Prehabilitation before major cancer surgery – a guide for patients

You have been referred to our service because you are having major surgery for cancer at St Vincent’s Hospital Melbourne. Major surgery is like running a marathon, and so preparation and training is required. Our aim is to have you as fit as possible at the time of surgery. This will help when you are recovering from surgery. We want you to return to normal functioning as quickly as possible.

Some patients having major cancer surgery have chemotherapy and/or radiotherapy before surgery. If this is the case, you will be given specific advice about staying as fit as possible during these treatments. This will include advice about staying active and having a good diet. Cigarette smokers will be given advice and assistance (nicotine replacement) to stop smoking.

Once you have completed your chemotherapy and radiotherapy we will focus on getting you as fit as possible. If you are not having chemotherapy or radiotherapy before surgery this process will begin immediately. This is what we refer to as “Prehabilitation”. The important parts of Prehabilitation are:

1. Diet and nutrition
2. Exercises to improve your fitness and strength
3. Breathing exercises to reduce the chance of pneumonia
4. Treatment of medical conditions

One to two months before your planned surgery you will receive a phone call or appointment so that the formal Prehabilitation process can begin. There is more detail on Prehabilitation process below.

The Prehabilitation process

1. Improving your diet and nutrition – you will be seen by a dietician who will give you specific advice about improving your nutrition before surgery. It is common to be prescribed nutritional supplements. There is a particular focus on protein. It is very important to have a high protein intake before major surgery, and your nutritional supplements will provide this.

2. Increasing your fitness and strength – patients who have cancer and have had chemotherapy or radiotherapy are less fit than they were beforehand. We want you to be as fit as possible so that you recover well from surgery. Our preference is that you attend the gym at St Vincent’s Hospital for regular, supervised exercise sessions. This means spending 30 minutes on an exercise bike and approximately 15 minutes doing some resistance exercises. We would like you to do this three times per week. If you live far away, or are otherwise unable to attend our gym, we will give you advice about exercising closer to home. Some patients find it difficult to use an exercise bike, and they will given different exercises. We encourage all patients to walk, but the exercise program you are prescribed will be more intense than simple walking. All patients can improve their fitness before surgery, and patients who are unfit should know that they are the ones who generally show the most improvement. We would typically recommend starting the exercise program approximately one week after chemotherapy/radiotherapy finishes, or as soon as possible if you are proceeding straight to surgery. Most patients will also have a cardiopulmonary exercise test, which is a 15 minutes test of your fitness. This may be repeated after one month of the exercise program.

3. Breathing exercises – it is very important that you do not get a chest infection after surgery. You will meet with a physiotherapist who will teach you breathing exercises that you need to practice at home before surgery. After surgery, the physiotherapist will ask you to do similar breathing exercises. These are an important part of preventing pneumonia.

4. Treatment of medical conditions – Most patients are referred to a Specialist Physician. Common medical problems that need to be treated before surgery are anaemia, poorly controlled diabetes, lung disease and heart disease. Your physician will give you specific advice and may change your medications as required.

In the weeks before surgery you will also see an Anaesthetist in our clinic (PAC-Anaesthesia). One important purpose of this visit is to provide information about pain relief after surgery, and what you should expect with regard to your recovery.

We understand that some of the tasks above are not easy and that they require multiple trips to our Hospital. They are a very important part of making sure your recovery is as smooth and fast as possible. A formal Prehabilitation Program is an important part of helping you achieve a smooth recovery.