Prehabilitation is a needs-based multi-modal intervention before and during cancer treatment.
Prehabilitation involves screening before needs-based assessment, enabling individualised prescription of exercise, nutrition and psychological interventions supported by behaviour change techniques.
Cancer prehabilitation aim
The aim of cancer prehabilitation is to:
- Optimise physical, nutritional and psychological status
- Enhance readiness for and tolerance of treatments
- Improve recovery and/or quality of life
What is included in prehabilitation
Prehabilitation is most commonly delivered using a multimodal and multidisciplinary approach, across a range of surgical populations, including cardiac, orthopaedic, upper and lower gastrointestinal, and thoracic surgery, as well as non-surgical cancer populations receiving treatments such as chemotherapy, radiotherapy, and haematological therapies
Although the optimal prehabilitation program has not yet been determined, current evidence and guidelines consistently recommend multimodal delivery1-6. Although the specific components of prehabilitation programs vary across healthcare settings and countries, the most common core domains include exercise, nutrition, and psychological support, with additional disciplines incorporated according to individual patient needs.
The Macmillan Cancer Support prehabilitation guidelines1, first developed in 2018, recommend a stepped approach to interventions, and categorises these into universal, targeted and specialist care based upon screening and assessment of individuals with cancer.
Figure 1. Modified from MacMillan Prehabilitation interventions triangle1.
Watch: Video example of a multidisciplinary prehabilitation program
Peter MacCallum Cancer Centre’s prehabilitation program, courtesy of Peter MacCallum Cancer Centre, 2024.
Enhanced recovery after surgery (ERAS) protocols
While some prehabilitation programs include education, cessation of smoking and medical optimisation, others see these as part of enhanced recovery after surgery (ERAS) protocols. ERAS refers to a multimodal perioperative care pathway that aims to reduce the stress response to surgery and accelerate post operative recovery7. The main components of ERAS across the surgical pathway are shown in Figure 2.
Figure 2. Components of ERAS across the surgical pathway
Adherence to ERAS varies between surgeons and centres and so the inclusion of targeted education and optimisation into a prehabilitation program may be important.