The 2026 APA Victorian Branch Winter Breakfast will turn its attention to a phase of care before the operating theatre – but one that may ultimately shape outcomes. 

Keynote speaker Professor Catherine Granger FACP will present ‘Prehab for major cancer surgery’, drawing on more than two decades of clinical and research experience in cardiorespiratory physiotherapy, with a particular focus on cancer care. 

A professor of physiotherapy and director of graduate research in the School of Health Sciences at the University of Melbourne, head of physiotherapy research at the Royal Melbourne Hospital and a Specialist Research Physiotherapist (as awarded by the Australian College of Physiotherapists in 2020), Catherine has led internationally recognised research translating exercise and rehabilitation into cancer care pathways for patients with lung cancer. 

Professor Catherine Granger FACP

Her focus is the period between diagnosis and surgery – often overlooked but increasingly difficult to ignore. 

Cancer surgery places a significant physiological and psychological burden on the body. 

As Catherine notes, many patients still arrive at surgery deconditioned and carrying additional health risks that can compromise recovery. 

Prehabilitation – or ‘prehab’ – is a multimodal intervention designed to change that trajectory. 

It combines exercise, nutrition, psychological support and patient education to improve functional capacity before surgery. 

While the concept itself is not new, Catherine says the evidence has shifted significantly in recent years. 

‘We’ve got to a point now where there’s so much evidence that people can’t ignore it anymore. 

'We really want to be able to offer all patients something in their lead-up to surgery.’ 

Prehabilitation principles are applicable across diverse cancer surgery types, including thoracic, abdominal, pelvic, and head and neck procedures. 

Across patient groups, fitter patients going into treatment tend to have better outcomes, including fewer complications, shorter hospital stays and, in some cases, improved survival. 

Catherine’s research, spanning more than 140 publications and supported by major funding bodies such as the National Health and Medical Research Council and Cancer Council Victoria, has helped establish this body of evidence. 

In 2025, she was named on the Stanford/Elsevier ‘World’s Top 2% Scientists’ list of most-cited researchers in the world. 

Her work has helped shift how preoperative care is understood, moving exercise and rehabilitation earlier into the surgical pathway. 

Catherine is currently on a research trip in the UK and Europe, working with research collaborators on physiotherapy and exercise interventions for patients with cancer. 

For health systems, however, adopting prehabilitation represents more than adding another service. 

Drawing on both clinical and research experience, Catherine says it requires hospitals, clinicians and health systems to invest in interventions delivered before the traditional point of care, with benefits often realised after surgery or discharge. 

‘I think it’s a big flip of mindset. We’re used to reacting to what happens after surgery, whereas this is trying to prevent issues before they occur.’ 

In practice, prehabilitation is not a single model but a spectrum of interventions. 

At one end are comprehensive, multidisciplinary programs involving physiotherapists, dietitians, psychologists, anaesthetists and nursing teams. 

Much of the research underpinning these programs comes from major abdominal surgery and complex cancer pathways. 

At the other end are more targeted approaches, including supervised exercise programs, respiratory training and single-session physiotherapy education. 

Catherine says even these smaller interventions can have measurable effects, particularly in reducing postoperative complications. 

Across all models, physiotherapists play a central role, particularly in designing and delivering exercise interventions and education for patients with complex conditions. 

‘These are complex patients to work with. They may never have exercised before, they may have underlying conditions and we need to work with them in a short period of time to get them as fit as possible.’ 

Time is one of the most significant constraints. 

In some cancer pathways, clinicians may have weeks or months to intervene. 

In others, particularly thoracic surgery, Catherine says the window can be as short as two weeks between diagnosis and surgery. 

This compresses assessment, engagement, program design and adherence into a brief, often stressful period for patients and their families, requiring clinicians to build trust quickly and tailor interventions to individual needs. 

‘In some pathways, we only have a couple of weeks. 

'We have to engage people quickly, build trust and help them understand why this matters. 

'Otherwise, we lose that opportunity.’ 

It also places a strong emphasis on communication and health literacy. 

Early implementation work shows that programs can falter not because they are ineffective but due to low uptake and adherence. 

‘We’re finding that sometimes the programs aren’t as feasible as we first thought. 

'The patient uptake rates and adherence rates to some programs are poor and, in some cases, it may be because there’s a mismatch in understanding. 

'We just don’t have days to lose. 

'We need to ensure that patients and their families are informed about the benefits of preparing for surgery and are given an opportunity to act upon the recommendations.’ 

Prehabilitation also depends on close coordination across the surgical pathway, with input from physiotherapists, surgeons, anaesthetists, physicians, nurses and other allied health professionals. 

‘This type of intervention is not something a physio can easily go off and do on their own. 

'We need everybody on board to achieve the best outcomes.’ 

Encouragingly, she says many medical colleagues are increasingly engaged, with some of the strongest research in prehabilitation emerging from anaesthetic and surgical fields, reflecting the increasingly multidisciplinary nature of prehabilitation. 

Even so, implementation remains uneven. 

Catherine observes that many hospitals are still in the early stages – building business cases, piloting programs and navigating funding constraints – as they work to embed prehabilitation into existing systems of care. 

Alongside clinical outcomes, cost is becoming a key consideration. 

The research physiotherapist says prehabilitation programs are relatively low-cost to deliver, particularly when compared with the expense of complications, extended ICU stays and prolonged hospital admissions. 

‘If you’re getting people out of ICU quicker and out of hospital quicker, the savings can be significant.’ 

These improvements can translate into meaningful health system savings, strengthening the case for wider implementation, although more research is needed. 

In a 2023 study published in BMC Medicine, titled ‘Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations’, researchers found some evidence that prehabilitation for patients awaiting elective surgery was cost-effective compared to usual preoperative care. 

They concluded that future economic evaluations ‘should be performed over a longer time horizon and apply a more comprehensive perspective’. 

More recently, in November 2025, the European Journal of Surgical Oncology published research titled ‘The financial impact of implementation of a prehabilitation program for colorectal cancer patients in the Netherlands: a budget impact analysis’, concluding that implementation of a prehabilitation program may reduce hospital costs. 

The study assessed real-world data from Dutch hospitals alongside published literature across five years, considering an annual rate of about 10,500 colorectal cancer surgeries. 

The researchers estimated the program could generate savings of about €64.3 million across five years, supporting its broader adoption. 

Looking ahead, Catherine expects demand for prehabilitation to grow. 

She points to the introduction of Australia’s national lung cancer screening program, which is likely to increase the number of patients identified earlier and referred for surgery. 

Earlier detection improves survival prospects but also increases the number of patients entering surgical pathways, often within tight timeframes, where prehabilitation can make a critical difference. While much of the focus is on hospital-based care, Catherine says prehabilitation is not limited to that setting. 

Private practices and community-based physiotherapists also have a role to play. 

‘There’s a whole untapped market of people with cancer who want to see a physio and are willing to pay for it.’ 

Catherine says the presentation will combine practical guidance with emerging research, with key takeaways including: 

• Prehabilitation reduces postoperative complications and improves recovery after major cancer surgery. Physiotherapists should screen at-risk patients early and offer prehabilitation as part of the surgical pathway. 
• Interventions range from a single preoperative physiotherapy education session to comprehensive multimodal programs delivered over weeks to months. They can be delivered in a variety of settings, including hospital, community and primary care settings, or via telehealth. 
• Physiotherapists should tailor the prehabilitation intervention to the individual patient, considering their risk profile, individual needs, time available before surgery and local resources. Collaboration with surgeons, anaesthetists, nurses, dietitians and other allied health professionals is important. 

As health systems face increasing pressure, prehabilitation is shifting from an emerging concept to an expected part of care. 

The question, Catherine says, is no longer whether it works but how quickly it can be embedded into practice so more patients can benefit before they reach the operating table. 

Her aim is to provide clinicians with both the rationale and the tools to begin integrating prehabilitation into their own practice. 

‘Further research is needed to optimise who benefits most, which components and dosage work best, and how to implement programs to maximise patient and health-service outcomes. 

'Ideally, we’d like everyone going into surgery to have something.’ 

The APA Vic Branch Winter Breakfast will be held on Friday 24 July, 6.30–9.30 am, at Leonda by the Yarra, Hawthorn. 

Visit australian.physio/pd/pd-product?id=13415 to register.