The HealthXchange website will cease selling SingHealth Pharmacare products from 20 December 2022.
Did You Know?
Facebook Page Box Widget
Cannot retrieve the URL specified in the Content Link property. For more assistance, contact your site administrator.
Prehabilitation helps to facilitate and optimise the patient's return to health following treatment.
The prehabilitation process begins when patients are newly diagnosed with cancer. Next, patients undergo frailty, functional, and mental wellness tests performed by the Prehabilitation team helmed by a Rehabilitation Specialist Doctor, who then draws up a personalised intervention plan that includes exercise prescriptions as well as advice relating to nutrition and mental wellness.
In the case of Changi General Hopital's (CGH) home-based programme, the hospital offers a one-stop solution in order to reduce the number of patient visits for pre-operation assessment and subsequently to allow patients to do their prehabilitation in the comfort of their homes. This eliminates the need for patients to make multiple visits to the hospital. For more on CGH's prehabilitation programme, read the article here.
If you have questions about prehabilitation care, don't hesitate to ask Dr Kwok Kah Meng, Consultant from the Department of Rehabilitation at CGH, a member of the SingHealth group, in this month's ‘Ask the Specialist’ Q&A forum.
The forum is open from 1 May to 25 May 2022.
To post your question, please log in as a member. If you are not a member, you can register for a FREE membership here.
If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
Question posted by Tang SY
Dear Dr Kwok,
Answered by Dr Kwok Kah Meng, Consultant, Department of Rehabilitation, Changi General Hospital (CGH)
1. While cancer treatment is critical to manage or eradicate the cancer, some side effects can happen. In some patients, these can cause functional decline and a delayed recovery. Cancer prehabilitation is the process of care, initiated before surgery or treatment for cancer, where patients’ physical, nutritional, medical and mental health domains are optimised, so as to facilitate their return to pre-treatment state of health.
Changi General Hospital (CGH)’s Cancer Prehabilitation Programme is a one-stop screen-and-intervene initiative which gives newly diagnosed patients a head-start in recovery before their cancer treatment or surgery. By adopting a home-based model and cutting down time spent in the hospital, patients can focus fully on their prehabilitation so as to achieve improved recovery outcomes.
CGH carried out a pilot study of some 60 colorectal cancer patients, which found that patients who have undergone prehabilitation showed significant improvement in physical tests measuring their functional capabilities. This also translated to better functional recovery after surgery. The patients also had a significant improvement in their mental health, and went home earlier by an average of 1.5 days after the surgery, with reduced readmission and mortality rates.
The CGH Cancer Prehabilitation Programme team will continue to care for the patients even after their cancer treatment (surgery, chemotherapy, radiotherapy) ends. It comes in the form of individualised follow-up plans that will leverage on the progress achieved (eg. in improvement of physical fitness) and to promote longer-term health benefits. In general, most types of cancer can benefit from prehabilitation.
2. The assessment to determine the suitability of a patient for cancer treatment is carried out by both the surgeon and anaesthetist if the treatment involves surgery or the oncologist if the treatment involves chemotherapy or radiotherapy. The purpose of prehabilitation is to optimise the health status of the patient before their cancer treatment commences, with the goal to facilitate subsequent recovery post-treatment and improvement to long-term health.
The surgeon or oncologist will typically recommend patients to the Cancer Prehabilitation Programme led by a rehabilitation medicine doctor. Patients are mostly seen on the same day for their first prehabilitation consultation. They will undergo a holistic health assessment comprising frailty, functional and mental wellness tests by the prehabilitation team. Based on the results and their medical conditions, the rehabilitation doctors will draw up a personalised intervention plan in four areas, including optimisation of pre-existing chronic conditions, an exercise prescription, and specific advice relating to nutrition and mental wellness.
At the second consultation, prior to their cancer treatment, patients will undergo the same set of assessment tests to measure their progress. We will continue to monitor their recovery after their surgery, chemotherapy or radiotherapy sessions.
3. In general, for the prehabilitation programme, we try to include all patients by working around these limitations in whichever possible ways, based on available resources and setting.
CGH has expanded its prehabilitation programme to include more patients with liver, pancreas, gallbladder, prostate, bladder, oesophagus and stomach cancers. We aim to include as many patients as possible based on resources and settings.
As for suitability pertaining to a particular cancer treatment, the managing surgery/oncology team will be in a better position to advise on alternatives. As cancer types and conditions vary for individuals, it is recommended that you seek advice from your oncology or surgery team, who will be able to advise on treatment options.
Question posted by kim
Hello Dr,
Thank you for your advice.
1. Protein is required for wound healing after a surgery. However, the body's ability to use protein effectively can be affected when one has cancer or if one has to undergo surgery. To overcome this, we will usually prescribe a protein-rich diet before surgery. Examples of protein-rich food include eggs, meat, milk or milk products, legumes and nuts, but this will need to be individualised based on the patient's needs and preferences. The commonly known "healthy diet" rules still apply, and one should avoid food that contain excessive salt, sugar and fat.
2. Exercising is one of the most important ways to build up your body for cancer treatment. In our Cancer Prehabilitation Programme, exercise forms an important component because it contributes to a faster recovery post-operation. For patients who experience challenges in starting exercises due to their medical conditions, they can undergo a prehabilitation consultation where the doctor can work out an individualised, practical, home-based exercise plan for them.
3. We also recognise the importance of maintaining mental wellness of patients undergoing cancer treatment. Noting that patients may feel stressed, anxious or depressed after a cancer diagnosis, we included a mental health assessment as one of the key areas in our prehabilitation consultation. Together with the patient’s family, we can then help advise them on coping strategies and reinforce positive behaviour in the areas of exercises and dietary intake. Under our multi-disciplinary approach, we may consider a referral to a medical social worker or a psychiatrist (very rarely) based on our assessment of their condition.
Question posted by Jeff
What are the physical and psychological effects that a patient can expect to face while undergoing cancer treatment?
How does prehabilitation prepare a patient for these effects?
The types of side effects depend on the mode of cancer treatment.
