Cancer Prehabilitation

Cancer incidence—particularly in younger demographics—is increasing, and simultaneously, treatment advances are rapidly progressing, resulting in many newly diagnosed people successfully achieving remission. Optimizing clinical outcomes is essential to improving cancer morbidity, mortality, and quality of life during treatment and survivorship. Prehabilitation provides a unique opportunity at diagnosis to optimize patients’ physical, nutritional, and psychosocial conditions to augment clinical outcomes and improve physical and mental well-being. Early at diagnosis, subsequent evaluation for- and initiation of an individualized multimodal prehabilitation program are critical to mitigate cancer morbidity and potentially reduce mortality. Physiatrist-directed cancer prehabilitation programs target cardiovascular fitness, locoregional dysfunction, malnutrition, and psychosocial dysfunction. Early prehabilitation interventions may enhance treatment efficacy and tolerance, thereby reducing hospital length of stay, postoperative complications, radiation, chemotherapy-associated toxicities, and cancer-related pain. Cardiovascular and locoregional exercise prescriptions can improve and maintain a patient’s function and quality of life as they progress through the cancer continuum of care. As an emerging standard of care, prehabilitation can generate significant clinical benefit. This chapter details unique focuses of prehabilitation in different cancer scenarios, identifying therapies that, when initiated early, may reduce complications from treatment. These personalized recommendations include reiterating treatments for psychiatric illness and stigma that are pervasive in certain cancers due to their associations with risk factors like smoking, alcohol use, and obesity. By targeting sleep, pain, stigma, and adjustment disorders and their unique contributing factors within cancer populations, treatment teams may improve outcomes and quality of life.