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Prehabilitation in radiation therapy: a scoping review

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Abstract

Purpose/objectives

Radiation therapy (RT) is a central component of cancer treatment with survival and long-term quality-of-life benefits across a spectrum of oncologic diagnoses. However, RT has been associated with varying levels of fatigue, pain, weight loss, and changes in mental health both during and post-treatment. Prehabilitation aims to optimize health prior to anti-neoplastic therapy in order to reduce side effects, increase adherence to treatment, expedite post-treatment recovery, and improve long-term outcomes. Though prehabilitation has been studied in those undergoing cancer-related surgery, literature on prehabilitation in individuals undergoing RT has not been comprehensively explored. Thus, this scoping review aims to summarize the existing literature focused on prehabilitation interventions for patients receiving RT.

Materials/methods

The PRISMA-ScR checklist for conducting scoping reviews was adopted to identify and evaluate studies investigating the efficacy of prehabilitation before and during RT for cancer over the past 21 years (10/2002–10/2022). A search of prehabilitation and RT was performed to identify studies investigating prehabilitation interventions in adult cancer patients undergoing RT.

Results

A total of 30 articles met inclusion criteria, yielding 3657 total participants. Eighteen (60%) studies were randomized controlled trials (RCTs) with sample sizes ranging from 21 to 221. The most commonly studied populations were patients with head and neck cancer, followed by rectal, breast, and lung cancer. A majority (80%) of studies evaluated one prehabilitation intervention (i.e., unimodal). Targeted physical exercises were the most common intervention, followed by general physical exercises and technology/apps. Adherence/feasibility was the most common primary outcome, representing 30% of studies. All studies reported data on sex, and 5 (17%) reported data on race and/or ethnicity.

Conclusions

Prehabilitation interventions have been successfully implemented in patients with cancer undergoing surgical treatment. Based on limited current literature, prehabilitation appears to have a promising effect in reducing morbidity in adult cancer patients requiring RT. Though our review identified many RCTs, they were frequently small sample trials with primary outcomes focused on feasibility, rather than functional status or quality of life. Thus, there is a need for adequately powered, randomized controlled intervention trials to investigate the efficacy of prehabilitation and maximize the treatment outcomes for patients undergoing RT.

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Data availability

The search strategies of the performed for this review are available upon request to the corresponding author.

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Authors and Affiliations

  1. College of Medicine, University of Nebraska Medical Center, 42Nd and, Emile St, Omaha, NE, 68198, USA

    Laura E. Flores

  2. Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, 42Nd and, Emile St, Omaha, NE, 68198, USA

    Danielle Westmark

  3. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA

    Nicole B. Katz, Tracey L. Hunter & Julie K. Silver

  4. Spaulding Rehabilitation Hospital, Charlestown, MA, USA

    Nicole B. Katz, Tracey L. Hunter & Julie K. Silver

  5. Department of Psychology, University of Chicago, Chicago, IL, USA

    Emily M. Silver

  6. Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Katherine M. Bryan

  7. Department of Radiation Oncology, Emory School of Medicine, Atlanta, GA, USA

    Reshma Jagsi

  8. Departments of Radiation Oncology and Neurological Surgery, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Shearwood McClelland III

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  1. Laura E. Flores
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Contributions

LEF, JKS, NBK, SMIII, RJ, DW contributed to conceptualization, investigation, methodology, article screening, data extraction, synthesis of review results, and writing-original draft. LEF, NBK, TLH, EMS, KMB contributed to article screening, data extraction, writing-review, and editing. LEF, JKS, KMB, NBK, RJ, DW, and SMIII, contributed to writing-review and editing. All authors contributed to manuscript preparation.

Corresponding author

Correspondence to Laura E. Flores.

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Competing interests

LEF, NBK, TLH, DW, KMB, SM3, JKS report no disclosures related to this work. Unrelated, JKS discloses that she participates in an advisory capacity for research funded by the National Institutes of Health as well as the Binational Scientific Foundation. She is a venture partner at Third Culture Capital. SM3 serves as a consultant for Gilmartin Capital, receives travel funding from GT Medical Technologies Inc., and receives research funding from the University Hospitals Minority Faculty Career Development Award, the ASTRO Emerging Investigator Award, the Robert Winn Diversity in Clinical Trials Career Development Award, and the National Cancer Institute Paul Calabresi K12 Clinical Oncology Research Career Development Program. RJ has stock options as compensation for her advisory board role in Equity Quotient, a company that evaluates culture in health care companies; she has received personal fees from the Greenwall Foundation, Doris Duke Charitable Foundation, and the National Institutes of Health and grants or contracts for unrelated work from the National Institutes of Health, the Doris Duke Charitable Foundation, the American Cancer Society, the Greenwall Foundation, the Susan G. Komen Foundation, and Genentech. She has served as an expert witness for Kleinbard, LLC.

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Shearwood McClelland III and Julie K. Silver are co-senior authors.

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Flores, L.E., Westmark, D., Katz, N.B. et al. Prehabilitation in radiation therapy: a scoping review. Support Care Cancer 32, 83 (2024). https://doi.org/10.1007/s00520-023-08262-9

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