Prehabilitation
Prehabilitation is the practice of enhancing a patient’s functional and psychological capacity before treatment commences. Ideally, prehabilitation interventions start as near to diagnosis as possible, helping people to prepare for the next stage of their care. It is of interest in the cancer context because of the well documented impact of cancer treatments, on immediate and long-term well-being, and quality of life. As the first stage of a care pathway, prehabilitation has the potential to decrease length of hospital stay and postoperative complications as well as to improve aspects of neuro-cognitive function and quality of life after completion of treatments.
Current evidence suggests that three key factors should be considered within the design of prehabilitation programmes: physical activity, nutrition (individualised requirements in relation to under nutrition, otherwise keeping to a healthy balanced diet) and psychological support. In addition, alcohol reduction and smoking cessation are also important to support the aims and objectives of prehabilitation.
There is a need for further research on prehabilitation including impact of programmes in non-surgical oncological treatments, definition of minimum and individualised ‘exercise prescriptions’, key goals of preoperative nutritional care, adherence and benefits in certain population subgroups such as frail older patients. Furthermore, the impact of prehabilitation programmes on mortality, disease prognosis and health economics need further exploration. However, work to date indicates that prehabilitation is safe, feasible and can be delivered alongside complex treatment pathways in different cancer sites including lung, colorectal and upper gastro-intestinal.
A growing number of national and international reports now recommend prehabilitation as part of cancer pathways and it is timely to explore how research findings can be implemented in Scotland. As such, a Prehabilitation Short Life Working Group (SLWG) was established in 2019 with the aim of establishing current practices in Scotland and informing the Scottish Government of recommendations for future implementation.
In September 2020 the Prehabilitation Short Life Working Group published its findings. The report can be accessed here.
Updated 03/01/2021