Prehabilitation and cancer

What is Prehabilitation?

Prehabilitation, or “prehab,” is a programme of support and preparation for treatment for patients about to undergo surgery or other medical interventions . Prehab prepares the patient for the operation or other treatment to increase their resilience and improve the outcomes of treatment. It involves a combination of physical exercise, nutritional advice, and psychological support to help individuals become as fit and healthy as possible before a procedure, which can lead to better outcomes, a faster recovery, and fewer complications. It’s a proactive approach to strengthening your body and mind to better cope with the stress of treatment. 

Indications for Prehab

Perhaps the most obvious procedures for which Prehab is applied are orthopaedic operations. Prehab for these patients is facilitated by the usually long interval between decision to operate and actually reaching the operating surgery.

This applies much less to cancer patients – for them the interval between diagnosis and treatment is kept as short as possible. The NHS target is that this should be no more than 31 days but this target is often missed. In Wales, for example, the average waiting time is 39 days and some patients have a much longer wait.

This time need not be totally wasted. It can be used to prepare the patient for the rigours of treatment which might include surgery, radiotherapy, chemotherapy or all three. Some of the benefits include faster recovery, particularly after surgery, reduced complications, improved quality of life and greater resilience.

Physical fitness and Effectiveness of cancer treatment

A number of measures of patient health are known to affect the success of cancer treatments. Preoperative level of physical fitness is a measure of survival in patients with lung cancer. A meta-analysis of studies on the success of operations for lung, bladder, liver, pancreatic, rectal and colorectal cancers has shown the a higher preoperative fitness level is associated with a lower risk of complications of surgery. The presence of frailty has been shown to increase the chance of post-op complications, longer hospital stay, and mortality.

Prehab has also been used to make it possible to operate at all. Some lung cancer patients have such low fitness levels that surgery is considered too unsafe before that low level of fitness is addressed.

Results of Prehab

A 2025 meta-analysis of randomised controlled trials (RCTs) compared preoperative exercise training versus no preoperative exercise for lung cancer patients scheduled for lung resection. A total of 16 RCTs with 1,022 individuals were included. Compared with no preoperative exercise, those treated had one third the risk of post-op complications and a significant reduction in hospital stay. Other benefits included better lung function and reduced breathlessness in the treated group. There was no difference in 30 day mortality but longer survival was not examined.

Some benefits of prehab in different cancer groups have also been analysed and were reported earlier this year. 96 studies were included and divided into the different cancer sites such as gynaecological, breast, urological, gastrointestinal and lung cancer. The wide variety and the variability in the actual exercise regimes used and their timing made it difficult to produce clear outcome measures  but the authors were able to identify benefits for patients with gullet and lung cancer. They concluded that “exercise as prehabilitation may have an important role in improving physical fitness, postoperative outcomes and accelerating recovery, especially in certain types of malignancies.”

Longer-term benefits of Prehab

The benefits of prehab for cancer patients are limited by the time available to initiate the exercise programme. There are also difficulties in continuing the programme during treatment; treatment which may involve recovery from surgery as well as coping with the side effects of chemotherapy and radiotherapy. However it is widely believed that exercise training should be incorporated in the management plan for cancer. Pre-operative application of this plan should start as soon as possible after diagnosis.

Cancer Management Plan

Prehabilitation is a very convenient and helpful introduction to the long-term exercise programme which, ideally, should be part of the management plan for most cancer patients. Next time I will discuss the benefits of such programmes in improving outcomes including the length of both healthspan and lifespan as well as reduction in side effects of treatment and other symptoms.