An evidence-informed case for personalised, multimodal and digitally enabled support before cancer treatment
People diagnosed with cancer can benefit substantially
Cancer and its treatments can rapidly reduce physical fitness, nutritional status, psychological resilience and ability to recover. Prehabilitation identifies an individual’s risks and needs before treatment, then builds capacity to help the person tolerate treatment, recover function and maintain quality of life. A systematic review of 16 randomised trials (2,017 participants) found improvements in gait, cardiopulmonary function, lung function, urinary continence and mood around 30 days after treatment, although effects were not uniform across all studies. Evidence is therefore promising and clinically meaningful, while still evolving rather than universal or guaranteed.
It must be personalised and multimodal
There is no effective “one-size-fits-all” programme. Prehabilitation should begin with assessment of fitness, symptoms, nutrition, comorbidities, treatment plan, goals, confidence and emotional needs. The resulting plan should combine, as appropriate: physical exercise (aerobic, resistance and condition-specific training); nutritional advice (screening, dietary counselling and supplementation where indicated); and mental coping strategies (education, stress and anxiety management, behavioural support and access to psychological care). The rationale is complementary: exercise addresses deconditioning, nutrition supports energy and tissue repair, and psychological support helps people cope, engage and adhere. Reviews and clinical guidance describe needs-based prescribing across these domains; combined approaches may outperform isolated interventions, but the precise “dose” should be tailored and clinically supervised.
Access is the challenge, and digital delivery is part of the answer
Despite its potential, routine implementation remains limited by workforce capacity, coordination, geography, time before treatment and the cost and complexity of delivering multidisciplinary care at scale. Digital prehabilitation, using apps, video consultations, connected devices, remote monitoring and digital education, can extend specialist support into patients’ homes, reduce travel and scheduling barriers, and support measurement and personalisation. A 2024 systematic review of 16 technology-enabled studies found all reported feasibility, with several reporting improvements in physical function, fatigue, quality of life, distress or anxiety; videoconference-supervised programmes tended to show better physical outcomes. However, the evidence base is still heterogeneous and mostly small, so “works as well” should be stated carefully: digital models can deliver comparable components and promising outcomes for selected patients, but robust head-to-head equivalence evidence is not yet established. Digital should expand access, not replace human clinical oversight or exclude people with low digital confidence.
Bottom line
Every person diagnosed with cancer should be assessed for prehabilitation and offered a proportionate, personalised plan. A digitally enabled, clinically governed model can make exercise, nutrition and psychological support more scalable and accessible, while preserving escalation to face-to-face and specialist services when needed.
Models of this kind already exist in UK practice: services such as QuestPrehab deliver multimodal prehabilitation remotely within NHS pathways, with clinical oversight retained. Further detail and service case studies are published at questprehab.com.
Selected scientific sources
[1] Silver JK et al. Prehabilitation for adults diagnosed with cancer. Eur J Cancer Care. 2019;28:e13023. doi:10.1111/ecc.13023
[2] West MA et al. Personalised multimodal prehabilitation in cancer. Front Oncol. 2022;12:1086739.
[3] Tay SS et al. The use of technology in cancer prehabilitation: a systematic review. Front Oncol. 2024;14:1321493.
[4] Macmillan Cancer Support. Principles and guidance for prehabilitation within the cancer continuum. (Full text)
[5] Example of a digitally enabled service: QuestPrehab, a UK digital prehabilitation service delivering exercise, nutrition and psychological support remotely within NHS cancer pathways. Service information and case studies at questprehab.com.