Prehab, Rehab May Improve Health and Well-Being in Patients Receiving CAR-T Cell Therapy

Patients with cancer who have received CAR-T cell therapy, or are in between treatments prior to receiving the therapy, may benefit from prehab and rehab, according to an expert.

Aimee Green, a specialist physiotherapist at The Christie NHS Foundation Trust in the United Kingdom, explained that patients who receive CAR-T cell therapy often experience significant physical declines after treatment. Personalized care, such as prehab and rehab, is important for patients to gain back independence and become healthy after treatment.

Understanding Prehab and Rehab

Green explained that prehab is when a patient with cancer prepares for treatment through healthy behaviors such as exercise, diet and psychological interventions. One study from 2019 concluded that prehab may reduce the length of hospital stay and complications and enhance recovery and quality of life after treatment. Another study from 2017 demonstrated benefits can be observed in as little as two weeks after prehab.

“Obviously, the earlier that we can intervene, the better for the patient outcomes,” Green said at the EBMT-European Hematology Association 4th European CAR-T Cell Therapy Meeting.

When considering prehab, a patient with cancer should have relapsed or refractory disease after two or more systemic therapies, be in between treatments and feel engaged in their personalized treatment.

“We need to consider that our patients have already lost some physical function, could have psychological impacts (and) may not be nutritionally optimized. We need to think about delivering the prehab early and, in some cases, we may need to deliver rehab to actually restore some of those impairments,” she explained.

Cancer rehabilitation is a very broad area, Green said, but it should be intergraded throughout cancer care. Rehab can be used to maintain or restore a patient’s function after cancer treatment, as well as reduce symptom burden and improve quality of life, she explained.

When delivering rehab, it is important to take into account the side effects CAR-T cell therapy may have on a patient with cancer including neurotoxicity, and there should be potential precautions on physical activity.

Receiving prehab or rehab can help improve a patient’s quality of life after treatment and help them get back where they were prior to it but receiving both can make a patient feel even better, Green said.

Green discussed 2020 data from Macmillan Cancer Support that demonstrated patients who receive prehab had an improved quality of life than those who did not. In addition, similar results were observed for those who received rehab. Those who received both prehab and rehab recovered to how they were feeling prior to treatment, and some even felt better.

Opportunities and Challenges

Prehab and rehab can be beneficial to patients with cancer receiving CAR-T cell therapy and great opportunities are arising with it. As CAR-T cell therapy continues to expand as a treatment option for many different hematological cancers and solid tumors, the opportunities for prehab and rehab to be beneficial in this special continue to grow. These opportunities include room for research and development of CAR-T cell therapy since it is a novel option; the demonstrated benefits of prehab in nonsurgical oncology; and the optimization of health and well-being between treatments. In addition, patients who are receiving CAR-T cell therapy may have received other lines of therapy, which may affect them psychologically during current treatment.

However, these opportunities with CAR-T cell therapy may also come with challenges, Green explained. Some challenges include limited evidence related to prehab and rehab, the absence of guidelines, limited patient access, impact related to the COVID-19 pandemic and the lack of education for patients, caregivers and families on the importance of prehab and rehab.

Green explained that patients with cancer should have access to personalized care during and after treatment. This can be ensured by a list of concerns created by the patient, patient-centered goals and interventions throughout the journey as the patient’s needs change.

“What’s important for one patient might be different than for somebody else, and we need to make sure we tailor our prehab around that,” she said.

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