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The First Thing You Should Do After a Cancer Diagnosis By Andrea Atkins


You’ve been diagnosed with cancer. Now what? According to recent studies, what you do before you begin treatments

can make a big difference in how you feel afterwards. Cancer prehabilitation is the latest medical thinking in cancer


If you’ve got cancer, the weeks between learning the news and when you have surgery—or start chemotherapy or

radiation—can be a long, worrisome time. But new studies are showing that patients can make good use of that time

by following a prescribed-by-their doctor plan of improved nutrition, exercise, and psychological assessment during

those weeks. Such prescriptions are known as “prehabilitation,” and these studies suggest that patients who do

“prehab” have better health outcomes than those who don’t.

“This is cutting edge, evolving treatment that is not offered everywhere,” says Julie Silver, M.D., associate chair of

Physical Medicine and Rehabilitation at Harvard Medical School, founder of Oncology Rehab Partners, author

of Before and After Cancer Treatment: Heal Faster, Better, Stronger, and a breast cancer survivor, herself. “But the

idea is that there are specific interventions that can be done to improve particular outcomes.”

For those who follow it, prehabilitation has been shown to accomplish several important improvements:

• Shorter hospital stays. Staying in the hospital following surgery can be uncomfortable and leave a patient more vulnerable to hospital-borne infections. Going home a day or two sooner is often the reward for those who follow a protocol. According to Silver, one hospital showed that prehab reduced lung cancer patient’s post-operative stay from five to three days. 

• Better Treatment Options: Some patients can improve their overall health through prehabilitation. For example, a thoracic surgeon who believed his lung cancer patient was too ill for surgery was able to perform the operation two months later after his patient improved her respiration and physical stamina through a prehabilitation program. “Many people stop chemo or radiation because they can’t tolerate the treatment,” Silver says. “That pause delays you getting to the next treatment. But prehab may get you to the next treatment faster—and decrease delays in treatment.” 

• Better Outcomes and Quicker Return to “Normal”: Cancer prehab was shown to improve patients’ ability to regain mobility after colo-rectal cancer treatment, according to Silver, citing a study from Canada. In this study, a group of patients was offered moderate aerobic and resistance exercises, nutrition counseling with protein supplementation, and relaxation exercises four weeks prior to surgery.  After surgery, when this group was compared with a group that had rehabilitation only, the prehab group recovered their physical functioning (ability to walk and get around) more quickly than those who did not. 

Not All Pre-Cancer Services Are Prehabilitation

Many hospitals offer services to patients awaiting cancer treatment, Silver says. But not all of those programs can be

called “prehab.” 

“The best prehab programs are not one-size-fits-all,” Silver says. “They are carefully prescribed, using protocols based

on the particular diagnosis and a patient’s baseline status.”

So a lung cancer patient, for example, would be prescribed exercises that focus on the muscles involved in breathing

to prevent post-operative complications such as pneumonia. For prostate cancer patients, exercises might focus on

strengthening the pelvic floor to reduce the chance of urinary incontinence while a head and neck cancer patient might

be working on swallowing exercises. But prehab is not just about exercise.

Improving a patient’s nutrition (and perhaps supplementing it) can improve their post-treatment outcome, Silver says.

Poor nutrition is associated with higher death rates, complications, and higher costs of treatment. 

Researchers studying cancer patients have also determined that almost 20 percent of them experience anxiety and

depression. Addressing those needs before surgery with stress reduction techniques and other psychological

interventions can be a big help in treating the “whole” patient.

Many of the prehab activities can be done at home. “The best prehab protocols have a component where the patient is

involved in carrying them on at home—whether that’s practicing stress reduction techniques like muscle relaxation or

meditation,” Silver says.

Not all hospitals offer prehab to their patients. To find a hospital near you that does, go and enter your zip code. 

If your hospital does not have such a program available, ask whether you can speak with a patient navigator,

someone who can help you identify and figure out access to the care you need. “These people are often nurses and

they are usually really terrific at helping to plug people in to get the right care at the right time,” Silver says. 

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