Preparing for surgery

When you are diagnosed with cancer, a team of specialists meet to talk about the best treatment and support for you. They are called your multidisciplinary team (MDT).

Once your MDT have talked about your care and have a plan for your surgery, you will have a clinic appointment. At the appointment, your surgeon will talk to you about your surgery and give you written information to read and take away. You might also meet a clinical nurse specialist (CNS) at this appointment. They are usually your main contact for any questions or support. They may sometimes be called your key worker.

It is important that you fully understand the information. Ask questions about anything that is unclear. If you do not meet a CNS at this appointment, you should ask about who to call if you have questions.

You usually make treatment decisions with your surgeon and CNS. This is called shared decision-making. You may talk to other healthcare professionals in your MDT. Sometimes, your surgeon or cancer doctor will offer you a choice of treatments that are equally effective. If this happens, they will give you time to decide which treatment you would prefer. Make sure you have enough information about all the treatment options to make your decision.

When you have all the information you need and have made your decision, your surgeon will ask you to sign a consent form to say that you agree (consent) to have surgery.

As well as information about your surgery, your surgeon or CNS may suggest things you can do to improve your general health before and after surgery. This is sometimes called prehabilitation.

Your surgeon and CNS may also talk about things you can do to reduce the time you spend in hospital and help you to recover as quickly as possible. This is called enhanced recovery.

Before surgery, you will also have a pre-operative assessment. This may involve having some tests to check your general health and fitness. You can also learn more about how to prepare for your surgery at this appointment.

Prehabilitation (sometimes call prehab) aims to get you as fit and healthy as possible for surgery. It can start as soon as you are diagnosed, or sometimes even before diagnosis.

It might feel difficult to think about making changes when you have just been diagnosed with cancer. But your healthcare team will suggest things that are realistic and suitable for you. They can give you help and support. Even small changes can make a big difference to your treatment and recovery.

Prehabilitation focuses on 3 main areas:

• nutrition
• mental well-being
• physical activity.

By making positive changes in these 3 areas, prehabilitation has been shown to:

• improve general fitness and nutrition before surgery
• reduce anxiety and improve mental health and well-being
• enhance recovery from surgery
• reduce the length of stay following surgery
• reduce the risk of complications from surgery
• develop a feeling of taking control of health and recovery
• improve quality of life for the future
• help to stop smoking
• help to stop drinking or drink less alcohol – there is more information about alcohol and drinking guidelines at drinkaware.co.uk.

If there is no prehabilitation service at your hospital, a nurse such as your key worker or clinical nurse specialist (CNS) will assess you to find out what help and support will benefit you. This will probably include a holistic needs assessment (HNA) to talk through your needs and concerns. You then agree on a plan for your care and support needs.

Your nurse will be able to provide you with information appropriate to your needs. If you have emotional or practical needs, your nurse may refer you to other professionals who can help.

If there is a prehabilitation service within your hospital or local area, then you can be referred by your clinical nurse specialist or someone else within your multidisciplinary team (MDT).

You will then have an appointment called an initial assessment to determine how the professionals in the prehabilitation service can help you. At the assessment, you will fill in some questionnaires. You may also have some physical tests, such as a 6-minute walk test (6MWT). This test measures how far and how long you can walk for in 6 minutes.

You may meet with the following healthcare professionals:

• dietitian
• physiotherapist
• occupational therapist
• counsellor or psychologist.

There are things you can do at home to help improve your general health ahead of surgery:

• If you smoke, stop smoking at least 2 weeks before surgery.
• Follow information and advice about healthy eating.
• Follow guidance about being more physically active
• If appropriate, drink less alcohol – information about alcohol and drinking guidelines can be found at drinkaware.co.uk
• Review other health conditions and regular medications.

If you are having major or complicated surgery, you often need more support. Depending on the type of cancer or surgery, this may include the following support:

• Information and support if you need to manage a urostomy or a stoma.
• Meeting with a physiotherapist for specific exercises for your type of surgery. You do these exercise before and after surgery to try to prevent complications in the weeks, months or years after surgery.
• Information and guidance about pelvic floor exercises to help recovery before and after surgery to the pelvic (lower tummy) area.
• Group education sessions about specific surgery, such as surgery to remove the prostate gland (prostatectomy). These sessions are sometimes called surgery school.
• Meeting with a counsellor or psychologist before surgery, especially if your surgery will cause big, or permanent, physical or emotional changes to your life.

We have more information in our videos about prehabilitation and preparing for cancer treatment.

We also have podcasts with Della, Clive and Jenny, who are living with cancer. In the podcasts, they share their thoughts and experiences of prehabilitation:

• Listen to Della and Clive's podcast (13 minutes).
• Listen to Jenny's podcast (8 minutes).

You might have follow-up appointments to check how your prehabilitation is going. Your family, friends or carers can help support your prehabilitation. We have more information about looking after someone with cancer.

You may also find it helps to talk to others going through similar experiences. You may want to join a support group or our Online Community.

You will have a pre-operative assessment around 1 or 2 weeks before your surgery. You will meet with a nurse who may do some tests and checks to make sure you are well enough for surgery. They will also give you information about your surgery and how to prepare for it.

If you need additional help and support, you may meet with other healthcare professionals who can assess you and plan your care.

In both these situations, it might mean having other appointments.

You may find it helpful to bring someone with you to the appointment, such as a family member, friend or carer. You could ask them to take notes during the conversation to help you to remember what was said afterwards. You can also ask whether you can record the appointment on a mobile device so you can listen to it later. Always check before doing this.

Some people might prefer to bring someone with them who is not a family member or friend. These people are called advocates. They can help if you find it difficult to understand your care and support, or find it hard to speak up. Advocates are independent of social services and the NHS. You can find more information about patient advocate services on the NHS website.

It important that you get information in a way you understand, and in the language you choose. We have more information about support to understand information and speaking up.

During the pre-operative assessment, the nurse will ask questions about your medical history. They will ask you about any prescribed medicines you take. Before your appointment, it might be helpful to write down the details of your medicines, when you take them and the dose. Or take them with you to show the nurse. They will also ask if you any medicines or supplements you buy in the pharmacy or shops.

The nurses or pharmacist may give you information about if and when to take your medicines before your surgery. This is important, especially if you take medicines to thin your blood (anticoagulants), or to manage diabetes or high blood pressure.

The nurse will also ask questions about your situation. This might involve you meeting with other healthcare professionals to be assessed, or for help and support to be arranged.

The nurse will weigh you and take your blood pressure, heart rate, oxygen level and temperature.

They may also do some of the following:

• take a blood test
• test your urine (pee)
• do a pregnancy test, if necessary
• take swabs from your nose and other parts of your body to check for a type of bacteria called MRSA.

Sometimes the nurse will arrange further tests, such as:

• lung function tests to check your lungs
• an electrocardiogram (ECG) to check the rhythm and rate of your heart.

The nurse will give you information about:

• when to come into hospital – this is usually on the day of your surgery, but it might be the day before
• when to stop eating or drinking before surgery
• what to bring to hospital with you
• how long your stay is expected to be
• when you can have visitors
• hospital parking charges, if this applies to you.

Depending on the operation or as part of enhanced recovery, the nurse might give you some high-energy nutritional drinks to take 2 days before surgery. These help your body prepare for the time after surgery when you are not eating or drinking. They can also help your body recover.

The nurse may give you an anti-septic body wash to use for a few days before your operation.

If someone is taking you to hospital, make sure you tell them in advance when the appointment is so they can make sure they are able to help.

Tell family and friends about the hospital’s visiting hours and give them a contact number.

The nurse will also talk to you about going home from hospital. This helps prepare you for what to expect. It means you can talk about whether you are likely to need any extra support.