3.6.1 Prehabilitation

Cancer prehabilitation uses a multidisciplinary approach combining exercise, nutrition and psychological strategies to prepare patients for the challenges of cancer treatment such as systemic therapy and radiation therapy. Team members may include anaesthetists, oncologists, surgeons, haematologists, nurses, clinical psychologists, exercise physiologists, physiotherapists and dietitians, among others.

For patients with low-grade lymphomas who may undergo multiple treatments over many decades, prehabilitation may be an ongoing intervention that becomes increasingly relevant as the patient ages and experiences additional medical, physical and psychological limitations.

Patient performance status is a central factor in cancer care and should be frequently assessed. All patients should be screened for malnutrition using a validated tool such as the Malnutrition Screening Tool (MST). The lead clinician should refer obese or malnourished patients to a dietitian preoperatively or before other treatments begin.

Patients who currently smoke should be encouraged to stop smoking before receiving or during treatment. This can include an offer of referral to Quitline in addition to smoking cessation pharmacotherapy if clinically appropriate.

Evidence in solid cancers indicates that patients who respond well to prehabilitation may have fewer complications after treatment. For example, those who were exercising before diagnosis and patients who use prehabilitation before starting treatment may improve their physical or psychological outcomes, or both, and this helps patients to function at a higher level throughout their cancer treatment (Cormie et al. 2017; Silver 2015).

For patients with low-grade lymphomas, including those who will initially undergo close observation in a ‘watch and wait’ approach, the multidisciplinary team should consider these specific prehabilitation assessments and interventions:

  • conducting a physical and psychological assessment to establish a baseline function level, including assessing coping strategies/abilities
  • identifying impairments and providing targeted interventions to improve the patient’s function level (Silver & Baima 2013)
  • an integrated and structured approach to self-care enquiry – identifying Social Health, Exercise, Education, Diet and Sleep Hygiene (SEEDS) is one such practical tool (Arden 2015)
  • referral to a psycho-oncology service to improve their knowledge and motivation towards healthy self-care care behaviours and to emotionally regulate throughout the course of the disease and treatments
  • reviewing the patient’s medication to ensure optimisation and to improve adherence to medicine used for comorbid conditions.

Following completion of primary cancer treatment, rehabilitation programs have considerable potential to enhance physical function.