Location
Suwanee, GA
Start Date
6-5-2025 1:00 PM
End Date
6-5-2025 4:00 PM
Description
Introduction
Prehabilitation is defined as the process of optimizing a patient’s health prior to a medical or surgical intervention. Although this is an emerging concept and is not yet standard of care, literature has shown prehabilitation to be a potentially useful tool in medicine. In the field of gastroenterology, it has been primarily used for patients undergoing surgery to remove cancers. We want to utilize prehabilitation and apply it towards patients that are awaiting oncological treatment for asymptomatic, advanced gastrointestinal malignancies. This case report highlights the need for a specific prehabilitation protocol in these scenarios and discusses evidence-based recommendations based on literature.
Case Report
A 65 year old female presented in November 2024 with bloating, abdominal discomfort, and epigastric pain. She previously had one screening colonoscopy over 10 years ago. Abdominal ultrasound showed lesions in the liver. A computed tomography of the abdomen and pelvis was ordered and showed multiple liver lesions concerning for metastasis, a small lesion at the head of the pancreas, and wall thickening of the rectum with enlarged mesorectal lymph nodes. Results were suspicious for rectal malignancy. In January 2025, she underwent colonoscopy, which was significant for invasive colonic adenocarcinoma with high grade dysplasia. She was referred to oncology, but had questions concerning steps to take prior to her initial appointment. She wanted to know how to optimize her health prior to her oncology consultation.
Discussion
Prehabilitation should be multimodal, including nutritional support, physical activity, pharmacologic interventions, and psychological counseling. A review of literature suggests that this may improve treatment tolerance and treatment outcomes. Nutritional recommendations include moderate coffee intake, avoidance of certain supplements (antioxidants, vitamin B12, and iron), and intermittent caloric restriction. Exercise has been shown to enhance recovery and disease-free survival, particularly in stage III colorectal cancer. Additionally, prophylactic antiemetic regimens specific to the chemotherapy regimen can mitigate chemotherapy-induced nausea and vomiting. Psychological support, including relaxation techniques and counseling, may help address stress and prepare the patient mentally and emotionally for treatment.
Conclusion
This case report addresses the need for a prehabilitation protocol for patients with advanced, asymptomatic gastrointestinal malignancy. We used evidence-based literature to discuss the specific case of an advanced rectal malignancy, but the future use of prehabilitation shows great potential. It can be tailored to the patient’s specific case, including different types of malignancies, patient age, other medications, etc. More research is needed on the utility and application of a prehabilitation protocol, not only in the field of gastroenterology, but in other fields as well.
Embargo Period
5-28-2025
Included in
A prehabilitation protocol for the asymptomatic, newly diagnosed, stage IV colon cancer patient.
Suwanee, GA
Introduction
Prehabilitation is defined as the process of optimizing a patient’s health prior to a medical or surgical intervention. Although this is an emerging concept and is not yet standard of care, literature has shown prehabilitation to be a potentially useful tool in medicine. In the field of gastroenterology, it has been primarily used for patients undergoing surgery to remove cancers. We want to utilize prehabilitation and apply it towards patients that are awaiting oncological treatment for asymptomatic, advanced gastrointestinal malignancies. This case report highlights the need for a specific prehabilitation protocol in these scenarios and discusses evidence-based recommendations based on literature.
Case Report
A 65 year old female presented in November 2024 with bloating, abdominal discomfort, and epigastric pain. She previously had one screening colonoscopy over 10 years ago. Abdominal ultrasound showed lesions in the liver. A computed tomography of the abdomen and pelvis was ordered and showed multiple liver lesions concerning for metastasis, a small lesion at the head of the pancreas, and wall thickening of the rectum with enlarged mesorectal lymph nodes. Results were suspicious for rectal malignancy. In January 2025, she underwent colonoscopy, which was significant for invasive colonic adenocarcinoma with high grade dysplasia. She was referred to oncology, but had questions concerning steps to take prior to her initial appointment. She wanted to know how to optimize her health prior to her oncology consultation.
Discussion
Prehabilitation should be multimodal, including nutritional support, physical activity, pharmacologic interventions, and psychological counseling. A review of literature suggests that this may improve treatment tolerance and treatment outcomes. Nutritional recommendations include moderate coffee intake, avoidance of certain supplements (antioxidants, vitamin B12, and iron), and intermittent caloric restriction. Exercise has been shown to enhance recovery and disease-free survival, particularly in stage III colorectal cancer. Additionally, prophylactic antiemetic regimens specific to the chemotherapy regimen can mitigate chemotherapy-induced nausea and vomiting. Psychological support, including relaxation techniques and counseling, may help address stress and prepare the patient mentally and emotionally for treatment.
Conclusion
This case report addresses the need for a prehabilitation protocol for patients with advanced, asymptomatic gastrointestinal malignancy. We used evidence-based literature to discuss the specific case of an advanced rectal malignancy, but the future use of prehabilitation shows great potential. It can be tailored to the patient’s specific case, including different types of malignancies, patient age, other medications, etc. More research is needed on the utility and application of a prehabilitation protocol, not only in the field of gastroenterology, but in other fields as well.