{"entity":{"id":"idea-bio2-prehabilitation-standard","kind":"idea","name":"Four weeks of training and nutrition before major cancer surgery, as standard","aka":[],"tldr":"Getting fitter and better nourished before an operation reduces complications and speeds recovery. It is cheap, but only a few hospitals do it.","summary":"Multimodal prehabilitation combining aerobic and resistance exercise, protein supplementation, anaemia correction and smoking cessation has reduced complications in randomised trials and meta-analyses of large abdominal cancer operations. Adoption is patchy because it requires service redesign rather than a product, and because delaying surgery by weeks feels counterintuitive.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Cachexia, toxicity and the limits of the patient): Fearon et al., Definition and classification of cancer cachexia (Lancet Oncology 2011)","url":"https://doi.org/10.1016/S1470-2045(10)70218-7"},{"label":"Molenaar et al., Effect of multimodal prehabilitation on reducing postoperative complications and enhancing functional capacity following colorectal cancer surgery: the PREHAB randomized clinical trial (JAMA Surgery 2023)","url":"https://doi.org/10.1001/jamasurg.2023.0198"},{"label":"Bottleneck evidence (Older and multimorbid patients are excluded and undertreated): Mohile et al., Evaluation of geriatric assessment and management on toxic effects of cancer treatment (GAP70+, Lancet 2021)","url":"https://doi.org/10.1016/S0140-6736(21)01789-X"}],"tags":["protocol-upgrade","upgrade:promising","evidence:moderate"],"related":["idea-exercise-as-adjuvant","idea-pu-enhanced-recovery-with-measured-compliance"],"cancers":["colorectal","esophageal","pancreatic","gastric"],"sections":["surgery","rejuvenation"],"technologies":["exercise-oncology","geriatric-assessment","prehabilitation","rejuv-rehab-prehabilitation-evidence","rejuv-rehab-prehabilitation-programme"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["prehab-trial"],"people":[],"bottlenecks":["b-cachexia-supportive","b-care-fragmentation","b-survivorship","b-aging-comorbidity","b-surgery-radiation-innovation"],"keyPapers":["paper-molenaar-jama-surg","paper-fearon-lancet-oncol"],"journals":[],"dependsOn":[],"notes":["Graded promising rather than proven: the corpus record rejuv-rehab-prehabilitation-evidence sets out that training before an operation reliably improves fitness, while the effect on complications depends on the operation and on who was recruited. Adoption is not measured by any survey OnCo holds."],"hypothesis":"System-wide prehabilitation reduces major postoperative complications by a fifth and length of stay by a day, and increases the proportion of patients fit to receive adjuvant therapy on time.","rationale":"Postoperative complications delay or prevent adjuvant therapy, which affects cancer outcomes, so a perioperative intervention has oncological consequences. The components are all cheap and have independent evidence.","test":"A stepped-wedge implementation trial across a regional surgical network with complications, length of stay and adjuvant therapy delivery as endpoints, and a cost analysis.","maturity":"being-tested-at-scale","actor":"clinic","cost":"medium","horizonYears":4},"route":"/ideas/idea-bio2-prehabilitation-standard/","neighbours":{"idea":[{"id":"idea-pu-enhanced-recovery-with-measured-compliance","kind":"idea","name":"Enhanced recovery after cancer surgery, with each element's compliance measured and fed back","route":"/ideas/idea-pu-enhanced-recovery-with-measured-compliance/"},{"id":"idea-exercise-as-adjuvant","kind":"idea","name":"Structured exercise prescribed like a drug in all curative-intent cancer care","route":"/ideas/idea-exercise-as-adjuvant/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"},{"id":"prehabilitation","kind":"technology","name":"Prehabilitation before cancer surgery","route":"/technologies/prehabilitation/"},{"id":"rejuv-rehab-prehabilitation-programme","kind":"technology","name":"What a prehabilitation programme actually contains, and how long it needs","route":"/technologies/rejuv-rehab-prehabilitation-programme/"},{"id":"rejuv-rehab-prehabilitation-evidence","kind":"technology","name":"What the randomised trials of prehabilitation found, operation by operation","route":"/technologies/rejuv-rehab-prehabilitation-evidence/"},{"id":"rejuv-rehab-commissioning-inequity","kind":"technology","name":"Where rehabilitation is commissioned, and who misses out","route":"/technologies/rejuv-rehab-commissioning-inequity/"}],"trial":[{"id":"prehab-trial","kind":"trial","name":"PREHAB: multimodal prehabilitation before colorectal cancer surgery","route":"/trials/prehab-trial/"}],"bottleneck":[{"id":"b-cachexia-supportive","kind":"bottleneck","name":"Cachexia, toxicity and the limits of the patient","route":"/bottlenecks/b-cachexia-supportive/"},{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"paper":[{"id":"paper-fearon-lancet-oncol","kind":"paper","name":"Definition and classification of cancer cachexia: an international consensus","route":"/key-papers/paper-fearon-lancet-oncol/"},{"id":"paper-molenaar-jama-surg","kind":"paper","name":"Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial","route":"/key-papers/paper-molenaar-jama-surg/"}],"term":[{"id":"prehabilitation-term","kind":"term","name":"Prehabilitation (the pre-treatment window)","route":"/terms/prehabilitation-term/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"},{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}