We conducted a pilot study (ISRCTN00061628 funded by Health Foundation) in 65 lung cancer surgery patients comparing F4S, an App based home rehabilitation structured exercise programme (with integrated patient and clinician bio-feedback), with conventional outpatient based prehabilitation. The F4S, developed by and for the NHS was designed “for all”, “personalised” and adaptive to the “continuum” of the patient pathway, incorporating the three prehabilitation phases: assessment, intervention and follow up . It includes tailored bespoke health information, e.g., on “your lungs, surgery, how to exercise, managing symptoms and recovery after surgery” (available on our website www.thoracicsurgery.co.uk). By presenting information in bite size snippets and being an individualised low resource programme that the patient can return to at their convenience, F4S mitigates many of the concerns and barriers raised about cancer prehabilitation programmes.

Our intervention was highly acceptable to patients (even to those with minimal technological experience), deliverable within the lung cancer pathway and resulted in significant improvement in physical function before surgery. There were no adverse or serious events relating to using the App at home. Patients in the App group managed to complete 4 times the number of exercise sessions before surgery when compared to the group who received outpatient prehabilitation. In addition, their shuttle walk test increased on average by 100 metre (P < 0.05) and the drop-out rate prior to surgery was very low. The cost of delivering the digital programme was significantly lower at £16 per patient versus £188 for conventional rehabilitation .

We conducted a single centre mixed method open label RCT “THIRSTY” in 64 lung cancer surgery patients (ISRCTN: 16535341 funded by Birmingham Health Partnership). A nutritional intervention regime of pre- and post-operative oral nutritional supplements was compared against standard care. Recruitment completed ahead of target, 97% of patients were compliant with nutritional drinks, and the intervention was highly acceptable to patients. In addition, there was a trend towards less weight loss and symptom burden in the intervention group.