Prehabilitation in geriatric oncology

Abstract

With advancing age, older adults with cancer often face reductions in functional capacity and comorbid conditions become more prevalent. An overall state of deconditioning can be further exacerbated by a combination of sedentary behaviour and malnutrition that independently contribute to cachexia, morbidity and mortality. Collectively, these changes can induce a state of frailty that undermines the tolerability and safety of cancer treatments. For example, among older adults with cancer undergoing surgery, those who are classified as frail by common multidimensional instruments (e.g., Comprehensive Geriatric Assessment) have a higher risk of surgical complications, longer hospital stays, higher readmission rates, and higher mortality. Given that frailty indices typically capture functional, psychosocial, and/or nutritional assessments, interventions that target deficits in these health domains including exercise, stress reduction, and dietary optimization, respectively, may be particularly valuable for reducing the risk of potential treatment-related adverse effects. In fact, the evidence supporting the role of pre-treatment conditioning via one or more targeted health behaviours, referred to as prehabilitation, has rapidly grown in recent years, giving rise to questions about its potential role in models of care. In this commentary, we provide a synopsis of prehabilitation for the older adult with cancer, including a brief review of its origins in geriatric and clinical care, current applications, and a pragmatic implementation model for consideration.