{"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"}],"tags":[],"related":["idea-exercise-as-adjuvant"],"cancers":["colorectal","esophageal","pancreatic"],"sections":[],"technologies":["exercise-oncology","geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-cachexia-supportive","b-care-fragmentation","b-survivorship"],"keyPapers":["paper-fearon-lancet-oncol"],"journals":[],"dependsOn":[],"notes":[],"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-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":"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/"}],"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":"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/"}],"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-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/"}],"term":[{"id":"prehabilitation-term","kind":"term","name":"Prehabilitation (the pre-treatment window)","route":"/terms/prehabilitation-term/"}],"trial":[{"id":"prehab-trial","kind":"trial","name":"PREHAB: multimodal prehabilitation before colorectal cancer surgery","route":"/trials/prehab-trial/"}],"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/"}]}}