Breast cancer prehab: Setting women up for better treatment outcomes

If we can bring patients into cancer wellness as soon as they’re diagnosed, they will be healthier and more resilient throughout treatment.”

Breast cancer patients are generally referred to a wellness program at some point during their cancer journey. The Novant Health team in the Charlotte area is making sure women start regaining their wellness much sooner — shortly after diagnosis and before surgical intervention.

“If we can bring patients into cancer wellness as soon as they’re diagnosed, they will be healthier and more resilient throughout treatment,” said Jan Wagoner, director of cardiopulmonary rehabilitation and cancer wellness at Novant Health. “The earlier they’re referred, the better.”

Novant Health is piloting a neoadjuvant chemotherapy prehab program for breast cancer patients as part of their greater cancer wellness program. The program began in 2022 at Novant Health Presbyterian Medical Center and has expanded to Huntersville and Matthews.

“Traditionally, a patient wouldn’t see a physical therapist until after their surgery and after there’s a problem,” said Michelle Newell, manager of cancer wellness and nutrition at Novant Health. “This way, we’re getting ahead of it by giving them tools in their toolbox before surgery, which means we can help them avoid issues post-op.”

A breast cancer diagnosis isn’t a signal to rest. It’s a signal to take action. This wellness program establishes an individualized timeline for improving overall well-being throughout each patient’s breast cancer journey.

Prehab patients enter a multidisciplinary wellness program while receiving chemotherapy.

“Patients begin exercising with us two to three days a week while they’re going through chemotherapy,” Newell said.

“It’s great because exercise minimizes the fatigue and side effects of treatment. Working out in a group setting adds a layer of psycho-social support.”

The education and support don’t stop with group exercise. “Our team includes nurses, all trained to work with cancer patients,” Newell said. “Patients receive education, nutrition recommendations and constant support for addressing medical needs, boosting motivation and resilience, and, in a way, we become their second family.”

The goal is for patients to start feeling better physically and mentally as soon as possible. “Exercise is medicine, food is medicine,” Newell said. “We teach them how they need to eat to feel good and how to safely exercise to maintain muscle, lean body mass and strength.”

Another important step in the prehab program is an early physical therapy evaluation.

“Once they have their surgery date set, they will have their prehab visit with a physical therapist,” said Erin Ball, regional manager of rehabilitation at Novant Health. “They work to address any preexisting problems that they need to get ahead of. This is also an opportunity to educate the patient about what to expect after surgery and to allay any fears.”

The focus on wellness continues after surgery.

As a result of prehab, patients can anticipate faster recovery. “They’ll come right back into cancer wellness as soon as their doctor clears them for exercise. They will continue their group exercise program and further evaluation with physical therapy,” Wagoner said.

The physical therapist examines how a patient moves, what their level of mobility is with their joints and tissues, and whether they have any restrictions. “It’s not unusual for a patient undergoing surgery for breast cancer to experience different challenges, whether it be scar tissue, tight muscles, pain or decreased range of motion,” Ball said. “If these concerns are not figured out quickly during recovery, they can start to snowball.”

The physical therapist guides the patient through relevant therapy, which can include massage, scar mobilization, joint mobilization, exercise and more.

After recovery, patients have the option to extend their wellness journey with Novant Health.

The post-surgery cancer wellness program is a three-month program that is a continuation of their prehab exercise.

Since prehab is so important for our neoadjuvant breast cancer survivors, Novant Health provides this program as a part of a patient’s cancer journey. The cancer wellness program is offered at a monthly fee. However, scholarships are available for those in need, making cancer wellness exercise affordable for all patients.

“Our support for these women lifts them and improves their quality of life at a time when their world has been turned upside down,” Wagoner said. “The prehab program empowers them to take control of their journey.”

This program has been so popular, our physicians asked to expand prehab to patients with other cancer diagnoses who receive neoadjuvant treatment plans. Such prehab is offered now in our cancer wellness programs throughout Novant Health.