Rehabilitation: A missing piece in cancer policy

Professor Tara Rampal from QuestPrehab discusses the role of prehabilitation in cancer care, noting its benefits as well as barriers to access and how these can be overcome via a ‘digital first’ approach

Prehabilitation is the focused, multimodal optimisation of patients in the weeks before surgery or cancer treatment, combining targeted exercise, nutritional support, psychological preparation and lifestyle change. It transforms the waiting period into an active phase that improves fitness, resilience and treatment tolerance. Evidence from UK and international programmes shows that prehab can reduce complications, shorten length of stay, lower readmissions and support faster return to usual activities and work, while improving quality of life and patient experience.

The National Cancer Plan recognises that improving survival requires not only earlier diagnosis and better treatments but also strengthened supportive care and rehabilitation. A ‘digital‐first’ offer of personalised support is highlighted as part of this vision, alongside ambitions to tackle inequalities and make better use of scarce workforce and estates. In this context, prehabilitation is a system‐level tool to help people arrive at treatment in the best possible shape – and to help services use every theatre slot and bed day wisely.

The evidence is clear, so why is prehabilitation not the standard of care?

Despite the strong evidence base and clear policy direction, prehabilitation is far from universal in cancer pathways. Provision remains patchy, with some areas offering sophisticated programmes and others with little or no structured support. Traditional gym‐ or clinic‐based models are resource‐intensive, competing with core clinical activity for space and staff, and many depend on short‐term innovation funding. Services also differ in eligibility criteria, intensity, duration and outcome measures, making it hard for commissioners to compare value or embed prehab consistently. Hospital‐centric models can entrench inequity, particularly for people in rural or deprived communities, those with caring responsibilities or inflexible work, and those with limited financial resources. Many programmes also lack robust operational and economic data – for example, on cancellations avoided, bed days released or readmissions reduced – so prehabilitation can struggle to compete when systems are making difficult investment choices.

Digital‐first prehabilitation as a policy lever

Digital prehabilitation offers a way to resolve many of these tensions. Instead of relying on a physical ‘prehab gym’, digital models combine virtual assessments, app‐based programmes, remote monitoring and telehealth to deliver personalised support at home and in the community. Patients can complete tailored exercise, nutrition and psychological tasks where they live, with guidance and feedback from clinicians delivered through secure digital platforms.

Multiple studies show that digital or hybrid prehab models are feasible, acceptable and capable of achieving comparable – and in some cases superior – outcomes to purely in‐person programmes, while using fewer resources. They allow specialist oaches to support larger cohorts more efficiently, support more precise targeting of higher‐risk patients and reduce unwarranted variation by standardising protocols and outcome measurement. Thoughtfully designed digital prehab can extend reach by reducing travel burden, fitting around work and caring responsibilities, and creating new routes to engage people who might otherwise disengage from services. Services must pay close attention to connectivity, accessibility, language and digital literacy, and be prepared to blend remote and in‐person support where needed. At system level, however, digital prehabilitation is a practical way to operationalise the National Cancer Plan’s ‘digital‐first’ ambition while addressing workforce and estate constraints.

Not all prehabilitation programmes are created equal

Digital prehabilitation is often miscast as a generic intervention: some exercises on an app, a few education modules and automated reminders. In reality, the design of the model – how deeply it is personalised, how well it integrates mind and body, and how effectively it supports behaviour change – determines whether it delivers marginal gains or transformative impact.

QuestPrehab is built on the premise that the ‘holy grail’ of prehabilitation is the combined effect of physical optimisation, psychological resilience and sustained motivation. The service moves beyond standard exercise prescriptions or one‐size‐fits‐all content libraries. Each patient receives a personalised programme based on clinical risk, baseline function, preferences and context. Exercise intensity, nutritional strategies, psychological tools and lifestyle goals are tailored from the outset and then dynamically adjusted as the person progresses or their circumstances change.

Major surgery and cancer treatment are physiologically, emotionally and cognitively demanding. QuestPrehab deliberately combines physical training with techniques to manage anxiety, build confidence and strengthen self‐efficacy. Coaching is central: rather than leaving patients alone with digital tasks, the model blends structured digital content with human support that uses behaviour‐change principles to sustain engagement over weeks and months. This combination of precision, holistic support and motivational coaching differentiates QuestPrehab from more generic, protocol‐only approaches. It underpins the service’s ability to deliver meaningful improvements in clinical outcomes and patient experience, while generating robust data on engagement, complications and resource use for value‐based decision‐making.

QuestPrehab: operationalising digital prehabilitation at scale

QuestPrehab is a clinically led digital prehabilitation platform and service designed specifically for major surgery and cancer pathways. It delivers personalised programmes across four core domains – exercise, nutrition, psychological support and lifestyle – through an app‐enabled virtual model that integrates alongside existing MDT and perioperative workflows. Patients undergo assessments and are allocated tailored ‘quests’ that guide them through progressive activities, with real‐time tracking of adherence and outcomes.

For clinicians, QuestPrehab offers streamlined dashboards and communication tools to monitor large cohorts, identify those who need extra support and make timely adjustments without excessive administrative burden. For organisations, it avoids the need for new physical estates while generating a rich dataset on engagement, functional gains and downstream utilisation. Evaluation across oncology cohorts has demonstrated reductions in postoperative readmissions and complications, alongside improvements in health‐related quality of life and faster return to usual activities. Economic analyses indicate that digital models such as QuestPrehab can be substantially more cost‐effective than traditional face‐to‐face prehab, driven by lower infrastructure costs, more efficient use of staff time, reduced travel and released bed days.

Crucially, QuestPrehab is aligned with the trajectory set by the National Cancer Plan and wider UK and European calls to harness digital health to address workforce shortages, improve equity and empower people to take an active role in their care. It provides practical implementation infrastructure for systems that want
to move quickly from policy intent to measurable improvement.

Policy priorities to mainstream digital prehabilitation

To move digital prehabilitation from promising innovation to routine component of cancer care, several policy priorities are clear. First, prehabilitation – including digital options – should be explicitly embedded within national and regional cancer pathways, service specifications and quality indicators, signalling that helping people prepare for treatment is core business rather than an optional extra. Second, systems need targeted investment in scalable digital infrastructure and robust evaluation, with innovation funding and procurement frameworks prioritising proven platforms that can demonstrate clinical outcomes, operational benefits and interoperability with wider cancer digital tools.

Equity must remain central. Digital prehab services should be co‐designed with patients and communities, with support for access, language and digital literacy, and with routine monitoring of uptake and outcomes by deprivation, ethnicity and geography. The goal must be to narrow, not widen, existing gaps in cancer outcomes and experience.

England has set an ambitious course for cancer care, with a clear expectation that digital innovation will help close the gap between what is possible and what is currently delivered. Digital prehabilitation is a ‘now’ solution: the evidence, technology and service models exist today. The opportunity for governments, integrated care systems and provider collaboratives is to make digital, personalised prehabilitation a standard offer on the cancer pathway
– and to partner with clinically led services such as QuestPrehab to accelerate implementation.

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