Building Resilience: Cancer Prehab and Rehab

Key Points

  • Resilience is the ability to recover quickly from difficulties.
  • Prehabilitation (prehab) involves strengthening your body, mind and spirit before treatment begins.
  • Many cancer treatment centers offer prehab programs and services, although not all formally call their services "prehab."
  • A rehabilitation (rehab) program is individually designed to restore health after treatment, sometimes to a higher level than before diagnosis.

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

Adversity and Personal Growth

Going through cancer treatment can be one of those adversities that make you more resilient and from which you can find important meaning for your life. There is a saying and a popular song: “What doesn’t kill you makes you stronger!” Many people with cancer find that to be true.

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

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.3 A network of hospitals in Pennsylvania also offers cancer prehab.4

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:

Cancer Rehabilitation: A Plan for Recovery

Cardiac Rehab: A Comparison

From the American Heart Association website:5

Cardiac rehab doesn’t change your past, but it can help you improve your heart’s future. It’s a medically supervised program designed to help improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery. Think of cardiac rehab as three equally important parts:

  • Exercise counseling and training: Exercise gets your heart pumping and your entire cardiovascular system working. You’ll learn how to get your body moving in ways that promote heart health.
  • Education for heart-healthy living: Managing your risk factors, choosing good nutrition, quitting smoking…education about heart-healthy living is a key element of cardiac rehab.
  • Counseling to reduce stress: Stress hurts your heart. This part of rehab helps you identify and tackle everyday sources of stress.

We at BCCT believe that rehabilitation after cancer treatment should become a standard part of survivorship care.

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.

 BCCT advisor Dwight McKee and his colleagues outline an approach to Cancer Rehab.6 Such a program would include the following elements:

  • Supervised exercise
  • Dietary counseling
  • Nutrition and cooking classes
  • Stress management, including re-establishing healthy bio-rhythms/sleep
  • Massage
  • Acupuncture
  • Support groups
  • Guidance in nutritional supplements and other natural products

To this list, BCCT adds smoking cessation programs

Without such a program, post-treatment patients are left to wander aimlessly, worrying about their cancer coming back with nothing to help them physically, psychologically or emotionally as this Sword of Damocles hangs over their heads.

After Cancer Care7

As you can see, a comprehensive cancer rehab program includes instruction, guidance and support in several of the healing practices presented on the BCCT website. Additionally, some people with cancer will need specific rehab services such as speech therapy after removal of the larynx, or physical therapy after mastectomy.

Cancer rehabilitation is not limited to those whose cancers are in remission. Evidence suggests that interprofessional palliative care rehabilitation programs are helpful to those with active cancer.8

Livestrong provides information on Rehabilitation After Cancer Care. Signs that a person might need rehabilitation services:

  • Feeling weaker now than when you were initially diagnosed.
  • Difficulty talking or swallowing
  • Pain that is not caused by cancer
  • Feeling more tired than before diagnosis
  • Muscular or orthopedic problems
  • Difficulty recovering from treatment and doing previous activities
  • Uncertainty about how much to exercise or how to best exercise
  • Memory problems or difficulty concentrating

If your oncology team has not discussed rehabilitation with you, you may need to be proactive and bring it up. The Livestrong webpage also suggests how you might create a rehabilitation plan with your oncology team.

Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on June 26, 2018.

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