Prehabilitation in Radiation Therapy: A Scoping Review

Abstract

Radiation therapy (RT) is a central component of cancer treatment with survival and long-term quality-of-life benefits across a spectrum of oncologic diagnoses. However, for certain cancers, RT has been associated with high levels of fatigue, pain, weight loss, and changes in mental health both during and post-treatment. Prehabilitation aims to optimize health prior to anti-neoplastic therapy in order to reduce complications, increase adherence to treatment, expedite posttreatment recovery, and improve long-term outcomes. Though prehabilitation has been studied in those undergoing cancer-related surgery, literature on prehabilitation in individuals undergoing RT has not been comprehensively explored. Thus, this scoping review aims to summarize the existing literature focused on prehabilitation interventions for patients receiving RT. The PRISMA-ScR checklist for conducting scoping reviews was adopted to identify and evaluate studies investigating the efficacy of prehabilitation before and during RT for cancer over the past 21 years (10/2002-10/2022). A search of prehabilitation and RT was performed to identify studies investigating prehabilitation interventions in adult cancer patients before or during RT. A total of 31 articles met inclusion criteria, yielding 4,031 total participants. Nineteen (61%) studies were randomized controlled trials with sample sizes ranging from 26-221. The most commonly studied populations were patients with head and neck cancer, followed by rectal, breast, and lung cancer. A majority (87%) of studies evaluated one prehabilitation intervention (i.e., unimodal). Targeted exercises were the most common intervention, followed by general exercises and technology/apps. Adherence/feasibility was the most common primary outcome, representing 23% of studies. All studies collected data on sex, and six (19%) studies collected data on race and/or ethnicity. Prehabilitation interventions have been successfully implemented in samples of patients with cancer undergoing surgical treatment. Studies demonstrating the efficacy of prehabilitation in RT are evolving. Though our review identified many RCTs, they were frequently small trials with primary outcomes focused on feasibility, rather than functional status. Thus, there is a need for adequately powered, randomized controlled intervention trials to investigate the efficacy of prehabilitation in RT.