Cancer patients who start rehabilitation before they begin treatment may recover more quickly from surgery, chemotherapy or radiation, some specialists say. But insurance coverage for "prehabilitation," as it's called, can be spotty, especially if the aim is to prevent problems rather than treat existing ones.
It seems intuitive that people's health during and after invasive surgery or a toxic course of chemo or radiation can be improved by being as physically and psychologically fit as possible going into it. But research to examine the impact of prehab is only in the beginning stages.
Prehabilitation is commonly associated with orthopedic operations such as knee and hip replacements or cardiac procedures. Now there's growing interest in also using prehab in cancer care to prepare for treatment and minimize some of its potential long-term physical impairments, such as heart and balance problems.
"It's really the philosophy of rehab, rebranded," says Samman Shahpar, a physiatrist at the Rehabilitation Institute of Chicago. (Physiatrists are doctors who specialize in physical medicine and rehabilitation.) The main component of cancer prehab is often a structured exercise program to improve the patient's endurance, strength or cardiorespiratory health.
FINDING THE BASELINE
The clinician establishes baseline measurements, such as determining how far a patient can walk on a treadmill in six minutes, and may set a goal for improvement. He or she also evaluates and addresses physical impairments, such as limited shoulder mobility, which could be problematic for a breast-cancer patient who will need to hold her shoulder in a particular position for radiation. Depending on the program, patients may also receive psychological and nutritional counseling or other services.
Some early research suggests prehab may improve people's ability to tolerate cancer treatment and return to normal physical functioning more quickly. In one randomized controlled trial, 77 people who were awaiting surgery for colorectal cancer participated in an exercise, relaxation and nutritional counseling program. Half went through the program in the four weeks before surgery and half in the eight weeks after it.
'PREHAB' WAS HELPFUL
Eight weeks after their surgery, 84 percent of prehab patients had matched or exceeded their baseline performance on a six-minute walking test, compared with 62 percent of rehab patients.
"Prehab could be a relatively cheap way to get people ready for cancer treatment and surgery, both of them stressors," says study co-author Francesco Carli, a professor of anesthesiology at McGill University in Montreal.
More study is needed to determine whether prehab actually improves cancer patients' outcomes, experts say.
"There are some physiatrists who don't believe in prehab," says Catherine Alfano, vice president of survivorship at the American Cancer Society. "They feel like the science isn't there yet."
Insurance plans typically cover rehabilitation services such as physical therapy and occupational therapy. But patients can face coverage problems such as preauthorization requirements and limits on visits.