What is Cancer Prehab and How Can It Help You Before Treatment?

Dr Marta Seretny, a senior lecturer in anaesthesiology and anaesthetist at Auckland Hospital and Dr Hanna van Waart, an exercise scientist and senior research fellow in anaesthesiology, are working together to develop these programmes. Seretny says their goal is to address the “terrible void” of time between a patient’s diagnosis with cancer and the start of their treatment. “They may be waiting - on paper - two weeks [to start treatment], but actually often it’s two, three, four, sometimes more weeks than that,” she tells the Herald. “So, for a long time, I’ve been wondering, can we use this space somehow? Can we prepare people more than just them seeing an anaesthetist, a nurse specialist, a surgeon? Can we think about it more holistically? And that kind of fits into this notion of building people up before a big physiological stressor, which is the definition of prehabilitation.” Prehabilitation for cancer is offered in places like Europe and Canada, but not many of these services have been co-designed - that is, created in consultation with cancer patients or survivors - and most of them have a limited uptake. Seretny and van Waart are aiming for a different approach. “What we really wanted to do from the very beginning is this bottom-up approach where we go to people who have just been through cancer treatment and say to them, ‘In this period between your diagnosis and when your treatment started, what would have helped you? What would have been good for you, for your whānau?’” Seretny says. “We want to come up with programmes that are really [about] what people need and the things that they want addressed, and then bring the evidence and the expertise in alongside them to do that.” Currently, the pair are focusing on breast cancer and sarcomas, as each programme will need to be specific to the type of cancer. They will be trialled in Auckland, with the goal of eventually rolling out throughout Aotearoa. Here’s what they want prehab programmes to be able to cover: Exercise and nutrition support Exercise can make the biggest impact on cancer treatment, van Waart says. “Exercise is basically medicine. If this was a pill, we would have prescribed it to everyone already,” she says. “[The Netherlands is] where I got into this field and researched the effect of exercise during chemotherapy, for people with breast cancer and colon cancer, and found that it was very beneficial to be physically active when you get chemotherapy.” Staying active during cancer treatment can help reduce fatigue and improve your physical condition, but it can also help with treatment adherence, such as your ability to cope with chemotherapy, she says, adding many patients question whether they can exercise and what they should be eating before and during treatment. “There is a higher chance of survival when you’re physically active. Rather than just being in a better physical condition, which helps with going through [treatment], it can also actually influence the tumour and the microenvironment of that tumour,” she says. It’s important that exercise and nutritional support is individualised and comes from experts, and that people have the space - like in a prehab programme - to ask these questions. “A lot of information gets thrown at [patients] in a very inaccessible way very often,” Seretny says. “People don’t necessarily have a space to get more support and ask these practical questions. “There’s a lot of misinformation out there, and people go on Google, and then by the time they’ve applied this information to themselves and they come to surgery, they’re often in a very bad way physically because of misinformation around nutrition, around exercise, around other things.” Financial help Finances are front of mind for many people diagnosed with cancer, whether around managing the costs of unfunded treatment, lifestyle adjustments or income loss. “What people wanted to know most about is how do they manage their finances? How do they support their children?” Seretny says. Useful prehab programmes could help patients assess their health insurance, if they have it, figure out if they’ll have to take time off work for treatment, and access government support if they’re eligible. Connection with other people with cancer People can feel alone after a cancer diagnosis, and connecting with others who can share their experiences early on can help. “They want to meet somebody else who’s had this type of rare cancer before and knows what to expect,” Seretny says. “[They want to ask] are they going to lose their hair? How do they deal with that?” Experts and those with first-hand experience of what comes next can also help them navigate physical changes that come with cancer treatment. “[For example], ‘I want to know how I can move my arm after my mastectomy’. [A prehab programme could say] here’s a physiotherapist at the very start who teaches you how to do that before surgery, so you’re really confident to do that afterwards.” Psychological and pastoral care There’s no one size fits all when it comes to cancer treatment, so mental health support needs to be individually tailored, Seretny says. “Our ultimate goal is to make sure that supportive care is part of normal care for people who receive that cancer diagnosis. How can we change this service [so] that we’re not just thinking about cutting out that cancer and fighting that, but [thinking about] when the cancer is gone, how are they?” For example, some patients might find the stress comes much later on, well after treatment has finished. “Say they’ve been through their whole treatment, it’s three years on and they’re coming back for a surveillance scan and a surveillance catch-up with their oncologist. They find that time really stressful, so they’re tapping back into that psychologist again.” Much of the support for people with cancer in New Zealand is Pākehā-focused, van Waart adds. “There are a lot of really nice initiatives, but maybe not necessarily tailored to especially Māori. This is where we’ve flipped it ... because the last thing that we want to do is increase the inequities by building this beautiful programme that’s really good for everyone but Māori.” The pair are aiming for a “solid Māori-focused approach at the centre”, Seretny says. “We really believe that getting that one right will flow out to others ... and appropriate practices for other communities.” Support for families and loved ones It’s important to establish support for families of cancer patients early on. This can help lighten the emotional weight being carried by the person undergoing treatment. “[For example,] women with breast cancer will often carry the load of their own diagnosis,” Seretny says. “Their biggest stress will be, ‘How do I support my teenage children? How do I support the parents that I’m caring for? How do I support my partner?’ So a lot of the people you think the individual will get support from aren’t there, because [the patient is] still trying to hold them emotionally and support them through their own diagnosis.” What’s next Over the next two years, Seretny and van Waart will speak to people who have been through cancer, their specialists, exercise scientists, physiotherapists, psychologists, “and we’ll have this package of care”. “Then we want to show that it is feasible to implement this package of care ... the biggest thing that we want to be able to do is to synergise with things that already exist, and then make sure that whatever is created at the end of it will be something that we can introduce across all of Aotearoa and address some of the physical barriers that some people have.” If you or someone you know has recently been diagnosed with cancer, there are many resources available through charities like the Cancer Society, the Breast Cancer Foundation, and Bowel Cancer New Zealand that can show you where to find support.