# Four weeks of training and nutrition before major cancer surgery, as standard

Source: https://onco.cc/ideas/idea-bio2-prehabilitation-standard/  
OnCo record `idea-bio2-prehabilitation-standard` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed 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

## Sources

- Bottleneck evidence (Cachexia, toxicity and the limits of the patient): Fearon et al., Definition and classification of cancer cachexia (Lancet Oncology 2011): https://doi.org/10.1016/S1470-2045(10)70218-7

## Connected records

- ideas: [Structured exercise prescribed like a drug in all curative-intent cancer care](https://onco.cc/ideas/idea-exercise-as-adjuvant/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/), [What a prehabilitation programme actually contains, and how long it needs](https://onco.cc/technologies/rejuv-rehab-prehabilitation-programme/), [What the randomised trials of prehabilitation found, operation by operation](https://onco.cc/technologies/rejuv-rehab-prehabilitation-evidence/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)
- key papers: [Definition and classification of cancer cachexia: an international consensus](https://onco.cc/key-papers/paper-fearon-lancet-oncol/)
- terms: [Prehabilitation (the pre-treatment window)](https://onco.cc/terms/prehabilitation-term/)
- trials: [PREHAB: multimodal prehabilitation before colorectal cancer surgery](https://onco.cc/trials/prehab-trial/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

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