Dr. Psutka recaps BCAN session on prehabilitation in bladder cancer care


"Given the time constraints and financial constraints of working in the systems that we all work within, trying to make it easier to get patients to these adjuvant services that do exist and making sure we capitalize and utilize those is critical," says Sarah P. Psutka, MD, MS.

In this video, Sarah P. Psutka, MD, MS, highlights a session that took place at the 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:

We had a really robust discussion. We started out by framing the problem around resilience. The way that I think about this is the problem is frailty, or vulnerability to stressors. Everyone has a specific personalized frailty profile. The objective is to cultivate resilience, which is the ability to withstand those stressors and bounce back to one's baseline or even potentially become stronger, fitter, more well, [and] healthier in the context of going through the stress of a cancer diagnosis and cancer treatment. Then, the solution that my co-panelists and I were proposing is that prehabilitation, or interventions that are put in place alongside medical care with the goal of increasing fitness, can help to bolster patients' resilience and mitigate their frailty profiles to help patients get through therapy more safely and also improve quality of life through survivorship.

We were taking a very broad lens here. We were thinking from diagnosis through treatment, and then post-treatment in the surveillance period and throughout the survivorship of bladder cancer. So, we started with that framework and dived into what resilience is and how its measured. We're taking a topic that has been well described in psychosocial medicine and in psychology and trying to apply it to oncology. It's an active area of research. It's a key priority area for research for the NIA and for oncology at this point.

I was lucky to be leading this panel with Dr. Hanna Hunter and Dr. Jessica Engle, who are both cancer rehabilitation doctors with a specific interest in this specialty and taking care of patients who are dealing with the diagnosis of cancer going through cancer therapy. Dr. Hunter got into talking about how to pragmatically set up a prehab program. We were taking an exercise-as-medicine lens to this, thinking about how she sets up screening for patients to identify specific personalized vulnerability profiles and areas where patients can improve. She's an amazing resource for us here at the Hutch because I end up sending a lot of my patients who are getting ready for abdominal surgery [or] cancer surgery to her. She will develop personalized exercise prescriptions that are meant to help a patient withstand the stresses and also the physical and functional disability that is expected with abdominal surgery.

Then, she talked about some exciting newer initiatives that we have here at the Hutch for supportive care collaboration. So, not having the onus for identifying all of the vulnerabilities beyond a single provider, but using all of the different adjunct specialties that surrounds cancer care. Nutrition, physical medicine and rehab, physical therapy, occupational therapy, oncology, primary care – having there be a fair amount of crosstalk so that if, for example, 1 patient is identified as having malnutrition, that can trigger a functional assessment to make sure they don't also have functional frailty and trigger auto referrals to the right people, so that it's not just the oncologist who has to identify all of the different additional services that need to be involved. I think that's important because a lot of times patients can fall through the cracks. We may not identify specific vulnerabilities if we're not looking for them. Given the time constraints and financial constraints of working in the systems that we all work within, trying to make it easier to get patients to these adjuvant services that do exist and making sure we capitalize and utilize those is critical.

Then, Dr. Engle brought up a couple of important points that sparked some exciting discussion around how to take a lifestyle medication lens to all of this and think about, pragmatically, healthy changes that are easy to institute. [She talked about] how we can help make it easier for patients to set up healthy habits that allow them to sustain their fitness, get through the tough therapies that we're asking them to get through, and then ultimately, improve their quality of life through survivorship. She also talked a lot about the robust virtual cancer support programs that are in existence already that we have to make sure we know about so we can get our patients to them. It was a pretty wide-ranging discussion with a lot of problem solving by this community that is very invested in trying to not only scientifically measure resilience, but also think about how we can improve our resilience profiles in our patients. [This meaning,] how we can start to link resources and make them easier to access to improve quality of life during cancer care and beyond.

This transcription has been edited for clarity.

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