From inoperable to operable: the impact of prehabilitation in advanced lung cancer

Abstract

Introduction A 77-year-old male with resectable stage T4 N1 M0 squamous cell lung carcinoma was referred to prehabilitation. Baseline assessment identified severe deconditioning (figure 1). Nutritional and psychological screening revealed no additional needs. The patient was initially deemed inoperable due to limited functional reserve. The patient completed four three weekly cycles of carboplatin, paclitaxel, and pembrolizumab. As neoadjuvant chemo-/immuno-therapy (NACT) can further reduce physical capacity, optimisation of the patient's fitness during treatment is essential (1). Methods The patient undertook a four-month prehabilitation programme alongside NACT, including 12 supervised sessions and a structured home exercise programme. Weekly sessions were advised due to the patient's presentation. Intervention included progressive resistance training of upper and lower limbs, moderate intensity continuous training (treadmill and stationary bike), alongside motivational interviewing. Initial prescription followed American College of Sports Medicine (ACSM) minimum guidelines: 150 minutes of moderate-intensity aerobic exercise and two weekly strengthening sessions (2). Exercise intensity and volume were progressed in line with functional improvements. Results Functional improvements were observed preoperatively with stable lung function (figure 1), alongside disease downstaging to T2a N1 M0. The patient demonstrated increased independence and exercise tolerance. Following NACT the patient underwent a successful lung wedge resection and mobilised on postoperative day two. Length of stay was seven days with no complications. Conclusion Structured prehabilitation delivered during NACTenabled a previously inoperable patient to achieve sufficient physiological reserve for curative intent surgery. Early integration of prehabilitation into lung cancer pathways can reduce deconditioning associated with NACT, enhance functional reserve, and support optimal recovery postsurgery. Disclosure No significant relationship. [Formula presented] Copyright © 2026 Elsevier B.V.