The Clinical Advisor asked Julie Silver, MD, this question: What is the role of primary care nurse practitioners and physician assistants in the cancer prehabilitation process?

Here is Silver’s response: 

When someone is suspected of having cancer or is newly diagnosed, the transition from primary care to oncology may involve delays. Cancer prehabilitation is a new field that has demonstrated improved physical and psychological health outcomes. Prehabilitation involves specific assessments and interventions performed by health care professionals during the distinct period of time before treatment begins. NPs and PAs are often involved and working on appropriate referrals and treatment plans.

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Being knowledgeable about prehabilitation and its benefits will ensure that patients receive this care. In oncology prehabilitation, protocols are ideally multimodal and include, but are not limited to, assessments and interventions for smoking cessation to improve surgical and other outcomes, nutrition supplementation and counseling (especially protein supplementation in vulnerable patients prior to surgery), psychosocial strategies (e.g., meditation or progressive muscle relaxation to decrease stress during this very stressful time), and exercise (both general exercise as well as targeted exercise, such as improving strength in breathing or swallowing muscles).

NPs and PAs who are part of oncology teams should be actively supporting multimodal prehabilitation protocols at their institutions. For those in primary care, it is important to consider making referrals to hospitals and cancer centers that provide prehabilitation. Primary care providers can help patients get a head start by prescribing smoking cessation interventions and referrals to dieticians, physical therapists, and mental health professionals. (196-5)

Julie Silver, MD, is an Associate Professor in the Department of Physical Medicine and Rehabilitation at the Harvard Medical School in Boston. Silver developed a national model for cancer prehabilitation and rehabilitation called the STAR (Survivorship Training and Rehabilitation) Program®, which has been adopted by more than 200 hospitals and cancer centers throughout the United States (

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