Cancer Prehabilitation and the Case for Delivering It Digitally at home
Turning the wait between diagnosis and treatment into preparation, at a scale health systems and patients can afford
Between a cancer diagnosis and the start of treatment there is usually a window of several weeks. Historically it has been dead time. Prehabilitation uses it. Through structured exercise, nutritional optimisation, psychological support and behaviour change delivered before treatment begins, patients arrive with greater physical and mental reserve. People who start fitter, better nourished and less anxious tolerate treatment better and recover faster.
What the evidence shows
• Fitness and mood improve across cancer types. A systematic review with meta-analysis of randomised trials found prehabilitation improved six-minute walk distance by 38.5 metres and significantly reduced both depression and anxiety scores.¹
• Serious surgical complications fall. In the international PREHAB trial of 251 colorectal patients, four weeks of multimodal prehabilitation cut severe postoperative complications from 29.7% to 17.1% (OR 0.47).² A blinded trial in high-risk abdominal surgery reduced the number of patients suffering complications by 51%.³
• Hospital stays shorten. Pooled data from 2,096 lung cancer surgery patients showed pulmonary complications more than halved (OR 0.45) and length of stay shortened by 2.46 days.⁴
• Benefits extend beyond surgery. In breast cancer, prehabilitation delivered during neoadjuvant chemotherapy protected arm function, improved walking capacity by 53 metres and significantly reduced cancer-related fatigue.⁵
• It is now UK policy, not just research. Guidance from Macmillan, the Royal College of Anaesthetists and the NIHR — published 2019, updated 2025 — recommends every person with cancer should have a co-developed, personalised prehabilitation care plan.⁶
The barrier is not evidence, it is access
Seventy per cent of the 1.8 million people living with cancer in the UK also live with at least one other long-term condition,⁶ precisely the group prehabilitation helps most, and the group least able to travel to a hospital gym while unwell. Face-to-face programmes are staff-intensive, geographically limited and hard to scale. Researchers designing current trials state it directly: compliance with hospital-based programmes is undermined by burdensome commuting, and prehabilitation must be personalised to individual profiles.⁷
Why digital delivery closes the gap (digital prehab)
A systematic review of remotely delivered, technology-supported prehabilitation before major surgery found it both feasible and highly acceptable to patients.⁸ A UK telehealth-delivered home-based service across colorectal, urology, breast and cardiothoracic centres enrolled 139 of 182 referrals and recorded significant improvements in self-perceived health and fatigue.⁹ Delivered digitally, a programme can start within days of diagnosis rather than waiting for a clinic slot, reach people in rural areas, in work or in under-served groups, and scale without new buildings. It also permits a depth of personalisation group classes cannot match: exercise intensity, protein targets and psychological support can be set from an individual’s baseline and adjusted continuously as fitness, treatment stage and symptoms change.
One caution runs through the digital health literature: technology alone does not hold people’s attention. Engagement and adherence rise substantially when a trusted human provides coaching, feedback and supportive accountability, and coached programmes consistently outperform self-guided ones.¹⁰ The strongest model is therefore neither purely digital nor purely face-to-face. Providers built around this “human-in-the-loop” approach, such as QuestPrehab, which delivers personalised prehabilitation remotely within NHS pathways, or through self referrals, pair the reach and tailoring of a digital platform with the named human relationship that keeps patients going through the hardest weeks of their lives.
Sources
1. Prehabilitation in cancer patients: systematic review with meta-analysis. BMC Cancer 2024. https://doi.org/10.1186/s12885-024-13023-w
2. Molenaar CJL et al. The PREHAB randomized clinical trial. JAMA Surg 2023;158:572–581. https://doi.org/10.1001/jamasurg.2023.0198
3. Barberan-Garcia A et al. Personalised prehabilitation, high-risk abdominal surgery. Ann Surg 2018;267:50–56. https://doi.org/10.1097/SLA.0000000000002293
4. Exercise prehabilitation before NSCLC surgery: systematic review and meta-analysis. 2023. https://www.sciencedirect.com/science/article/pii/S0748798323000902
5. Casanovas-Álvarez A et al. PREOptimize breast cancer RCT. Phys Ther 2024;104:pzae151. https://doi.org/10.1093/ptj/pzae151
6. Prehabilitation for people with cancer: guidance. Macmillan, RCoA and NIHR (2019; updated 2025). https://www.macmillan.org.uk/healthcare-professionals/cancer-pathways/prehabilitation
7. Kleve G et al. dHOPE digital home-based prehabilitation: trial protocol. Front Digit Health 2025. https://doi.org/10.3389/fdgth.2025.1609678
8. Blumenau Pedersen M et al. Digital technologies for home-based prehabilitation: review. The Surgeon 2023. https://doi.org/10.1016/j.surge.2023.05.006
9. Telehealth-delivered home-based prehabilitation for cancer patients. Curr Oncol 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293185/
10. Supportive accountability model in digital health interventions: scoping review. JMIR 2025. https://doi.org/10.2196/72639