Preparing for and Not Waiting for Surgery

Abstract

Cancer surgery is an essential treatment strategy but can disrupt patients' physical and psychological health. With worldwide demand for surgery expected to increase, this review aims to raise awareness of this global public health concern, present a stepwise framework for preoperative risk evaluation, and propose the adoption of personalised prehabilitation to mitigate risk. Perioperative medicine is a growing speciality that aims to improve clinical outcome by preparing patients for the stress associated with surgery. Preparation should begin at contemplation of surgery, with universal screening for established risk factors, physical fitness, nutritional status, psychological health, and, where applicable, frailty and cognitive function. Patients at risk should undergo a formal assessment with a qualified healthcare professional which informs meaningful shared decision-making discussion and personalised prehabilitation prescription incorporating, where indicated, exercise, nutrition, psychological support, 'surgery schools', and referral to existing local services. The foundational principles of prehabilitation can be adapted to local context, culture, and population. Clinical services should be co-designed with all stakeholders, including patient representatives, and require careful mapping of patient pathways and use of multi-disciplinary professional input. Future research should optimise prehabilitation interventions, adopting standardised outcome measures and robust health economic evaluation.

Keywords: cancer surgery; cognitive; exercise; functional capacity; nutrition; perioperative medicine; physical fitness; prehabilitation; psychology.

Figure 1

Overview of the differential health trajectories related to adherence to prehabilitation prior to surgery. The cancer care continuum begins at the point of diagnosis and contemplation of surgery. While the health system works through necessary diagnostic and administrative processes, the patient can begin to prepare to face the metabolic stress of surgery. Those who arrive at the operating theatre physically fit, nutritionally replete, and psychologically prepared are likely to suffer less severe response to surgical stress, recover more quickly and more fully, and regain previous or improved functional capacity and quality of life in the longer-term postoperative period.

Figure 2

Overview of the proposed framework for optimal preparation prior to surgery. The period between diagnosis and surgery can be repurposed from waiting time to preparation time. This is reliant upon early screening for risk and targeted assessment, informing meaningful shared decision-making, surgical education, and personalised prehabilitation prescription, underpinned by behaviour change, established medical management, and enhanced recovery techniques.