“Prehab is the hot new topic in the world of rehabilitation because we’re seeing that it can improve outcomes when we prepare patients for the challenges they may face in cancer treatment,” adds Dr. Maltser, chair of the department of physical medicine and rehabilitation at Glen Cove Hospital and the director of Northwell’s cancer rehabilitation program.

A breast cancer patient, for example, may be offered pre-surgical surveillance of their lymph nodes to detect and treat lymphedema — pain and swelling caused by the build-up of fluid; she may also get education on exercise to strengthen shoulder muscles and to improve overall physical endurance. In addition, she can work with a nutritionist to improve her food choices and better prepare for surgery.   

Prehab addresses mental well-being

Cancer prehab also can help patients manage their diagnosis on an emotional level.

“From the time of diagnosis, cancer can take away a patient’s sense of agency,” says Catherine Alfano, PhD, vice president, cancer care management and research at Northwell Health. “When we give patients a prevention program, we’re telling them that, to the extent that they do these things, they’re taking back control over their health. They’re more engaged in their care.”

That’s an important point considering cancer can be an arduous journey for some patients. In addition to services and resources, rehabilitation reassures patients that they’re not alone during a complex time.

“Patients with cancer become survivors the day they get diagnosed,” Dr. Maltser says. “Cancer rehabilitation is recognized as a critical part of survivorship.

Dr. Alfano adds, “That can mean preventing what we can with prehabilitation and addressing the issues we cannot prevent early on with rehabilitation, offering a proactive whole-patient approach to care.”

The wide-ranging benefits of rehab and prehab

Cancer patients of all kinds undergo surgeries and treatments that can impact their quality of life; prehab can help preserve wellness. Along with rehabilitation, it can prevent patients from accepting a new normal and resisting programs that can help.

Sometimes, Dr. Maltser explains, patients with cancer have suffered from difficult side effects for so long that they react emotionally when a doctor offers a straightforward solution like exercise to a painful, ongoing problem.

Dr. Maltser says it’s common for patients to struggle to complete everyday tasks, like washing their hair or getting dressed. But sometimes people normalize or rationalize their discomfort as just another part of their cancer experience.

It doesn’t have to be that way.

Cancer rehabilitation optimizes patients’ ability to function, even as they undergo treatment, when it’s done right, and at the right time, Dr. Alfano says.

“This is all about their quality of life and their ability to fully participate in life,” she continues. “That’s what our patients are asking us for. They want to be able to take care of their kids and their aging parents, fulfill their community roles and their jobs.”

Cancer pain management

Cancer prehab and rehabilitation address a range of problems associated with both the cancer itself and the effects of some of its treatments. Patients may suffer from fatigue (one of the most common cancer-related challenges), pain, low physical functioning, problems with cognition, or deteriorating emotional wellness.

In addition to breast cancer, cancer prehabilitation and rehabilitation can benefit patients with brain tumors, gynecological cancer, head and neck cancer, lung cancer, musculoskeletal cancer and spinal tumors.

The ways prehab and rehab can help

Together, the patient’s team of providers creates a personalized treatment plan to help that patient recover from the functional challenges they may develop throughout their cancer journey. That can go beyond physical therapy; cancer rehabilitation addresses the whole patient and can include:

Fatigue

Fatigue after cancer treatment is common and can be caused by many factors. Physical therapy and supervised exercise can lessen fatigue, improve endurance, strengthen muscles and transition the patient to a safe exercise program they can continue on their own.    

Cancer pain

Specialists can evaluate patients’ type and level of pain to determine whether they need medication and/or physical therapy for relief.

Lymphedema therapy

Lymphedema is swelling that occurs when protein-rich fluid accumulates and blocks the drainage of lymph fluid, and it often occurs in the arm, hand, breast, or torso, impeding movement. It also raises the risk of skin infections and sepsis and can lead to skin changes and breakdown. Providers may recommend compression bandages or stockings, massage, skin care and, rarely, surgery to remove swollen tissue or create new drainage routes.

Awareness of lymphedema is on the rise. Dr. Maltser recently was approved for 2022 Outreach Programming Grant from the Manhasset Women’s Coalition Against Breast Cancer for a 12-week prehabilitation program. For women undergoing chemotherapy before surgery, they will get lymphedema screening and surveillance, nutrition and psychosocial education and a supervised weekly exercise regimen.

Spasticity

This occurs when muscles stiffen or tighten, preventing normal fluid movement. Sometimes muscles can resist being stretched, which can affect movement, speech and gait.

Prehab and rehab techniques

Bracing/orthotics

When patients suffer from weakness, sometimes specialists prescribe assistive devices to make everyday tasks — like walking, bathing and dressing — a bit easier.

Electrodiagnostic testing

Sometimes providers conduct tests, such as nerve conduction studies — to diagnose measure how quickly nerves carry electrical signals to muscles. These tests can be used to determine if a patient has an injury related to nerve or muscle function.   

Joint and trigger-point injections

Sometimes cancer patients experience muscle tension that can be released by injecting a small needle to deliver pain relief directly into the affected area.   

Some patients may require occupational, speech and swallow therapies, or nutritional or behavioral counseling.

“Our goal is to weave these interventions together with one team medicine approach that treats the cancer and all of the toxicity management and the functional management at the same time, and allows that patient to participate in life fully,” Dr. Alfano says.