheduled for larynx removal. Ask your cancer providers if they provide or refer patients to cancer prehab services and what those services are. If they don’t, consider researching the types of prehabilitation services helpful for your situation before your treatment begins, then talk with your doctor about helping you access those services. Help with practical issues such as transportation, child care, and paying medical bills are part of prehab, as well as psychological counseling. Some places to start your search:

• Bottom Line Inc: Cancer Prehab: The First Thing You Need after a Diagnosis
• The UK's Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research Cancer and Nutrition Collaboration's 2019 report, Prehabilitation for People with Cancer, which includes guidelines for cancer prehabilitation programs. This 86-page document discusses physical activity and exercise, nutrition, and psychological support for cancer patients who are facing treatment with surgery, chemotherapy and/or radiotherapy.
• Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. American Journal of Physical Medicine & Rehabilitation 2013 Aug;92(8):715-27.
• Silver J. Cancer prehabilitation: important lessons from a best practices model. Journal of Hematology Oncology Pharmacy. 2015 Mar;8(2).

Cancer Rehabilitation: A Plan for Recovery

We at BCCT believe that rehabilitation after cancer treatment should become a standard part of survivorship care, just as cardiac rehab is for those with heart disease. A cancer rehab program would be tailored to the special needs of cancer survivors, using evidence-based educational programs and supportive therapies to restore health, and quite possibly improve a person’s health above their pre-cancer diagnosis baseline.

Read more

Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on September 26, 2019.

1. Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
2. Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. American Journal of Physical Medicine & Rehabilitation. 2013 Aug;92(8):715-27.
3. Trépanier M, Minnella EM et al. Improved disease-free survival after prehabilitation for colorectal cancer surgery. Annals of Surgery. 2019 Sep;270(3):493-501.
4. Eight Massachusetts healthcare facilities join in statewide cancer rehab initiative. Monthly Oncology Rehab Partners Newsletter. Viewed February 06, 2018; Cohn M. Cancer 'prehab' may provide better post-op outcomes. Baltimore Sun. January 29, 2016. Viewed February 6, 2018; Pirschel C. The power of prehabilitation. Oncology Nursing Society (ONS) Voice. May 3, 2016. Viewed February 6, 2018.
5. New oncology rehabilitation program puts Allegheny Health Network cancer patients on the road to a healthy, active survivorship. Allegheny Health Network. December 19, 2016. Viewed February 6, 2018.
6. What is Cardiac Rehabilitation? American Heart Association. Viewed June 5, 2018.
7. Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
8. Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
9. Martin RC et al. Results from a structured interprofessional palliative care rehabilitation program in oncology. 2013 Annual ASCO Meeting. Journal of Clinical Oncology. 31. 2013. AbstID:e20598.

View All References

More Information

• Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research Cancer and Nutrition Collaboration: Prehabilitation for People with Cancer
• The American Society for Clinical Oncology: Cancer.net
  • Follow-up Care After Cancer Treatment
  • Rehabilitation
• Justin F Black, DO: Cancer and Rehabilitation. Medscape
• Cancer prehab/rehab services may be available in your area. Search the Internet, your phone book, and your local medical providers for leads.
• American Institute for Cancer Research: New American Plate Challenge
• Lise Alschuler and Karolyn A. Gazella: iThrive Plan
• The New School at Commonweal: Keith Block, MD: Life over Cancer—Achieving A Survivor’s Edge
• The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 1
• The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 2
• Henry Mayo Clinic: Keith Block: New Roads to Health: Life over Cancer
• McDougall Advanced Study Weekend: Keith Block MD Speaks about a New Model of Integrative Cancer Treatment
• Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
• Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
• Martin L. Rossman, MD: Fighting Cancer