Cancer survivors have a significantly poorer health-related quality of life (HRQOL) than people without a cancer history. A recent study estimated that about 3.3 million survivors in the U.S. have poor physical HRQOL and almost 1.4 million have poor mental HRQOL. Alarming numbers!
As a rehabilitation physician I want to ensure that every cancer patient heals as well as possible. Prehabilitation before treatments and rehabilitation after treatments, will dramatically improve these statistics – and survivors’ lives. Cancer prehab and rehab prevent and alleviate the treatment-related impairments that make it so difficult for many women to return to their daily activities and fulfill their roles as partners, mothers, grandmothers, friends and working professionals.
Cancer prehabilitation is a new and quickly evolving medical field that is on its way to becoming accepted as a crucial first-step after a diagnosis. Offered during the short window of time between diagnosis and treatments, the goal of prehab is to improve a patient’s physical and emotional health in preparation for the challenges ahead. I often talk about prehab by using this metaphor: treatments are the impending storm and prehab is an umbrella that gives newly diagnosed patients some protection.
Prehab can help to decrease stress and increase physical strength and endurance. Patients may be provided with nutritional counseling, lifestyle coaching (e.g., smoking cessation) and emotional support (e.g., stress reduction strategies). A recent review I authored, showed that physical and psychological prehab interventions can: 1) reduce complications from treatments, 2) decrease the length of hospital stays and readmissions, and 3) help facilitate a return to normal function.
During the prehab period, it’s important to perform screening tests to determine the status of an individual’s overall health. For example, a breast cancer patient scheduled to have surgery in 3 weeks would be screened for pre-existing physical problems (especially those that are neurologic or musculoskeletal). If there are physical impairments, she would begin PT before she has surgery. If she is relatively fit, she would be prescribed general exercise and specific upper body range of motion and strengthening exercises.
Rehabilitation services may be offered at any point during the care continuum, and the goal is to help survivors recover from the debilitating side effects and aftereffects of surgery, chemotherapy, radiation and other treatments. Effective rehabilitation programs are multidisciplinary. This means a team of rehabilitation professionals (rehab physician/physiatrist, PT, occupational and speech therapist, social worker) works with each survivor on a personalized recovery plan. Cancer rehab has been shown to successfully improve pain, function, and quality of life in survivors. And services are typically covered by health insurance.
My own work has focused on making cancer rehab/prehab available at hospitals and cancer centers around the country. It is important for survivors to be able to get the care they need to heal optimally and return to doing the things that bring them satisfaction and joy. I encourage everyone to find out more about cancer prehab and rehab and to advocate for these services, for the best possible health outcomes.
Julie Silver is a rehabilitation physician and founder of the STAR Program, a model of cancer rehab and prehab that’s been implemented in more than 200 institutions in the US