What is cancer prehabilitation

Cancer prehabilitation is a concept that has become more and more fashionable in recent years. It is the time between cancer diagnosis (biopsy, CT scan, etc.) and the start of active treatment, be it surgery, chemotherapy or radiotherapy. It is usually a few days and sometimes even a few weeks.

It is a time in which the patient can prepare himself with his oncologist to know what side effects there may be in the treatment with surgery, chemotherapy or radiotherapy and prepare himself physically to face these side effects with: training, a nutritional improvement with a hyperproteic diet personalized to the type of cancer he has, psychology at an emotional level, if necessary, etc.

It is a process in which the patient goes from being in a passive phase waiting to be called to be in an active phase in which he/she will try to be as prepared as possible to have fewer pauses in the treatment, without having to suspend the treatment, since this influences to a great extent to achieve the cure of the disease.

What does this process consist of?

The treatment is multidisciplinary and, obviously, personalized. It would correspond, for example, to a man who has colon cancer and is going to have to undergo surgery that is going to cause diarrhea, weight loss, etc. Well, in this case, before it happens, we would have to try to supplement the patient, try to prepare him physically as well to avoid a hernia around the ostomy, etc., that is to say, certain treatment, adjusted to each patient, in which a nutritionist, a physiotherapist, an oncologist, a psychologist, a physical trainer, etc. would normally participate.

Although here in Spain we have very good chemotherapy and radiotherapy, both in public and private hospitals, but everything related to quality of life is not so well promoted.

What specific guidelines should the patient follow?

Normally, one of the things that tends to happen when there is a diagnosis of cancer or a chemotherapy, radiotherapy or surgery treatment is that there is usually a loss of weight, which is mostly due to a loss of muscle mass in the legs, back, etc.

This weight loss usually causes something called asthenia, a tiredness that is not cured by lying on the couch or in bed and that comes from this loss of muscle. Therefore, the first guideline that any patient should follow is to do physical exercise of strength. Exercise is not contraindicated before, during or after cancer. In addition, it should be combined with a diet according to the patient’s needs and starting point. Generally, try to increase protein intake with foods such as eggs, meat, etc., to avoid the loss of muscle mass which will cause more fatigue and less tolerance to treatment. It is also advisable to take this into account in order to be able to return to the state one was in prior to the diagnosis.

Can it have any type of contraindication for the patient?

One problem we oncologists have is that we know a lot about chemotherapy, radiotherapy and surgery, but we know very little about physiotherapy, nutrition, physical exercise, etc. Therefore, we tend to give very general guidelines such as “eat well”, “exercise”, etc. When the patient then asks us what exercise he/she should do, we need the support of a physical trainer or someone qualified and well trained to advise us, to help us and to be a multidisciplinary team, but personalized for each patient and each type of cancer. Many times we end up supplementing patients with shakes and certain food supplements, when what we really need is to provide a good diet, but for that we need the support of a nutritionist. Therefore, in answer to the question, it is not contraindicated, but we do try to reduce the side effects, that there is an admission or interruption of chemo or radio treatment, which when they are suspended or delayed for 15 days because the patient’s defenses are low, in the end, if this is in clinical studies, we increase the chances of relapse. Therefore, a chemo or radio treatment should not be suspended and we should try not to delay it. There are times when there are times that cannot be controlled, such as a biopsy or the result of an MRI or the time needed for an operating room, but this is a time in which the patient can try to avoid these side effects.

Read Now 👉  "We have the possibility to diagnose and treat all types of tumors"

How long does cancer prehabilitation last and does it have a specific duration?

Cancer prehabilitation is the time that passes from the time the patient is diagnosed until treatment begins. So, there are certain hospitals that with the COVID pandemic, prehabilitation has been longer than it should be. Frankly, the shorter the better because that will mean that treatment is started sooner. However, during treatment or following chemotherapy, a prehabilitation to cancer is not contraindicated. In the end, it is to be treated by a multidisciplinary and interdisciplinary group of specialists who work together and know your needs, so it should not last more than 3-4 weeks. These weeks can allow you to gain a lot of time to start treatment later on.

Should we then wait for the oncologist to refer us to these other specialists?

Oncology patients are often very dependent on their oncologist, which can be a very good thing, but the oncologist does not have to know everything. And the patient should not wait for his oncologist to refer him to a physiotherapist, a nutritionist, a psychologist, etc. The patient has to know that there is a need and that everything he does is going to be good. What we want to avoid are those treatments that are not scientifically proven. That does make the oncologist nervous because he does not know how it is going to affect the chemotherapy. However, relying on different services like the ones we have discussed are always enriching and you should not be afraid of them.