Before surgery for stomach or food pipe cancer, doctors are finding that preparing your body and mind ahead of time really helps. Experts from different health fields—including exercise specialists, nutrition experts, and a patient who went through this—met to figure out what preparation works best. They agreed that the best approach combines three things: exercise, healthy eating, and mental health support. This study shows that hospitals should offer these preparation programs to all patients facing this type of surgery, not just some of them.
The Quick Take
- What they studied: What are the most important ways to help patients prepare their bodies and minds before surgery for upper stomach and food pipe cancers?
- Who participated: Eight healthcare experts including physical therapists, nutrition specialists, and one patient who had experienced this type of cancer surgery
- Key finding: Experts strongly agreed (100% agreement on 8 ideas, 70% or higher on 31 ideas) that the best preparation combines exercise, good nutrition, and mental health support all together, rather than focusing on just one area
- What it means for you: If you or a loved one needs surgery for stomach cancer, ask your hospital about prehabilitation programs that include all three components. These programs may help you recover faster and have better outcomes, though more research is still needed to confirm the exact benefits.
The Research Details
This study used a special method called a ’nominal group technique’ to bring together experts and get their opinions. Eight people participated in an online meeting in November 2023. Before the meeting, each person individually wrote down their ideas about three main topics: what exercises and treatments should be included, how to actually deliver these programs in hospitals, and how to help people stick with the program. During the meeting, the group discussed these ideas together, organized them into groups, and then everyone voted anonymously (without saying their name) on which ideas were most important. The researchers used special software called GroupMap to collect and organize all the votes.
This approach is valuable because it combines what we already know from research studies with real-world experience from people who work with these patients every day. It’s like bringing together a team of coaches and a player to figure out the best training plan. The anonymous voting part is important because it means people aren’t influenced by who else is in the room.
This research matters because many hospitals don’t currently offer preparation programs before cancer surgery, even though early evidence suggests they help. By getting experts to agree on what should be included, this study provides a roadmap that hospitals can follow. It also shows that experts believe these programs should include multiple parts working together, not just one thing. This kind of expert consensus helps hospitals know where to focus their resources and effort.
This study has both strengths and limitations. The strength is that it brought together different types of experts (physical therapists, nutrition experts, and a patient) who all work with these patients. The main limitation is the small number of people involved (only 8). Also, this study tells us what experts think should happen, but it doesn’t prove that these programs actually work better than current care. The researchers were honest about this and noted that more research is needed to test whether these programs actually improve patient outcomes.
What the Results Show
The experts reached strong agreement on several key points. First, they all agreed that prehabilitation should include three core components working together: exercise training, nutrition support, and mental health/psychological support. This wasn’t just a slight preference—it was complete agreement among all eight experts. The study found that 8 out of 89 different ideas received 100% agreement from all experts, and 31 out of 89 ideas (about one-third) received agreement from at least 70% of the group.
The experts also agreed that these programs should involve multiple types of healthcare workers (called ‘multidisciplinary’). This means patients should work with physical therapists, dietitians, psychologists, and doctors all coordinating together rather than seeing separate specialists who don’t communicate. The consensus suggests that this team approach is important for success.
Another important finding was that experts believe these programs should be tailored to individual patients. Not everyone needs the same amount of exercise or nutrition support, so programs should be customized based on each person’s starting fitness level, health conditions, and goals. The experts also emphasized that helping patients stay motivated and actually complete the program is just as important as designing the program itself.
Beyond the main findings, experts also agreed on several other important points. They felt that prehabilitation should start as soon as possible after a patient is diagnosed with cancer and scheduled for surgery. They also agreed that hospitals need to think about the cost of these programs and whether they’re worth the money—though they noted this needs more research. The experts emphasized that patient education is crucial; people need to understand why they’re doing these exercises and eating certain foods. Finally, they agreed that tracking progress and giving patients feedback about their improvements helps keep people motivated.
This study confirms what smaller research studies have been suggesting: that combining exercise, nutrition, and mental health support works better than focusing on just one area. Previous research has shown benefits from each of these three components separately, but this expert consensus suggests they work best together. The findings align with growing evidence in other types of surgery (like hip replacement and heart surgery) where prehabilitation programs have shown promise. However, for stomach and food pipe cancer specifically, there hasn’t been enough research yet to prove these programs work, which is why this expert consensus is valuable—it gives hospitals a direction to move in while more studies are being done.
This study has several important limitations to understand. First, only 8 experts participated, which is a small group. While these were experienced experts, a larger group might have had different opinions. Second, this study tells us what experts think should happen, but it doesn’t actually test whether these programs improve patient outcomes. We don’t yet have proof that patients who do prehabilitation have better surgery results than those who don’t. Third, the study was done in the UK, so the recommendations might need adjustment for different healthcare systems in other countries. Finally, the study didn’t include many patient voices—only one patient advocate participated, so we don’t know if patients would actually want to do these programs or if they would find them helpful in real life.
The Bottom Line
Based on this expert consensus, patients facing surgery for stomach or food pipe cancer should ask their hospital about prehabilitation programs that include exercise, nutrition support, and mental health support all together. These programs should start as soon as possible after surgery is scheduled and should be personalized to your individual needs. However, it’s important to understand that while experts believe these programs are valuable, we still need more research to prove they actually improve surgery outcomes. Talk with your medical team about what programs are available and whether they’re right for your situation. Confidence level: Moderate—this is expert opinion supported by some research, but not yet proven in large studies.
This research is most relevant for people diagnosed with cancer of the stomach, food pipe, or other upper digestive organs who are scheduled for surgery. It’s also important for their family members and caregivers who want to support them. Healthcare providers, hospital administrators, and physical therapists should pay attention because this gives them guidance on how to set up these programs. People with other types of cancer or those not having surgery probably won’t benefit directly from this research, though some of the ideas might apply to them as well.
Prehabilitation programs typically run for 4-8 weeks before surgery, depending on how soon your surgery is scheduled. You might start noticing improvements in your strength and energy within 2-3 weeks. The real benefits—like faster recovery after surgery and fewer complications—would typically show up in the weeks and months after your operation. However, this study doesn’t provide specific timelines because the research hasn’t been done yet to measure these outcomes.
Want to Apply This Research?
- Track three daily metrics: (1) Exercise minutes completed (target: 150 minutes per week of moderate activity), (2) Nutrition goals met (servings of protein, fruits, vegetables), and (3) Mental health check-in (mood rating 1-10 and any stress management activities completed). Create a simple dashboard showing weekly progress toward these three goals.
- Set up daily reminders for exercise sessions, meal prep planning, and a 5-minute relaxation or breathing exercise. Use the app to log each completed activity and celebrate small wins with progress badges. Share your prehabilitation plan with a family member or friend who can check in on your progress and provide encouragement.
- Weekly review of all three components (exercise, nutrition, mental health) with visual progress charts. Monthly check-ins with your healthcare team using app-generated reports showing adherence and progress. Track any changes in energy levels, strength, or mood to identify what’s working best for you personally. Continue tracking after surgery to monitor recovery progress and identify any setbacks early.
This research represents expert consensus on what should be included in prehabilitation programs, but it does not provide proof that these programs improve surgical outcomes. Before starting any exercise program, nutrition plan, or mental health intervention, especially if you have been diagnosed with cancer, please consult with your medical team. This information is educational and should not replace personalized medical advice from your healthcare provider. The effectiveness of prehabilitation programs for upper gastrointestinal cancer surgery has not yet been definitively proven in large clinical trials, so discuss with your doctors whether these programs are appropriate for your specific situation.