Universal prehabilitation is the provision of expert advice on exercise, nutrition and psychological support, along with behaviour change advice, to all individuals before cancer treatment.
Who should receive universal interventions
Universal interventions are generally applicable to all people with cancer. This includes information to promote a healthy lifestyle, with a focus on modifiable behaviours that can make the greatest improvement to an individual’s health and wellbeing, including1:
- Healthy eating
- Keeping to a healthy weight
- Being physically active and physically fit
- Improving mental health and wellbeing
- Stopping smoking
- Drinking alcohol only within the recommended limits and ceasing 4 weeks before surgery.
Universal interventions for all people with cancer also provide education on2:
- Motivation and behaviour change
- How to self-manage
- How to recognise and respond to any changes in physical and/or psychological state
- Further resources and supports available.
Who can provide universal interventions
Universal interventions can be delivered by any member of the multidisciplinary team as well as primary care providers or may be self-guided by the individual with cancer. It may be delivered through written resources, videos and/or a group class face to face or through video conferencing.
Universal intervention recommendations for people with cancer undergoing major surgery
In addition to the general universal intervention recommendations for all people with cancer above, there are a number of more specific exercise, nutrition and psychological universal intervention strategies that are recommended to better prepare patients for major surgery.
MacMillan Cancer Support guideline1 recommends offering universal interventions to all people with cancer awaiting surgery, but individual health services will need to decide if this is provided just to eligible individuals for their prehabilitation program, or more broadly to others undergoing cancer surgery, based on the format of the universal interventions and resources available.
People with cancer receiving targeted and specialist interventions in particular areas (exercise +/- nutrition +/- psychology) should also receive the universal intervention.
Cessation of smoking*
Recommend quitting smoking at least 4 weeks before surgery. Education and advice should cover:
- Benefits of quitting
- How to develop a quit plan
- Triggers to smoking
- Strategies to stop smoking
- Quitting medications available
- Resources and support services to assist.
For more information about providing individualised patient assessment and intervention see Medical optimisation: Respiratory
Resources to direct individuals with cancer to assist with smoking cessation: Visit Quit website.
Cessation of alcohol*
Recommend drinking alcohol only within the recommended limits and cessation of alcohol for 4 weeks prior to surgery. Education and advice should cover:
- Recommended alcohol intake limits (for the time period earlier then 4 weeks prior to surgery)
- Benefits of stopping drinking
- Strategies to stop drinking
- Triggers to drinking
- Resources and support services available to assist.
Resources to direct individuals with cancer to assist with managing alcohol:
Visit Cancer Council website
Visit Australian Government Department of Health website
*Note that unhelpful health behaviours such as smoking or alcohol use may be associated with high levels of distress, and extra care should be taken to ensure adequate psychological screening for these individuals with cancer and consideration of targeted or specialist level of psychological prehabilitation intervention. Graded tasks may be required to gradually reduce rather than immediately cease substances for some individuals.
Evaluation of universal interventions
Services should consider implementing measures such as patient reported outcome measures (PROMs) e.g. EQ-5D-5L and patient reported experiences measures (PREMs) to evaluate the universal intervention. This may occur at any timepoint relevant to your service. Further information on these evaluation measures can be found here.