ideasIdea
Four weeks of training and nutrition before major cancer surgery, as standard
Getting fitter and better nourished before an operation reduces complications and speeds recovery. It is cheap, but only a few hospitals do it.
Multimodal prehabilitation combining aerobic and resistance exercise, protein supplementation, anaemia correction and smoking cessation has reduced complications in randomised trials and meta-analyses of major abdominal cancer surgery. Adoption is patchy because it requires service redesign rather than a product, and because delaying surgery by weeks feels counterintuitive.
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.
What would test it
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
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks
- Cachexia, toxicity and the limits of the patient · Patients often die of wasting or cannot tolerate the doses that would work. Treating the patient, not just the tumour, lags far behind.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.