Advances in Prehabilitation

Motaz Qadan, MD, PhD, is a hepatobiliary and pancreatic surgical oncologist in the Mass General Cancer Center and a surgeon in the Division of Gastrointestinal and Oncologic Surgery at Massachusetts General Hospital. In this video, he discusses his research on prehabilitation and its promising potential for patients with pancreatic cancer.

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Transcript

The research that I'm talking about today is prehabilitation. What that comes from, I think, is rehabilitation—which is where we used to send patients after they have these large operations—to get stronger and improve their nutrition in the form of rehabilitation at rehab centers. The thought for prehabilitation is, why not bring this forward before the time of the operation in order to help them gain strength and improve their nutrition going into surgery? The idea is that they would likely do better at the time of the operation, recover faster, and, ideally, have fewer complications as well.

We are already seeing some promising data from prehabilitation use both anecdotally and in early trials, as well as from some of the retrospective data. We know that if patients are healthier going into their operation they're healthier coming out of their operation, and so that's really ideally the argument to make for doing this.

The other important thing to me is that this allows patients to engage themselves in their own care, which is usually a difficult thing to do in cancer because this is, generally speaking, an uncontrollable entity. To give patients some control over their tumors and be able to control their outcomes to some extent is tremendously helpful. While in general, patients who have pancreatic cancer tend to suffer from a number of complications usually related to these tumors—these tumors are aggressive, they can secrete cytokines, these chemicals generally cause a decline in their health status and preoperative condition—these tumors can also block the stomach and block the gastrointestinal tract thereby causing even more impaired nutrition than an average tumor. I think that if we're able to treat those patients and optimize them beforehand, then that's going to result in a huge improvement in their gastrointestinal tract and in their general condition.

We also found that when we examined those patients before and after they receive the therapies they require for the treatment of their pancreas cancer, namely chemotherapy, that a lot of these patients experience a notable decline in their general condition just from the chemotherapy alone. In fact, with the help of Naomi M. Sell, MD, we investigated this and found that approximately one-third of patients will have a decline in their muscle mass, which is representative of their general condition that represents their health, their nutrition and their physical abilities.

And so the fact that one-third of those patients undergo a decline, we compared with their outcomes—not just their outcomes from an operation, but generally even their cancer outcomes (so looking at things like survival, two-year survival, recurrence of tumors). [What we found was] that patients who have had a decline in their health status, i.e., their preoperative exercise capacity and their nutritional condition, actually have worse outcomes even when it comes to their cancer specifically.

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