Prehabilitation for people with cancer: principles and guidance for prehabilitation within the management and support of people with cancer | The Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration
This document calls for changes to the delivery of cancer care across the UK, with a greater focus on prehabilitation including nutrition, physical activity and psychological support.
What is prehabilitation?
Prehabilitation supports people living with cancer to prepare for treatment. It promotes healthy behaviours and prescribes exercise, nutrition and psychological interventions based on a person’s needs, to help them find their best way through.
When should it be implemented?
Prehabilitation should be implemented in the early stages of the patient pathway, ideally soon after diagnosis and well in advance of treatment for maximum benefit. It should be seen as part of the rehabilitation pathway, as a way to optimise a person’s health and wellbeing, maximising their resilience to treatment throughout the cancer journey.
What are the benefits?
Prehabilitation offers patients and care givers three main benefits:
Personal empowerment: A sense of control and purpose, which prepares people for treatment and improves their quality of life
Physical and psychological resilience: An opportunity to improve physiological function and psychological wellbeing, which offers resilience to the effects of cancer treatment, enhances the quality of recovery and helps people to live life as fully as they can
Long-term health: An opportunity to reflect on the role of healthy lifestyle practices after a cancer diagnosis, to promote positive health behaviour change.
Around 500 cases of cancer in women every week in the UK could be prevented by keeping a healthy weight and increasing exercise | British Journal of Cancer | story via Cancer Research UK
The latest figures, calculated from 2015 cancer data, found that whilst smoking remains the biggest preventable cause of cancer, everyday changes to live a little more healthily can have a large impact.
By keeping a healthy weight, drinking less alcohol, eating more fibre, cutting down on processed meat and being more active, more than 26,000 cancer cases in women could be avoided each year.
This equates to 15% of all cancers diagnosed in women each year in the UK. More than 24,000 cases of cancer in men could also be avoided with the same approach.
More than 2,500 cancer cases a week could be avoided | Cancer Research UK | March 2018
Cancer Research UK has published findings which demonstrate that almost 4 in 10 ( 37.7 per cent) of cancers could have been prevented. The landmark study highlights that many lifestyle factors could contribute to an individual’s risk of developing cancer. The study identifies 135, 500 cases of cancer a year in the UK that could be prevented through lifestyle changes. The research findings have been published this month in the British Journal of Cancer(thefull abstract at the end of the post).
While smoking was to blame for the largest percentage of preventable cancer cases, using data from 2015 the researchers observed, tobacco smoke caused around 32,200 cases of cancer in men (17.7% of all male cancer cases) and around 22,000 (12.4%) in women.
Obesity is the second highest contributory risk to developing cancer: around 22,800 (6.3%) cases of cancer a year are down to being overweight or obese. This is equivalent to around 13,200 (7.5%) cases of cancer in women and around 9,600 (5.2%) in men. The results imply that 5% (1 in 20) cancer cases might possibly be prevented by maintaining a health weight. Obesity has been linked to 13 different types of cancer, such as cancers of the bowel, breast and kidney.
The third greatest factor in preventable cancers was overexposure to UV radiation from the sun and sunbeds, associated with around 13,600 cases of melanoma skin cancer a year, 3.8% of all cancer cases.
Other preventable lifestyle risks outlined in the study were eating too little fibre causing around 11,900 cases equivalent to 3.3% each, drinking too much alcohol (attributed to causing 11,700 cases or 3.3% each.
In repsonse to the findings of the research, Sir Harpal Kumar, Cancer Research UK’s chief executive, said: “Leading a healthy life doesn’t guarantee that a person won’t get cancer, but it can stack the odds in your favour. These figures show that we each can take positive steps to help reduce our individual risk of the disease.” (Cancer Research UK)
Full reference: Brown, K. F., et al | 2018 | The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015 |British Journal of Cancer | doi:10.1038/s41416-018-0029-6
Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.
Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.
Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.
Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.
Cancer Research UK is offering a free online cancer awareness training Talking about cancer. This course aims to separate myths from facts and encourage healthy lifestyle changes and spotting cancer early.
Limiting weight gain may help to reduce risk of eight cancers | Science Daily| New England Journal of Medicine
An international team of researchers has identified eight additional types of cancer linked to excess weight and obesity: stomach, liver, gall bladder, pancreas, ovary, meningioma (a type of brain tumor), thyroid cancer and the blood cancer multiple myeloma.
Limiting weight gain over the decades could help to reduce the risk of these cancers, the data suggest.
The findings, published Aug. 25 in The New England Journal of Medicine, are based on a review of more than 1,000 studies of excess weight and cancer risk analyzed by the World Health Organization’s International Agency for Cancer on Research (IARC), based in France.
Full reference: Lauby-Secretan, B. et al. Body Fatness and Cancer — Viewpoint of the IARC Working Group. New England Journal of Medicine, 2016; 375 (8): 794 DOI: 10.1056/NEJMsr1606602
Lengacher, C.A. et al. (2016). Journal of Clinical Oncology. vol. 34(24). pp. 2827-2834
Purpose :The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe.
Patients and Methods: A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects.
Results :Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC).
Conclusion :The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes.
Jenks, S. (2016) JNCI: Jnl of National Cancer Institute. Volume 108, Issue 8
Even moderate leisure-time physical activity may protect against 13 cancers, according to a massive observational study that appeared May 16 in JAMA Internal Medicine (doi:10.1001/jamainternmed.2016.1548).
But which type of exercise brings the most benefit is not yet clear, researchers say, nor is exercise alone likely to account for its association with a lower cancer risk in colon, breast, and endometrial cancers, among others.
“Physical activity is not a stand-alone, magic bullet,” said William McCarthy, Ph.D., adjunct professor in the department of health services in the Fielding School of Public Health at the University of California, Los Angeles. “The biggest bang [in risk reduction] comes when exercise is coupled with a Mediterranean-style diet and not smoking.”
Still, McCarthy said, the recent joint study by researchers at the National Cancer Institute and the American Cancer Society highlights exercise’s importance to cancer risk and overall health, despite what he described as years of skepticism in the scientific community. “It’s a shot in the arm for those of us doing exercise studies for years,” he said.
Researchers at both organizations analyzed pooled data for the self-reported leisure-time physical activities of 1.44 million people in 12 U.S. and European studies conducted between 1982 and 2004. Analyzing data from those combined studies gave investigators greater statistical power than a single study.