Dr. Psutka on integrating prehabilitation tools into urologic care


“In terms of trying to help patients access the services, the biggest part is just being aware of what's available where you work,” says Sarah P. Psutka, MD, MS.

In this video, Sarah P. Psutka, MD, MS, discusses ways that urologists can incorportate prehabilitation practices in patient encounters, which was a topic discussed during a session at the Bladder Cancer Advocacy Network (BCAN) Think Tank titled, “Cultivating resilience across the spectrum of bladder cancer care: developing a multimodal (p)rehabilitation toolkit." Psutka is an associate professor of urology and urologic oncologist at the University of Washington Medical Center and Fred Hutchinson Cancer Center in Seattle, Washington.

Video Transcript:

It's going to depend for each surgeon on what their local resources look like. One of the nice things about this session is we had folks from academic cancer centers and folks from community practices, so we were able to think about what resources are available broadly, and which might be more specific to one's own practice environment. In terms of trying to help patients access the services, the biggest part is just being aware of what's available where you work. As a urologist, when I see my patients, I try to understand from their perspective, where they see their potential weaknesses are at. I also do fairly detailed functional assessments with a geriatric assessment in clinic to identify specific risks that we can mitigate. If you don't look for risks, you can't know that somebody needs help with those problems. So, if you don't look for malnutrition, you may not know that a patient needs to get to nutrition. If you don't look for physical frailty, you may not know that a patient would benefit from PM&R. The tricky bit is accessing screening tools and integrating those into your practice in a way that doesn't add a ton of time or a ton of cost to an average practice encounter.

But [there are] basic things that all urologists can do. First of all, there are a lot of resources that are publicly available for patients who are dealing with a cancer diagnosis. Patient facing advocacy organizations like BCAN are a great repository of potential tools, webinars, educational resources, that we can direct our patients to that don't require a single provider to have handouts or videos that are on-demand or ready to access. I do think it's important to talk to patients about their physical function, their activities of daily living, their independence at baseline, and then identify potential areas of weakness. Social support is a really big factor in bolstering resilience and supporting patients as they go through cancer care, so understanding the ecosystem within which a patient lives at home and who's available to help them as they're recovering from a major intervention is really critical. It can be as simple, and I say that somewhat facetiously, because I know that none of this is simple, but small moves are getting the social work involved early. Because they can do a much more detailed deep dive into that patient's ecosystem at home and their support network and understand if they need a visiting nurse or if they need to help with transportation, things like that, for folks who are dealing with low resources.

On the other hand, asking about weight loss and nutrition is really critical to identify those risk factors. And then physical function; we do some basic physical function assessments, but for patients who are going to go through a major abdominal operation, and potentially with chemotherapy or systemic therapy on either end of that surgery, I do think about understanding a patient's basic physical activity profile. Then, I have a low threshold, especially with my older patients and my patients who come in and they're using assistive devices, or they say they're not moving around much at home. I have a low threshold to get them over to physical medicine and rehab for a really detailed assessment. Especially if they say, "I'm interested in in trying to get stronger for surgery or to try to improve my physical activity profile", then that's a great time to partner with patients and engage them in their care and say, "Here's the one thing that you can really do. You can work on your exercise, you can work on your nutrition as you're going through therapy, and I can get you to people who can help you with that." So, a big part of it is knowing who your teammates are, and then, if you identify specific weaknesses or vulnerabilities within your patient, getting them to the right folks to help them out.

This transcription has been edited for clarity.

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