OnCo
ideasIdea

Multimodal prehabilitation for older patients before major cancer surgery

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.

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.

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.
What would test it
A stepped-wedge implementation across ten surgical units with complications, length of stay, and functional recovery as endpoints.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks

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