Cancer Services – Prehabilitation – Bradford Teaching Hospitals NHS Foundation Trust

Welcome to Cancer Services' Prehabilitation page

Prehabilitation (prehab) enables people with cancer to prepare for treatment by promoting healthy behaviours in order to help them cope better with treatment and improve their long-term outcomes. Think of it like rehabilitation that takes place before the event, rather than after.

At Bradford Teaching Hospitals NHS Foundation Trust, we will support patients to engage in exercise, healthy eating and have improved emotional well-being. This should lead to reduced time spent in hospital and reduced need for readmission to hospital.

The video below (Prepwell, South Tees NHS, 2018) explains changes you can make to improve your health and wellbeing and the benefits of doing so.

The video focuses on surgery but also applies to people having radiotherapy and chemotherapy treatments.

What does prehabilitation involve?

Prehabilitation combines many aspects of your health and well-being. The three main components are physical activity, nutrition/dietary support and psychological well-being

We will also support you with other behaviour change, such as stopping smoking or alcohol reduction if you would like.

How this may help you:

Better response to treatment
Quicker recovery
Fewer problems during treatment
Reduced anxiety and improved mood
Improved energy levels
Take an active part in your cancer care
Reduce the risk of cancer recurrence
Improve your general fitness and other health conditions
Be able to do your normal activities

Physical activity

There is lots of evidence to suggest that it is safe to keep active in the weeks leading up to surgery and during chemotherapy and radiotherapy. This can help with:

Reducing tiredness
Managing any side effects of treatment
Keeping your heart healthy
Reducing anxiety and depression
Maintaining a healthy weight
Strengthening muscles
Improving flexibility & balance
Increasing confidence and self esteem
Reducing the risk of cancer coming back
Improving overall quality of life

Physical activity doesn’t have to mean a lot of hard work, it could just be going out for a walk, gardening or using your stairs at home. Anything that makes you feel a bit out of breath!

Macmillan Cancer Support has a series of videos taking you through some exercises that you can do at home, see the link below.

Your ability to undertake any form of exercise will depend on a number of factors, such as your current fitness level and any underlying health conditions, such as high blood pressure. It is important to make sure you speak to your GP or your key worker before taking up any new forms of exercise.

www.youtube.com/playlist?list=PL4YhGgVzlQXjhq6UYbX7idSDYcPX5PRy9

(Macmillan Move More programme including warm up, strength & endurance, cool down, 2016)

The podcast below talks about the benefits of remaining physically active before, during and after cancer treatment. This podcast was produced in collaboration with Macmillan Cancer Support to support patients during their cancer journey amidst the COVID-19 crisis.

topmedtalk.libsyn.com/topmedtalk-macmillan-cancer-support-get-active-and-feel-good

Diet and nutrition

Eating a variety of foods from all food groups is beneficial to overall health and wellbeing. This may aid tolerance to treatment and help you to cope with the symptoms and side-effects of cancer and cancer treatments. There are many diets, herbal medicines and dietary supplements that claim to cure cancer or slow its growth; however there is no reliable scientific evidence to support this. Some products may be harmful when taken during chemotherapy or radiotherapy because they can interfere with how these treatments work. It is important that you speak with your doctor or specialist nurse about any over-the-counter supplements—including vitamins and herbal supplements – you are taking or planning to take.

For people who are underweight, losing weight or at risk of losing weight, there is strong evidence that improving nutrition can benefit clinical outcomes, particularly around surgery, for example reducing risk of complications after surgery and promoting wound healing. Eating well can also improve your ability to be physically active, maintain your weight and improve your energy levels.

Here at BTHFT, we have a Macmillan Oncology Specialist Dietetic Service which provides support and advice to people affected by cancer with any concerns about their nutrition, weight, eating and drinking.

There is lots of information out there about nutrition and cancer, particularly on the internet and not all of this is reliable. The Macmillan Oncology dieticians can support you with tailored practical dietary advice and support from the point of diagnosis, during treatment and through to living with and beyond cancer. We can help if you:

are experiencing weight loss
are underweight
are struggling with eating and drinking due to symptoms/ side-effects such as:
- poor appetite
- taste changes
- swallowing difficulties
- feeling full quickly
- dry or sore mouth
- changes in bowel habit, e.g. constipation or diarrhoea
have questions about alternative diets.

We accept referrals for people with (or who have had) cancer who are over the age of 18, have a Bradford GP or are undergoing their cancer treatment at Bradford Teaching Hospitals. Just ask your GP, consultant or clinical nurse specialist to refer you to the Macmillan oncology dietitians.

There are some websites listed in the ‘Useful links’ section which are good places to look for reliable information on cancer and nutrition:

And in the video below, Highly Specialist Macmillan Oncology Dietitian Fiona Enright explains more about the service.

The podcast below also discusses how you can ‘eat well to stay well’ when facing a cancer diagnosis.

https://topmedtalk.libsyn.com/topmedtalk-macmillan-cancer-support-healthy-eating-and-cancer

Psychology and emotion

The emotional impact of cancer

People will experience different emotions following a diagnosis of cancer, during their treatment and beyond. These challenges and life changes will affect those living with the diagnosis, and those close to them, and for many it can feel like being on an emotional rollercoaster.

There is no right or wrong way to feel when you have a cancer diagnosis, and different feelings can show up throughout your cancer journey. What is perhaps most important is to acknowledge how you are feeling and do the best you can to be kind and compassionate to yourself. We are all different, so it is good to find out what will support you best with whatever particular worries or challenges you meet along the way.

What can help?

Struggling with difficult feelings on our own can be tough and lonely. Perhaps some of the feelings you are experiencing are very new, perhaps they were already there. It is important to find someone you trust to talk to about how you are feeling. This could be a trusted friend, colleague, family member, religious leader or healthcare professional. Sharing our worries and concerns can help us to find ways through, and discover what we need to take care of ourselves or others, or just to feel a little less alone.

Sometimes the strategies that can help us to deal with stressful feelings or worry are deceptively simple, but very effective when we put them into practice. Here are a few ideas:

Dealing with problems that can be addressed

It may be that some of our worries or concerns can be addressed and have a solution, for example getting information from a health professional or having a conversation we have been putting off. It is often helpful when we can focus on what we can control, even when our mind is still full of worries and concerns about lots of things.

Finding what helps you to relax

We may become aware of feeling stressed and needing to let go of some of the tension we are holding in our bodies, as best we can. People find relaxation in different things such as taking a warm bath, taking a walk or being in nature. Additionally some people find relaxation exercises can help, such as progressive muscle relaxation, calm/safe place imagery or soothing/deep breathing techniques.

Mindfulness

Learning to acknowledge what we are experiencing (thoughts, feelings, body sensations, urges) without judgement can really help us to see more clearly what is going on for us and make wise choices about what we need. This kindly, present-moment awareness is called “mindfulness”. Mindfulness can help us to better understand ourselves and what we need and also to take in good things that are here – even amidst difficult situations. If you wish, you can take steps to develop it in your own life. This video from Every Mind Matters takes you through a short breathing exercise you can try:

https://www.youtube.com/watch?v=wfDTp2GogaQ&app=desktop (Mindful breathing exercise, NHS Every Mind Matters, 2019).

There is lots more information on mental wellbeing including mindfulness and managing stress and anxiety the NHS website, https://www.nhs.uk/conditions/stress-anxiety-depression/mindfulness/ This also includes a selection of audio guides you can listen to in your own time to help you through feelings such as anxiety or a low mood https://www.nhs.uk/conditions/stress-anxiety-depression/moodzone-mental-wellbeing-audio-guides/.

Bradford Teaching Hospitals has a mindfulness service which can be accessed here: https://www.bradfordhospitals.nhs.uk/mindfulness/ Here you can find information about the Mindfulness courses we run at the Trust and some other useful links and videos.

Talking therapy

People are often able to manage the challenges they meet with cancer through support from family, friends and healthcare professionals. However, sometimes the difficult thoughts and feelings can impact on day to day life, mood and relationships in a way that feels unmanageable. When this happens, some people find it helpful to speak to a professional who has an understanding of the psychological effects of cancer, in a confidential setting.

We have a Clinical Health Psychology service in BTHFT to offer you support throughout your treatment and to help you find strategies to cope with difficult thoughts and feelings. Speak with your Specialist Nurse, your GP or another member of the hospital team who can advise and refer you if they think this service would be beneficial for you. Common concerns that they can help with include:

Feeling low, upset or angry after a diagnosis or treatment for cancer
Decisions about treatment and coping with treatment
Worries or fears about the future
Changes to the body after cancer or treatment
Difficulties in relationships that are impacted by cancer, including sexual intimacy

Other resources

The podcast below can help you to work through any difficult feelings you may be having. Hear how it is important to allow yourself to reflect; part of understanding your mental health is about regaining control, we are allowed to let ourselves feel difficult thoughts as part of the process of monitoring and working with them.

https://topmedtalk.libsyn.com/topmedtalk-macmillan-cancer-support-mental-well-being-for-the-patient (2020)

Crisis support

For support in a crisis or with general mental health needs, please contact Bradford’s First Response team on 01274 221181, your GP or the Samaritans on 116 123.

Supporting our wellbeing during coronavirus

The coronavirus pandemic is bringing uncertainty and great worry into many of our lives. We are being asked to stay at home and may find ourselves feeling isolated or anxious. We might be worried about ourselves or family members, especially if they are elderly or have underlying health conditions.

Often there are small steps that we can take to look after our wellbeing. Here are some important yet simple steps we can consider:

Acknowledge our thoughts and feelings, without judging them
Be kind to ourselves when things are tough, try to offer the same kindness we would with a dear friend
Take a pause when we feel overwhelmed, and ask ourselves what we need to take care
Focus on the things that we can control, including what we can do to support ourselves and others
Keep or create new routines
Exercise or move our bodies in whatever way if possible for us, following the guidance on social distancing or isolation
Stay connected to people – reach out and keep in touch with people you are connected with, for example using phone or video
Limit how often you read the media coverage
Avoid coping strategies that might have unhelpful consequences, such as drinking, drugs or smoking

Macmillan Cancer Relief SafeFit

SafeFit has been designed, in response to COVID-19, to support people living with cancer to maintain and improve their physical and emotional wellbeing, whilst following Government guidelines.

Smoking cessation

If you smoke, giving up is the healthiest decision you can make. Smoking can be a difficult habit to break, but there is plenty of support available. Smoking is the single biggest avoidable risk factor for cancer.

If you are having treatment for cancer, stopping smoking may help the treatment work better. It can help your body respond better to the treatment and heal more quickly. You are likely to have fewer, less severe side effects from cancer treatment if you do not smoke. The risk of cancer coming back after treatment may also be lower if you have stopped smoking.

If you decide to stop smoking before having surgery, it is best to do this 8 weeks beforehand. However, stopping even a few weeks before surgery and not smoking afterwards will reduce the risk of complications. If you stop smoking before having surgery:

you are likely to recover more quickly
you are more likely have a shorter stay in hospital
your wound is likely to heal more quickly.

Research has shown that stopping smoking during and after radiotherapy may make the treatment more effective. It can also reduce the side effects of radiotherapy.

BTHFT Stop Smoking Service

Support is available from the hospital to help you give up smoking. We have a specialist adviser who can give you lots of information about giving up smoking, help you prepare a plan for stopping and work out whether you would benefit from medicines to help improve withdrawal symptoms and reduce cravings.

If you feel you would benefit from this service, please speak with your nurse specialist who will refer you for an appointment.

You can also contact the Bradford District Stop Smoking Service on 01274 437700.

Useful links:

Cancer Services – Prehabilitation