There is a lot of evidence that pre-treatment rehabilitation (prehabilitation or pre-hab) both speeds up and benefits a patient’s recovery after surgical orthopedic treatment for knee and hip replacement as well as cardiac conditions. Having pre-hab, which is often covered by insurance after orthopedic surgery, is pretty standard.
Now, based on an article published in Kaiser Health News, cancer survivors who do pre-hab prior to their beginning treatment may recover more quickly from surgery, chemotherapy or radiation. Despite this there is little, if any, insurance coverage for cancer treatment pre-hab. Our current medical insurance system is not designed to treat future problems, but instead is designed to treat existing ones.
Intuitively, I believe like in the case of orthopedic surgery, people’s health during and after invasive surgery, a toxic course of chemotherapy or radiation to treat cancer can be improved by being as physically and psychologically fit as possible prior to the treatment. But research to examine the impact of pre-hab in cancer survivors is very limited (http://www.ncbi.nlm.nih.gov/pubmed/24439570).
Now is the time for more research into pre-hab for cancer care. We need to better prepare cancer survivors, both physically and emotionally, for treatment. We need to provide the evidence that pre-hab will minimize recovery time as well as improve a survivor’s quality of life (QoL) so that insurance companies can be convinced to provide coverage.
“It’s really the philosophy of rehab, rebranded,” says Dr. Samman Shahpar, a physiatrist at the Rehabilitation Institute of Chicago.
The main component of cancer pre-hab should consist of a structured exercise program to improve a survivor’s endurance, strength and cardio-respiratory health. Survivors should also receive psychological and nutritional counseling as well as services that could help them cope with their specific personal living situations (i.e. dealing with living in a 4 floor walk-up apartment or preparing them to gain or lose weight).
The concept of pre-hab and its ability to improve people’s ability to tolerate cancer treatment and return to normal physical and psychological functioning more quickly does already have its roots in some evidence based research. (http://www.ncbi.nlm.nih.gov/pubmed/25076007)
“Pre-hab could be a relatively cheap way to get people ready for cancer treatment and surgery, both of them stressors,” says Dr. Francesco Carli, a professor of anesthesiology at McGill University in Montreal.
There is no question that more study is needed to determine whether pre-hab actually improves cancer patients’ outcomes. However, there is enough existing evidence that should support additional funding for the needed research.
This research is needed so that we can argue that insurance coverage can be extended to pre-hab. All cancer survivors have issues and problems that are not related to their cancer, however having a cancer diagnosis adds significantly to their problems, especially as they move into invasive, life interrupting and altering changes. Pre-hab offers the possibility of a cheaper way to get survivors back on track more quickly.