By Krupali Desai, MD (Ayurveda), MPH, and Alyona Weinstein, MSN, FNP-BC
Thoracic surgery, a treatment for patients with lung and esophageal cancers, has been associated with high morbidity and mortality risk, especially in those with reduced cardiopulmonary function. Studies also show that low physical activity levels and poor cardiopulmonary fitness before surgery have a clear correlation with postoperative complications and prolong postsurgery recovery. Therefore, optimizing fitness prior to surgery with prehabilitation (prehab) may help reduce complications and optimize recovery.
Prehabilitation for Thoracic Cancer Surgery
Data show that prehab programs improve physical activity levels, cardiorespiratory fitness, and muscle strength in patients undergoing thoracic cancer surgery. Notably, the programs also reduce postoperative complications and length of hospital stay (LOS).
The American Society of Clinical Oncology clinical guidelines recommend preoperative exercise for patients with lung cancer undergoing surgery. However, the COVID-19 pandemic severely disrupted access to onsite exercise programs, creating an opportunity to develop virtual programs to meet the needs of this patient population.
A Mind-Body Thoracic Prehabilitation Program
For the current study, the Integrative Medicine and Thoracic Services at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, NY, developed and implemented a virtual, synchronous, mind-body prehab program to help patients with thoracic cancer prepare for surgery and recover following the procedure. The program comprised two 45-minute fitness and mind-body classes each week delivered via Zoom videoconferencing. The free classes were led by a fitness specialist and tailored to individual participants’ strength and limitations. After engaging with the program, participants’ qualitative data suggested that they felt stronger, more connected to their peers, and better prepared before and after surgery.
To evaluate the impact on perioperative outcomes, the team conducted a retrospective cohort study at MSKCC’s thoracic oncology surgical department. All participants were aged 18 or older, had a thoracic cancer diagnosis, and were scheduled for surgery between December 2019 and December 2021. LOS and whether patients had a hospital readmission or urgent care center visit within 30 days of discharge were extracted using an electronic database. A total of 519 patients were included in the analysis: 119 in the prehab group and 400 in the control arm.
We found that the prehab group had fewer hospital readmissions compared to the control group (4 versus 45, respectively), but the difference in urgent care visits was statistically insignificant. Similarly, LOS was not significantly different between the groups. A multivariable logistic regression showed participation in the prehab program to be associated with significantly lower likelihood of readmission in patients with lung cancer compared to those with esophageal cancer.
What This Means for Oncology Nurses
Our study showed that patients who participated in a virtual mind-body prehab program had fewer hospital readmissions within 30 days of discharge compared to nonparticipants.
Evidence shows that mind-body approaches—including relaxation, meditation, yoga, and exercise—before surgery decrease stress, anxiety, pain, and nausea in patients with cancer. Exercise prior to surgery may also help reduce the risk of postsurgical complications. Virtual mind-body programs can be safe and effective for patients who are unable to access them in person. Oncology nurses have a role in raising awareness of programs available for patients, educating patients about the benefits of prehab programs, and encouraging patients to participate.
Learn more about the oncology nurse’s role in prehabilitation and exercise care coordination on the Oncology Nursing Podcast™ Episode 195: Exercise’s Effect on Patient and Provider Well-Being, Episode 82: Physical Activity Prescriptions in Cancer Care, and Episode 15: Incorporating Physical Activity in Patient Care. Listen using the players embedded below or on your favorite podcast platform.