Frank, a 74-year-old man, was referred to the oncology clinic for workup on a suspicious lung nodule found during a lung cancer screening.

Frank tells Justin, the oncology nurse, that he blames himself for smoking “all these years.” He also reports that up until nine months ago, he played 18 holes of golf twice a week, but “now I just don’t have the stamina.” He asks Justin if there is anything he can do to help prepare for “what might lie ahead.”

What Would You Do?

Where rehabilitation is typically done once cancer treatment is complete, prehabilitation helps patients before treatments starts and often continues throughout treatment. Prehabilitation is a multimodal program focusing on more than just physical conditioning. Overall stressors may be addressed by teaching techniques such as progressive muscle relaxation and meditation; additionally, financial and psychosocial resources, alcohol and smoking cessation, and other resources pertinent to individual patient needs can be addressed. In short, by assessing patients’ prehabilitation needs, tailored interventions help prepare them for the journey ahead. Patients presenting with lung cancer are often deconditioned, and most people would agree: a new cancer diagnosis presents a multitude of additional challenges.

In a literature review, Silver and Baima found studies that suggested improved outcomes in patients with chronic obstructive pulmonary disease and small cell lung cancer who had prehabilitation prior to beginning their treatment course. One study reported improved oxygen capacity and reduced hospital stays as positive outcomes of a short-term physical therapy intervention initiated prior to treatment. Another study demonstrated improved lung function in patients who participated in two weeks of exercise interventions followed by three months of rehabilitation after lung resection. Prehabilitation has also been proposed as an especially important intervention for older adults whose age-related changes may affect their ability to tolerate surgery or cancer treatments.

Justin tells Frank about a prehabilitation program the institution offers. Frank is enrolled in a program consisting of walking, progressive muscle relaxation, and smoking cessation. Two weeks later, his oncologist confirms early-stage squamous cell lung cancer. Frank is a surgical candidate. He reports that he feels better prepared for the upcoming surgery; his stamina and oxygen-carrying capacity have improved, and he has been wearing a patch to help curb his urge to smoke. 

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