Discussion
anxiety, breast cancer, pain, UL pain, UL dysfunction, depression, disability
BREAST CANCER
Prehabilitation is an emerging research area [Multi-modal prehabilitation should be considered by clinicians within clinical service re-design [Multimodal prehabilitation should consider all facets of the person and include support from oncology specialist nurses and programs such as exercise, psychology, and nutrition and educational components as needed by the individual. Long-term physical and psychological wellness is key to recovering from BC treatments and its side effects. Implementing a prehabilitation program could ensure people are well supported as they go through this period of their lives.Quitting smoking has been shown to increase survival, improve healing times and surgical outcomes [As part of holistic care for participants with BC prehabilitation, UL assessment and therapy should form part of prehabilitation given that UL dysfunction is a common effect of treatment. UL pain was shown to increase over time indicating that disability will also increase for many. This shows the need to support the patient through the treatment phase and beyond even with a successful prehabilitation program. Understanding the impact of movement and exercise over this period should be a high priority and future direction for research. Exercise improved anxiety and stress and participants and health care workers were supportive of the program and believed it helped with their recovery. The qualitative exploration identified that participants wanted multimodal interventions rather than unimodal.Complementary and alternative programs may be supportive of the goal of prehabilitation in people with BC. These included psychological support, aromatherapy, traditional medicine, comprehensive nursing, and relaxation techniques including mind–body work. Improvements in cognition, mental state, quality of life, decreased anxiety, depression, and pain were attributed to complementary therapies, in all but one study in this review.While some significant changes were observed in this review there are limitations that must be considered. Studies did not always report the type of BC (or treatment/ specific surgery details), increasing the heterogeneity, and not allowing us to draw more accurate conclusions for the type of participants, including male participants. However, what we have shown is that prehabilitation could improve many outcomes for people with breast cancer and should be further explored.