# Multimodal prehabilitation for older patients before major cancer surgery

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

## TL;DR

A few weeks of exercise, nutrition and mental preparation before a big operation helps older patients recover faster and with fewer complications. It costs little and should be routine.

## Summary

Prehabilitation programmes combining exercise, nutritional optimisation, and psychological support before surgery have shown reductions in complications and length of stay in colorectal and other cancer surgery, including in randomised trials, with the largest effects in frail and older patients. The waiting time before surgery is usually long enough. Making prehabilitation a standard offer for patients over 70 scheduled for major cancer surgery would apply existing evidence.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Prehabilitation will reduce postoperative complications by at least 25% and length of stay by at least one day in patients over 70, with improved functional recovery at three months.
- Rationale: Physiological reserve determines surgical outcome in older patients and is modifiable in weeks; the evidence base is now sufficient for implementation.
- Proposed test: A stepped-wedge implementation across ten surgical units with complications, length of stay, and functional recovery as endpoints.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- 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): https://doi.org/10.1016/S0140-6736(21)01789-X

## 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/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [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/), [Where rehabilitation is commissioned, and who misses out](https://onco.cc/technologies/rejuv-rehab-commissioning-inequity/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- 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: [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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