Delivering equitable access to prehabilitation services to optimise outcomes for patients with lung cancer - Best practice recommendations from a UK roundtable event.

INTRODUCTION: Prehabilitation in patients with lung cancer has historically been focused on those undergoing surgical resection. However, its benefits could be applicable to those undergoing all forms of treatment both in the curative- and palliative-intent settings.

MATERIALS AND METHODS: Twelve healthcare professionals convened to discuss prehabilitation across the spectrum of lung cancer management, aiming to share best practice and provide practical guidance.

RESULTS: Prehabilitation should be considered as part of a holistic treatment package for all patients diagnosed with lung cancer. A robust evidence base exists for patients undergoing surgery, with a developing and promising evidence base in other treatment pathways. Whilst further research is recommended, there is a strong ethical argument based on 'distributive justice' to adopt stage and treatment-agnostic delivery. Prehabilitation should begin as early as possible, ideally when a patient enters the diagnostic pathway. The benefits outweigh any negatives of delivering prehabilitation to people who do not have cancer and can only be delivered with a stage and treatment-agnostic ethos. Prehabilitation in the palliative treatment setting differs from the curative-intent setting, with patients facing more prolonged fluctuations in functional capacity as well as the psychological and physiological impact of ongoing treatment.

DISCUSSION: Stage and treatment-agnostic prehabilitation should become a standard of care within the lung cancer pathway.