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What Can I Do to Feel Better?

(Hint: The answer may include cancer prehabilitation.)

by Julie Silver, MD

When I was diagnosed with cancer 10 years ago, I re­member my initial shock. I also recall that I had to wait to start treatment. I had medical appointments during that period, but I also had plenty of time to worry. As a rehabilitation physician, I know there is a better way to use this critical window of time between diagnosis and the beginning of treatment – and it’s called cancer prehabilitation.

Cancer prehabilitation should be standard care for most newly diagnosed individuals. The goal of prehabilitation is to prepare a person – both physically and emotionally – for upcoming surgery and other cancer treatments. For exam­ple, if you’re newly diagnosed with prostate cancer, you would attend a pre­habilitation workshop where you would learn pelvic floor muscle exercises to decrease the potential for post-operative urinary incontinence. You would also learn strategies to reduce anxiety and lower stress.

In prehabilitation, it’s ideal to com­bine emotional support techniques with physical strategies for improving gen­eral strength and endurance, as well as more focused physiological outcomes, such as shoulder range-of-motion exercises for a woman about to have a mastectomy or swallowing exercises for a man facing head and neck cancer treatment. This tag team of emotional and physical support through scientifi­cally proven interventions is designed to improve both your treatment experience and your health outcomes.

The goal of prehabilitation is to prepare a person – both physically and emotionally – for upcoming surgery and other cancer treatments.

Author of Article photo

Dr. Julie Silver

A cancer diagnosis affects both physical and emotional health, and the relationship between the two is strong, meaning it’s likely that the better you feel physically, the better you will feel emotionally, and vice versa. A recent study found that survivors have a sig­nificantly worse quality of life due to physical or emotional problems than people who haven’t had cancer. The study also found that more survivors had a reduced quality of life because of physical problems rather than emo­tional ones. Other studies have shown that one of the leading causes of dis­tress in survivors is physical disability. The obvious conclusion is that if we prevent physical problems early on through prehabilitation interventions, many cancer survivors will feel better both physically and emotionally.

Too often, cancer survivors struggle more than they need to. They may have a cluster of side effects, including pain, fatigue, and stress, that feed off of each other, making it hard to sleep at night and function during the day. While each side effect might not be a big problem on its own, together they can cause sig­nificant physical and emotional disability.

Rehabilitation teams work together to address several cancer-related issues at once. This has a synergistic healing effect that can markedly improve how survivors feel and function in a rela­tively short period. Cancer prehabilitation can help survivors of all types and stages of cancer to function at a higher level and feel better.

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Dr. Julie Silver is an associate professor in the department of Physical Medicine and Rehabilitation at Harvard Medical School in Boston, MA. She is the author of What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope (American Cancer Society). Dr. Silver has developed a national model for cancer rehabilitation called the STAR Program (Survivorship Training and Rehabilitation), which has been adopted by more than 100 hospitals and cancer centers throughout the United States. Learn more about the STAR Program at

This article was published in Coping® with Cancer magazine, November/December 2013.