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Meta-Analysis
. 2018 Feb;12(1):64-73.
doi: 10.1007/s11764-017-0645-9. Epub 2017 Sep 12.

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

C Treanor  1 , T Kyaw  2 , M Donnelly  2   3
Affiliations
Meta-Analysis

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

C Treanor et al. J Cancer Surviv. 2018 Feb.

Abstract

Purpose: The purpose of the study is to systematically review and synthesise randomised controlled trials investigating the effectiveness of prehabilitation compared to usual care for newly diagnosed, adult-onset cancer patients.

Methods: MEDLINE, EMBASE, PsycINFO, CINAHL and SSCI were searched up to April 2017. Studies were included if disease-related, treatment-related, patient-reported and health service utilisation outcomes were assessed. Two reviewers independently reviewed and appraised the risk of bias of each study.

Results: Eighteen studies were included. Interventions comprised one or more of the following components: psychological support, education and exercise. Meta-analyses found that pelvic floor muscle training (PFMT) significantly increased odds of continence at 3 months (OR = 3.29, 95% CI = 1.57-6.91), but did not significantly reduce daily pad use at 6 months post-surgery Mean Difference (MD)= ( = - 0.96, 95% CI = - 2.04-0.12) for prostate cancer patients. Although quality of life improved due to PFMT, functional ability or distress did not. Further meta-analyses indicated that pre-surgical exercise significantly reduced length of hospital stay (MD = - 4.18, 95% CI = - 5.43-- 2.93) and significantly lowered odds of post-surgery complications (OR = 0.25, 95% CI = 0.10-0.66) for lung cancer patients. Psychology-based prehabilitation significantly improved mood, physical well-being and immune function for prostate cancer patients and improved fatigue and psychological outcomes and a trend for better quality of life among breast cancer patients. Risk of bias was high for most studies.

Conclusions: Prehabilitation appears to benefit cancer patients. Rigorous trials are needed to investigate the effectiveness of prehabilitation among other cancer sites and other related effects. The cost-effectiveness of prehabilitation remains unanswered.

Implications for cancer survivors: Providing interventions earlier in the care pathway may lead to better outcomes for patients during survivorship.

Keywords: Cancer; Meta-analysis; Prehabilitation; Systematic review.

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