Prehabilitation and Rehabilitation in Older Adults with Cancer and Frailty

Prehabilitation (prehab) and rehabilitation (rehab) offer multi-modal intervention strategies (primarily exercise, nutrition and well-being) aimed at addressing functional changes associated with cancer and at optimising peoples’ health across the cancer continuum. This is particularly important for older adults diagnosed with cancer and experiencing frailty, due to their increased prevalence of co-morbidities, associated functional impairment and resulting reduced adaptive capacity to tolerate cancer pathways. This chapter aims to provide considerations for the integration of prehab and rehab delivery into the clinical care plans of older cancer patients with frailty providing relevant best practice examples alongside evidence from the scientific literature. Sections of the chapter are structured according to Dietz’s phases of rehabilitation including preventative, restorative, supportive and palliative phases. The importance of using a Comprehensive Geriatric Assessment, as well as having a regular and dynamic risk evaluation is highlighted for these older cancer patients. Interdisciplinary prehab and rehab interventions suitable for older patients with frailty undergoing different medical cancer treatment modalities (including surgical and oncological treatments) are presented and discussed with examples of programmes from two continents provided. Individualisation of prehab and rehab interventions based upon personalised assessment is discussed as a key component to achieving effective benefits for this group of patients. Good care in the absence of readily available prehab and rehab services is also described. Finally, research recommendations are made to advance the detailed understanding, efficacy and guidance of prehab and rehab provisions for older adults with cancer and frailty using clinical, functional and quality of life outcome metrics.