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Mike Cohen beat the statistics, but he still felt guilty. After a battle with esophageal cancer, he was left wondering: “Why did I make it? What am I here to do?”
When his wife, Ros, was diagnosed with the same cancer just two years later, Mike had his answer: “I made it because I had to get her through.”
Mike says that watching a loved one fight cancer is “far tougher” than being sick yourself. But an innovative “prehabilitation” program meant Mike wasn’t supporting Ros’ recovery alone.
The Newcastle program – known as C-SPRITES – is led by clinical specialist physiotherapist Dr Jennifer Mackney. She says prehabilitation is a “multimodal intervention” delivered before surgery, incorporating exercise training, nutritional optimisation, psychological support and education.
Ros had lost 10 kilograms in just a month of chemotherapy and radiation, leaving her barely able to walk from the carpark to the hospital front door, let alone face surgery. Ahead of a keyhole esophagectomy, Ros attended prehabilitation three times a week for three weeks, and felt herself grow stronger with each session, both physically and mentally.
For Ros, the program meant taking back agency over her body after months of being shuttled between tests and treatments. “Finally, I could actually participate in my recovery,” she says.
The camaraderie formed with other patients was “so uplifting”, Ros says. Meanwhile, the personalised support ahead of her operation “took away the stress of thinking: can I get through this?”
“I felt a bit like a sports person preparing for a marathon,” she says. “It rebuilt me.”
Dr Mackney says prehabilitation can significantly lower the risk of postoperative complications and reduce the length of hospital stay by about two days, with the potential to save the healthcare system money.
“Part of the challenge is that prehab isn’t uniquely funded as a program yet,” says Dr Mackney, and it isn’t covered by Medicare or health insurers. Instead, programs such as C-SPRITES – first trialled at John Hunter Hospital – are often initiated as part of a research program and funded by grants.
Dr Judith Lacey, who leads the integrative oncology program at Chris O’Brien Lifehouse, says prehabilitation is a “relatively new” concept in cancer care, so funding hasn’t caught up with it yet.
“For us to advance in this space we need to provide the evidence, and that’s where we’ve been focusing over the last few years, running research programs and publishing [our findings].”
C-SPRITES is now expanding in five rural and regional locations, supported by the NSW Regional Cancer Research Network and the Hunter Medical Research Institute.
While her success cannot be solely credited to prehabilitation, Ros was able to go home 10 days after surgery.
In comparison, Mike was discharged after three weeks following his more intensive esophagectomy. However, he was only home for two nights before returning to hospital for four months with a collapsed lung and possible sepsis.
Mike has been cancer-free since July 2023, and Ros since January of this year.
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