About this Research Topic
Surgery remains a cornerstone of modern cancer care. Novel approaches and technological advances have made surgery safer, with significantly lower stress response and improved outcomes. Despite these innovations, major cancer surgery still carries substantial risks. Postoperative complications prolong hospital stay, increases costs, increases readmissions and impairs ‘back to baseline’ recovery. A cancer diagnosis alone has far-reaching effects. Impaired physical activity, fitness, psychological health and quality of life (QoL) are especially apparent in the frail and elderly, especially those undergoing surgery. This may underpin the association between complications and survival following cancer treatment.
Multimodality prehabilitation is a revolutionary, holistic, personalized intervention to optimize patients’ physiological and psychological resilience in the face of a physiologically stressful event by optimizing healthy behaviors, improving physical and psychological fitness through utilizing a multi-professional multiphasic care bundle. People living with cancer, comorbidity, poor physical, and psychological health are particularly at risk of adverse outcomes, especially when undergoing cancer treatments, notwithstanding poorer outcomes after surgery compared to patients who are cancer-free or physiologically fitter. A multi-professional approach to prehabilitation enables people with cancer to prepare for treatment through promoting healthy behaviors and a needs-based prescribing of (a) exercise, (b) nutrition (c) psychological interventions, and (d) ‘toxicity’ mitigation. Profound physiological stressors for people with cancer include surgery as well as radiotherapy and systemic or palliative anti-cancer therapies. Prehabilitation is relevant in all these situations.
Prehabilitation aims to (i) empower patients; (ii) maximize resilience enabling early achievement of treatment milestones; (iii) improve long-term health through sustained behavioral change, and (iv) improve outcomes from cancer treatments. Currently, patients arriving at the doorstep of major elective surgery rarely benefit from tailored optimization due to inefficient surgical pathways, designed with different aims in mind, and rigid time constraints relating to the interval between diagnosis and the surgical date. Opportunities to optimize modifiable risk factors such as pre-existing comorbidity, fitness, nutrition, psychology, and deleterious cancer therapy effects are being missed. Multimodality prehabilitation has been reported to improve physical fitness, nutritional and mental status, reduce complications, enhance recovery, reduce hospital stay, improve quality of life and reduce health-care costs. Despite this growing evidence base reimbursement for prehabilitation and therefore large-scale implementation is not yet achieved. Health commissioners and insurances need conclusive evidence from robust multi-center trials to ensure value-based prehabilitation care on a large scale.
This Research Topic aims to bring together international experts in multimodality prehabilitation to comprehensively review and discuss the benefits of specific prehabilitation interventions, implementation strategies in various health-care models, as well as publish original research and set the future clinical and academic direction of travel. Important topics considered are:
1) Conceptual framework of the cancer prehabilitation continuum;
2) Physical activity and exercise prescription;
3) Psychological interventions either in a group or one-to-one basis;
4) Models of behavior change in health care after a cancer diagnosis;
5) Nutritional interventions and their interactions with other cancer prehabilitation elements
6) Targeting intoxications – Smoking and alcohol cessation, polypharmacy, sleep deprivation, and frailty
7) Cancer prehabilitation service development and implementation into health care systems
8) Health-care cancer pathway re-engineering and perioperative medicine integrated care
9) Cancer prehabilitation as a healthcare service - Workforce planning and service delivery
10) Cancer prehabilitation research agenda
11) Standardization of cancer prehabilitation research outcomes
Keywords: Cancer, prehabilitation, perioperative, surgery, health outcomes
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