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Prehabilitation for older adults undergoing lung cancer surgery should emphasize activities of daily living, self-care, mobility, and resilience.

A prehabilitation program may increase physical and pulmonary capacity in older adult patients undergoing lung cancer surgery and minimize adverse effects afterward, according to a literature review published in Clinical Lung Cancer.

“While prehabilitation is applicable to the broad spectrum of cancer surgery, the ideal prehabilitation may vary by type of surgery and the particular needs of patient populations,” wrote Jane Y. Zhao, MD, and coauthors. “As such, prehabilitation for lung cancer surgery in older adults may consist of multimodal interventions including home-based physical training, education, behavior modification, nutritional repletion, and relaxation strategies.”

The literature review reported on the effects of prehabilitation in patients undergoing lung cancer surgery from studies published through April 2022.

According to the review, current guidelines recommend surgical prehabilitation before lung cancer surgery for its beneficial effects on postoperative outcomes. Prehabilitation enhances physical function in areas including the 6-minute walk test, helps respiratory function, reduces hospital lengths of stay, and decreases surgical complications. Improved mental health and social function have also been associated with prehabilitation.

“Poor physical capability and psychological symptoms such as anxiety and depression are common among older adults with non-small cell lung cancers,” the authors wrote, “and represent potentially modifiable risk factors to help patients to achieve resiliency rather than disability.”

The authors advised that prehabilitation for older adults should emphasize activities of daily living, self-care, mobility, and resilience compared with young patients. The optimal duration or frequency of prehabilitation is up for debate, but most patients are advised to begin their programs after assessment and to continue after surgery. Focusing too much on prehabilitation to the point of allowing for disease progression is, of course, an area of potential concern.

Although previous studies investigating prehabilitation have included older patients, evidence gaps remain as to how it affects daily living, self-care, mobility, and resilience in older patients specifically, the review explains. The impact of frailty, too, requires further study.

“Interventions that focus on empowering older adults to enhance resiliency and prevent functional decline during preoperative therapy and surgery are urgently needed,” the authors advised.