Prehabilitation can have an impact
In 2023, Molenaar et al. published results from the PREHAB Randomised Clinical Trial (2), which found that a four-week supervised lifestyle intervention for patients diagnosed with colorectal cancer could reduce postoperative complications by almost 50 %. However, this four-week timeframe is two weeks longer than that outlined in the patient pathway for colorectal cancer in Norway (3). The results from the study raise the concern that a singular focus on throughput times and the timing of the surgery may have caused avoidable postoperative complications in many patients that could have been avoided if the time had been taken to implement a personalised prehabilitation programme. But complications were hardly what Solberg had in mind when she referred to the care pathways as a 'success'.
Prehabilitation is a term that has only gained traction in Norway in the last few years, although it was first mentioned in connection with the development of the enhanced recovery after surgery (ERAS) protocol back in 1997 (4). It refers to a lifestyle intervention that serves as preparation for treatment, as opposed to rehabilitation, which involves recovery after treatment. Prehabilitation also differs from preventive medicine in that it refers to a treatment intervention following a diagnosis, while preventive medicine denotes a lifestyle that specifically prevents the onset of disease.
A multimodal prehabilitation programme consists of four 'pillars': physical exercise to strengthen the heart and build muscle, optimisation of diet (primarily to ensure adequate protein intake), psychological support to mentally prepare patients for the upcoming process, and smoking cessation (5). The aim is to empower patients to take an active role in their treatment, thereby enhancing their sense of control and improving their tolerance for cancer surgery (6). This, in turn, will lead to a better quality of life (7), fewer complications (8) and faster recovery (9, 10). Prehabilitation can also provide long-term benefits in the form of a sustainable healthier lifestyle after treatment is completed (11).
One weakness in the available evidence, however, is the lack of standardised prehabilitation programmes. The length, content and outcome measures of the programmes vary, but most document some kind of health benefit (12–14). In the study by Molenaar et al., patients were offered three hours of supervised exercise per week for four weeks, which is a relatively short programme, but it nevertheless had a striking effect on the complication rate (2). Shorter periods in hospital have been reported among patients who receive prehabilitation, possibly by up to two days (15), which is also consistent with a quality improvement project by Akershus University Hospital (16). Different levels of cost savings associated with prehabilitation have also been reported, but further studies are needed to estimate national savings (17).