Experts say ‘prehabilitation’ should become part of routine oncology care protocols to boost patients’ chances.
Gerry Gajadharsingh writes:
“The concept of prehabilitation has been around for a long time, especially in the relation to orthopaedic operations, that’s not of course to say that most patients engage with prehabilitation! Sometimes it’s difficult enough, getting patients to do rehabilitation after injury and surgery, especially in the UK. There’s no doubt that in many cases, getting a patient fit for surgery and then offering structured rehabilitation post-surgery, can often make a positive difference in terms of the outcomes, or the length of time it takes for recovery.
Research below now suggest that this should be applied to patients undergoing cancer treatment.
The CPC says that across all types of surgery, about 12 per cent of operations have a complication. However, pre-operation preparation can halve the rate of complications, with exercise particularly effective. Physically inactive patients have at least four times the rate of complications.”
The Times
Kay Lay
Persuading cancer patients to take exercise classes, improve their diet and talk through their problems can improve their survival rates, according to pioneering research.
Experts say “prehabilitation” should become part of routine cancer care protocols to boost UK patients’ chances.
An increasing body of evidence shows the important role fitness can play in how cancer patients fare after surgery and other treatments.
A team at University Hospital Southampton found that a programme of high-intensity exercise during the six-week gap between chemotherapy and surgery could return patients’ physical fitness to pre-chemo levels before going under the knife.
“We know that in major surgery, physical fitness has a big impact on how fast you recover, your chances of complications and your long-term outcomes,” Prof Mike Grocott, head of the university’s critical care research group, said of the findings.
“Not only have we shown this improvement in pre-surgery fitness, evidence of reduced complications and massively improved quality of life, we’ve also published data showing that this kind of exercise results in the tumour itself shrinking ahead of surgery.”
Separate research from the same group showed that a patient’s level of physical fitness before surgery for certain cancers was an indicator of how well they would recover.
Dr David Selwyn, director of the Centre for Perioperative Care (CPC) at the Royal College of Anaesthetists, said UK hospitals should integrate prehabilitation services not only for cancer patients but “as a general intervention for all patients requiring surgery”.
He said: “There is substantial evidence that there is a correlation between the patient’s pre-operation health and the chance their operation will have to be cancelled, or that they will experience surgical complications. This can be due to a range of health and lifestyle issues, such as smoking, physical inactivity, frailty or unaddressed diabetes or anaemia.”
Selwyn added: “We need to transform waiting lists into preparation lists, where hospitals provide early screening and prehabilitation services that actively help people address any issues identified before they undergo surgery.”
He added that healthy behaviours adopted before surgery “tend to stick”, improving quality of life and the overall UK population’s health.
Earlier this year, a study presented at the American Society for Clinical Oncology’s annual meeting in Chicago showed that a short course of yoga could lower levels of inflammation in cancer survivors. Another showed higher survival rates in patients who were more active before diagnosis.
The CPC says that across all types of surgery, about 12 per cent of operations have a complication. However, pre-operation preparation can halve the rate of complications, with exercise particularly effective. Physically inactive patients have at least four times the rate of complications.
The Planets cancer charity, which helps patients with pancreatic, liver, colorectal, abdominal and neuroendocrine cancer, offers patients access to a qualified fitness instructor as a routine part of their care following diagnosis.
Joanne Green, co-founder of the charity and herself a neuroendocrine cancer patient, holds a degree in exercise science, a diploma in exercise referral and a qualification in cancer rehabilitation. She said: “There is increasing evidence to show exercise before, during and after cancer treatment not only boosts the effectiveness of it but also reduces side-effects such as fatigue and weight change, as well as depression and anxiety.
“However, there is still some work to be done to ensure it is an integral component of a patient’s cancer treatment plan, which is why our charity has established a referral route via clinical nurse specialists to ensure there is additional support.”
Prof Tara Rampal, a consultant anaesthetist, founded QuestPrehab, a service that now covers all acute trusts and GP practices in Kent. The digital service offers cancer patients personalised support with exercise, diet and mental health. She said focusing on improving cancer patients’ health-related quality of life and lowering fatigue levels could have an impact beyond the treatment itself.
“It’s this loss of functional capacity that contributes to holding back a grandmother from chasing her grandkids on a beach, that prevents a father from being able to walk his daughter down the aisle,” she said.
When Brian Bushell retired as a pharmacist at the age of 74, he hoped he would need to think about nothing more strenuous than his passions of model railways, classical guitar and soprano saxophone. But two years later he was diagnosed with prostate cancer and told he would need hormone therapy and radiotherapy.
He weighed 20st 12lb (132.5kg), had recently been diagnosed with type 2 diabetes and needed six types of medicine. It was time, he thought, to “turn things around”. Using QuestPrehab, he worked with an exercise physiologist.
Four months later, he had lost 2st 8lb, had lower blood pressure, was no longer considered to have type 2 diabetes and has come off half of his medicine. He completed radiotherapy in the summer of 2021 and has a good prognosis.
Bushell said: “I’m feeling generally healthier and am now able to walk a lot further with very little pain or discomfort. The weight loss obviously accounts for this … and I think the programme saved the NHS money by not having to do a hip operation.”