Strengthening cancer prevention before surgery: The power of prehabilitation

Strengthening cancer prevention before surgery: The power of prehabilitation

Receiving treatment before cancer surgery that does not directly target the cancer itself, but rather aims to improve the patient's physical and mental condition, may seem unusual at first. But that's exactly what so-called prehabilitation is all about - preparing for the upcoming operation through a variety of supportive measures. This can have a significant impact on the recovery and quality of life of those affected. Research, such as the study presented in October 2023, examines the feasibility and benefits of such multimodal prehabilitation in a day clinic for integrative medicine before cancer surgery.

The aim of this study was to examine whether patients are able to regularly attend and complete a program consisting of mind-body medicine, exercise therapy, nutritional therapy, naturopathic advice and the use of a yarrow liver wrap in the weeks before their operation. A success would be if 80% of enrolled patients could complete at least 6 of the 8 weekly sessions, each lasting 6.5 hours.

The study was aimed at adult cancer patients whose primary tumor is located in the abdomen or breast and who require neoadjuvant (before surgery) treatment. The study's multimodal approach is intended not only to improve physical assessments and quality of life, but also to provide a comprehensive overview of and potentially mitigate side effects of prior therapy.

The results could have far-reaching implications for treatment practice. If such a prehabilitation program is shown to be feasible and effective, such programs could be institutionalized to shorten recovery times after surgery and reduce the overall burden on patients. In addition, it could lead to a rethink in treatment by increasing the importance of complementary treatment methods and integrative medicine in the general oncological treatment plan.

It is important to emphasize that participants in the study received a range of treatments aimed at physical, mental and nutritional health, rather than directly treating the cancer. This holistic view could be a key to the success of prehabilitation, as it potentially treats the whole person and not just the disease.

While the study is still in the starting blocks and only 23 patients have been enrolled by February 2023, the dominant participation of breast cancer patients suggests that there is a high interest or need for such preoperative preparation programs, particularly in this group. Evaluation of this approach will provide important insights into the applicability and benefits of prehabilitation in oncology.

Basic terms and concepts:

• Prehabilitation: Vorbereitende Maßnahmen zur Verbesserung der körperlichen und geistigen Verfassung eines Patienten vor einer Operation.
• Neoadjuvante Behandlung: Eine Therapie, die vor der Hauptbehandlung, meist einer Operation, durchgeführt wird, um den Erfolg der Operation zu verbessern.
• Multimodal: Die Anwendung von mehreren verschiedenen Behandlungsmethoden oder -ansätzen.
• Integrative Medizin: Eine ganzheitliche Behandlungsform, die konventionelle medizinische Therapien mit alternativen oder komplementären Methoden kombiniert.

Effectiveness of multimodal prehabilitation in integrative medicine for cancer patients

The present study investigates the feasibility of a preoperative prehabilitation program in an integrative medicine day hospital (PRIME-DC) for cancer patients undergoing neoadjuvant treatment before undergoing surgery. The basic assumption is that such prehabilitation can not only strengthen the physical resilience of patients before surgery, but also help to improve their quality of life through multimodal approaches, including mind-body medicine, exercise therapy, nutritional therapy, naturopathic advice, and the use of a yarrow liver compress.

methodology

This study included adult cancer patients with primary abdominal cancer or breast cancer undergoing neoadjuvant oncological treatment. Eligibility for the program is based on the assumption that this patient group will either require extensive surgical intervention, implying a need for prehabilitation, or undergo several months of neoadjuvant treatment with significant treatment-related side effects.

The main criterion of the study is adherence to the day clinic program, defined as participation in the sessions. This adherence is considered to exist if 80% of enrolled patients are able to attend at least 6 of the 8 weekly meetings, each lasting 6.5 hours. Secondary endpoints include patients' physical assessment and quality of life as well as a structured assessment of neoadjuvant treatment side effects.

Results

As of February 2023, 23 patients have been enrolled in the program, with breast cancer being the dominant cancer entity with 18 patients enrolled. The procedures used adhere to the principles of the Declaration of Helsinki.

Conclusions

The presented protocol combines aspects of prehabilitation, lifestyle modification, naturopathic counseling, nutritional support and naturopathic treatment in an innovative and integrative manner. This approach promises to not only improve physical resilience before surgical procedures, but also offers the opportunity to address patients' unmet needs and help them modify their lifestyle in a sustainable way.

From a methodological point of view, the program is characterized by its multimodality and comprehensive consideration of patient needs. The combination of different therapeutic approaches aims to provide the best possible support in the fight against the disease and to significantly improve the patient's quality of life. The results of this study could have far-reaching implications for the treatment and care of cancer patients, particularly in the preparatory phase before surgical procedures.

Further information about the study