LAUSR

In this month’s issue of European Urology, Pang et al [1] describe their prospective experience with an enhanced recovery after surgery (ERAS) care pathway for patients undergoing radical cystectomy. Patients managed by this protocol had reduced length of stay (8 vs 18 d, p < 0.001) and intraoperative blood loss (600 vs 1050 ml, p < 0.001) without concomitant rises in readmissions (15% vs 25%, p < 0.04) or detriments in oncological outcomes (equivalent survival). The authors should be commended for completing a large-scale, well-designed effort tailored to cystectomy and advising participants to engage in prehabilitationrelated activities. While counseling is a cornerstone of preoperative preparation, this raises an important consideration: if we tell our cystectomy patients to exercise more before surgery, how well will words alone prompt lifestyle adjustments? Evolving efforts to optimize health of patients by bolstering their nutritional, functional, and psychological well-being before surgery represent a growing and heterogeneous body of interventions commonly referred to as prehabilitation. However, changing the behavior of elderly patients diagnosed with cancer is a complex task, and compliance to a given program is as important as its content. Methodology from research on social, implementation, and behavioral health sciences may improve our ability to understand a patient’s perceived barriers and propensity to begin habits that lead to a healthier lifestyle. During the postsurgical period, the healing process is often encumbered by multiple obstacles: disrupted sleep, less energy, poor mood, increased anxiety, reduced cognitive function, and decreased fitness. Patient-centered