Building Resilience: Cancer Prehab and Rehab

Adversity and Personal Growth

Going through cancer treatment can be one of those adversities that make you more resilient and from which you can find important meaning for your life. There is a saying and a popular song: “What doesn’t kill you makes you stronger!” Many people with cancer find that to be true.


Resilience is the ability to recover quickly from difficulties such as the rigors of cancer treatment. Resilience is connected to higher quality of life and, in some cases, improved outcomes for people with cancer. Many factors contribute to your level of resilience:

  • Your previous experiences in dealing with adversity
  • Your coping skills
  • Your social support systems
  • Your resources
  • Your general health

Some people may have innate strengths and qualities that support their resilience, while others must cultivate and enhance the ability to persist and recover during adverse times. These techniques may enhance resilience:

  • Self-care practices that support physical, mental and emotional health
  • Receiving information, guidance, support and therapies from others, such as enlisting a social worker to help you access resources for transportation, paying for your treatments and child care
  • Learning mind-body skills to manage stress

Pretreatment Approaches (“Prehab”)

After a cancer diagnosis and before treatment begins, you can prepare your body/mind/spirit so that you are in the best shape possible to meet the challenges of cancer treatment. This process is called cancer prehabilitation.Examples:

  • Men preparing for radical prostatectomy can learn to do pelvic floor exercises to strengthen these muscles and reduce the risk of incontinence after surgery. These men can also learn stress management skills with the goal of improving mood both before and after surgery.
  • The Society for Integrative Oncology 2013 clinical practice guidelines suggest supervised exercise-based pulmonary (p)rehabilitation in patients awaiting pulmonary resection for suspected lung cancer with compromised lung function, with a goal of improving cardiorespiratory fitness and functional capacity.

Centers and practices that offer cancer prehab generally begin with a baseline of patients’ physical and psychological health for these reasons:

  • Assess functional level
  • Identify any impairments
  • Provide information and therapies which would promote physical and emotional health.

The goal is to reduce the occurrence and/or severity of future impairments from cancer treatment.

Cancer Rehabilitation: A Plan for Recovery

We at LHC believe that rehabilitation after cancer treatment should become a standard part of survivorship care, just as cardiac rehab is for those with heart disease. A cancer rehab program would be tailored to the special needs of cancer survivors, using evidence-based educational programs and supportive therapies to restore health, and quite possibly improve a person’s health above their pre-cancer diagnosis baseline.

An approach to Cancer Rehab, such a program would include the following elements:

  • Supervised exercise
  • Dietary counseling
  • Nutrition and cooking classes
  • Stress management, including re-establishing healthy bio-rhythms/sleep
  • Massage
  • Acupuncture
  • Support groups
  • Guidance in nutritional supplements and other natural products

Cancer rehabilitation is not limited to those whose cancers are in remission. Evidence suggests that interprofessional palliative care rehabilitation programs are helpful to those with active cancer.

Livestrong provides information on Rehabilitation After Cancer Care. Signs that a person might need rehabilitation services-

  • Feeling weaker now than when you were initially diagnosed.
  • Difficulty talking or swallowing
  • Pain that is not caused by cancer
  • Feeling more tired than before diagnosis
  • Muscular or orthopedic problems
  • Difficulty recovering from treatment and doing previous activities
  • Uncertainty about how much to exercise or how to best exercise
  • Memory problems or difficulty concentrating

If your oncology team has not discussed rehabilitation with you, you may need to be proactive and bring it up. The Livestrong webpage also suggests how you might create a rehabilitation plan with your oncology team.

Cardiac Rehab – A Comparison

From the American Heart Association website-

Cardiac rehab doesn’t change your past, but it can help you improve your heart’s future. It’s a medically supervised program designed to help improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery. Think of cardiac rehab as three equally important parts-

  • Exercise counseling and training: Exercise gets your heart pumping and your entire cardiovascular system working. You’ll learn how to get your body moving in ways that promote heart health.
  • Education for heart-healthy living: Managing your risk factors, choosing good nutrition, quitting smoking…education about heart-healthy living is a key element of cardiac rehab.
  • Counseling to reduce stress: Stress hurts your heart. This part of rehab helps you identify and tackle everyday sources of stress.

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