癌症康复预备:降低治疗相关发病率、增加癌症治疗选择和改善身心健康结局的机会。

Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.

机构信息

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts 02115, USA.

出版信息

Am J Phys Med Rehabil. 2013 Aug;92(8):715-27. doi: 10.1097/PHM.0b013e31829b4afe.

Abstract

Cancer prehabilitation, a process on the continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment, includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient's health to reduce the incidence and the severity of current and future impairments. There is a growing body of scientific evidence that supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments. This is the first review of cancer prehabilitation, and the purpose was to describe early studies in the noncancer population and then the historical focus in cancer patients on aerobic conditioning and building strength and stamina through an appropriate exercise regimen. More recent research shows that opportunities exist to use other unimodal or multimodal prehabilitation interventions to decrease morbidity, improve physical and psychological health outcomes, increase the number of potential treatment options, decrease hospital readmissions, and reduce both direct and indirect healthcare costs attributed to cancer. Future research may demonstrate increased compliance with acute cancer treatment protocols and, therefore, improved survival outcomes. New studies suggest that a multimodal approach that incorporates both physical and psychological prehabilitation interventions may be more effective than a unimodal approach that addresses just one or the other. In an impairment-driven cancer rehabilitation model, identifying current and anticipating future impairments are the critical first steps in improving healthcare outcomes and decreasing costs. More research is urgently needed to evaluate the most effective prehabilitation interventions, and combinations thereof, for survivors of all types of cancer.

摘要

癌症康复,是在癌症诊断和开始急性治疗之间的连续护理过程中的一部分,包括身体和心理评估,以确定一个基线功能水平,识别功能障碍,并提供有针对性的干预措施,以改善患者的健康状况,减少当前和未来的功能障碍的发生率和严重程度。越来越多的科学证据支持为新诊断的癌症患者做好准备,并在开始急性治疗前优化他们的健康状况。这是对癌症康复的首次综述,目的是描述非癌症人群中的早期研究,然后是癌症患者历史上对有氧训练和通过适当的运动方案增强力量和耐力的关注。最近的研究表明,有机会使用其他单一或多种康复干预措施来降低发病率,改善身体和心理健康结果,增加潜在的治疗选择数量,减少医院再入院率,并降低癌症相关的直接和间接医疗保健成本。未来的研究可能表明,对癌症急性治疗方案的遵守度增加,从而改善生存结果。新的研究表明,将身体和心理康复干预措施结合起来的多模式方法可能比只针对一种或另一种方法的单模式方法更有效。在以功能障碍为导向的癌症康复模式中,确定当前和预期未来的功能障碍是改善医疗保健结果和降低成本的关键第一步。迫切需要更多的研究来评估最有效的康复干预措施,以及它们的组合,适用于所有类型的癌症幸存者。

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