Understanding Prehabilitation for Lung Cancer Surgery

*Please note: This slide show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about any questions you may have regarding a medical condition.

What is prehabilitation for lung cancer surgery?

You've probably heard of rehabilitation – treatment after an injury, surgery, or illness to recover and regain strength, mobility, and ability.

Prehabilitation is similar but starts before surgery or another treatment. The goal is to help boost your physical health, mental health, and nutrition before surgery.¹

The challenge of lung cancer surgery

Lung cancer surgery is a major operation. It usually involves a hospital stay, general anesthesia, medications for pain and for preventing infection, as well as removal of the tumor in your lung.

Lung surgery is stressful especially when you are already coping with the negative effects of lung cancer. It can also be mentally stressful for you, your family, and caregivers.

Benefits of prehabilitation for lung cancer surgery

Studies show that prehabilitation benefits include tolerating the stress of surgery better with less risk of complications, as well as a faster recovery and better outlook after the operation.^2,3

It may even help people who were not previously well enough for surgery recover enough to have it.⁴

What’s involved in prehabilitation?

Prehabilitation is different for everyone. It may include exercise, physical therapy, treatment to help you stop smoking, nutrition counseling and support, treatment for anxiety and depression, and respiratory therapy to help improve your lung function.⁵

Smoking cessation as part of prehabilitation

If you smoke, quitting is one of the most important steps of preparing for surgery. Studies show it helps people with lung cancer live longer and lowers the risk or time until cancer may return.^6,7 It also reduces the risk of lung problems and infections after surgery.⁸

Blood sugar control in prehabilitation

Controlling your blood sugar is another important step to get ready for surgery. This can help prevent infection and maintain control of diabetes.

You and your doctor will work together to determine your healthiest blood sugar level and goals.¹⁰

Exercise prehabilitation

Many people with lung cancer get little physical activity.¹¹ Exercising as you prepare for surgery helps you recover and increases your ability to be active after surgery.^12,13

Even as little as 6 weeks of increased activity before surgery can help you recover after surgery.²

Medications, supplements, and prehabilitation

Preparing for your surgery includes meeting with your doctor to review all the medications, supplements, non-prescription medicines, herbs (including cannabis), and vitamins that you take on a regular basis.

This review is important because some of these can cause harmful reactions while receiving anesthesia during surgery or slow down your recovery.¹⁴ You may need to stop taking some regular medications and supplements a few days to weeks before surgery. Your doctor will determine when you can begin taking your medications and supplements again after surgery.

Nutrition for prehabilitation

Good nutrition is another important part of healing and recovery. Your doctor may ask you to talk with a nutrition specialist to make sure you are getting the vitamins, minerals, protein, and other nutrients that will help you tolerate surgery and heal as well as possible.¹⁵

Respiratory therapy for prehabilitation

Your doctor may recommend that you see a respiratory therapist to help prepare for surgery. Research shows that people who do breathing exercises before surgery have less shortness of breath after surgery and better results from the operation.¹⁶

Psychological support in prehabilitation

Studies have also shown that people struggling with anxiety, depression, or other mental health concerns tend to do worse emotionally with surgery. Your doctor might recommend counseling or other mental health support before surgery and encourage you to continue with individual or group support after surgery.

Psychological support in prehabilitation

Being anxious or depressed can also keep you from taking part in other types of prehabilitation, which can make you less able to get physically ready for surgery, as well as cause mental health issues.¹⁷

When should I start prehabilitation for lung cancer surgery?

Doctors often recommend six weeks of prehabilitation before lung cancer surgery, but prehabilitation can still help even if you have less time.

If you smoke, it is best to stop smoking as soon as possible.

Getting good nutrition and building your fitness through exercise are helpful no matter how long you have before surgery.

Talk with your doctor about lung cancer surgery prehabilitation

Talk with your doctor about prehabilitation when you discuss the option of lung cancer surgery. You may want to ask about it under the name ERAS, which stands for "enhanced recovery after surgery". You can ask if the hospital where you will have your surgery is an ERAS hospital.

References

1. Durrand J, Singh SJ, Danjoux G. Prehabilitation. Clin Med (Lond). 2019 Nov;19(6):458-464.
2. Chen F, Wang G. Enhanced recovery after surgery for lung cancer patients. Open Med (Wars). 2020 Mar 19;15:198-203.
3. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD, Naidu B. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS^®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019 Jan 1;55(1):91-115.
4. Goldsmith I, Chesterfield-Thomas G, Toghill H. Pre-treatment optimization with pulmonary rehabilitation in lung cancer: Making the inoperable patients operable. EClinicalMedicine. 2020 Nov 30;31:100663.
5. Shukla A, Granger CL, Wright GM, Edbrooke L, Denehy L. Attitudes and perceptions to prehabilitation in lung cancer. Integr Cancer Ther. 2020 Jan-Dec;19:1534735420924466.
6. Murray RL, O'Dowd E. Smoking cessation and lung cancer: never too late to quit. Lancet Public Health. 2023 Sep;8(9):e664-e665.
7. Caini S, Del Riccio M, Vettori V, Scotti V, Martinoli C, Raimondi S, Cammarata G, Palli D, Banini M, Masala G, Gandini S. Quitting smoking at or around diagnosis improves the overall survival of lung cancer patients: a systematic review and meta-analysis. J Thorac Oncol. 2022 May;17(5):623-636.
8. The Scope Radio. University of Utah [podcast episode]. Dr. Tom Miller and Dr. Dan Vargo. October 20, 2015.
   https://healthcare.utah.edu/the-scope/all/2015/10/preparing-your-body-surgery-can-make-your-recovery-faster-and-more-painless
9. Jassem J. Tobacco smoking after diagnosis of cancer: clinical aspects. Transl Lung Cancer Res. 2019 May;8(Suppl 1):S50-S58.
10. Duggan EW, Carlson K, Umpierrez GE. Perioperative Hyperglycemia Management: An Update. Anesthesiology. 2017 Mar;126(3):547-560. Erratum in: Anesthesiology. 2018 Nov;129(5):1053.
11. Avancini A, Sartori G, Gkountakos A, Casali M, Trestini I, Tregnago D, Bria E, Jones LW, Milella M, Lanza M, Pilotto S. Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled? Oncologist. 2020 Mar;25(3):e555-e569.
12. Sanchez-Lorente D, Navarro-Ripoll R, Guzman R, Moises J, Gimeno E, Boada M, Molins L. Prehabilitation in thoracic surgery. J Thorac Dis. 2018 Aug;10(Suppl 22):S2593-S2600.
13. Sebio García R, Yáñez-Brage MI, Giménez Moolhuyzen E, Salorio Riobo M, Lista Paz A, Borro Mate JM. Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial. Clin Rehabil. 2017 Aug;31(8):1057-1067.
14. Cummings KC 3rd, Keshock M, Ganesh R, Sigmund A, Kashiwagi D, Devarajan J, Grant PJ, Urman RD, Mauck KF. Preoperative management of surgical patients using dietary supplements: society for perioperative assessment and quality improvement (SPAQI) consensus statement. Mayo Clin Proc. 2021 May;96(5):1342-1355.
15. Ferreira V, Lawson C, Ekmekjian T, Carli F, Scheede-Bergdahl C, Chevalier S. Effects of preoperative nutrition and multimodal prehabilitation on functional capacity and postoperative complications in surgical lung cancer patients: a systematic review. Support Care Cancer. 2021 Oct;29(10):5597-5610.
16. Goldsmith I, Chesterfield-Thomas G, Toghill H. Pre-treatment optimization with pulmonary rehabilitation in lung cancer: Making the inoperable patients operable. EClinicalMedicine. 2020 Nov 30;31:100663.
17. Grimmett C, Heneka N, Chambers S. Psychological interventions prior to cancer surgery: a review of reviews. Curr Anesthesiol Rep. 2022;12(1):78-87.