Cancer prehabilitation uses a multidisciplinary approach combining exercise, nutrition and psychological strategies to prepare women for the challenges of cancer treatment such as surgery, chemotherapy, immunotherapy and radiation therapy.

Evidence indicates that for newly diagnosed cancer patients, prehabilitation prior to starting treatment can be beneficial. This may include conducting a physical and psychological assessment to establish a baseline function level, identifying impairments and providing targeted interventions to improve the woman’s health, thereby reducing the incidence and severity of current and future impairments related to cancer and its treatment (Silver & Baima 2013).

Medications should be reviewed at this point to ensure optimisation and to improve adherence to medicines used for comorbid conditions.

Screening with a validated screening tool (such as the National Comprehensive Cancer Network Distress Thermometer and Problem Checklist) and assessment and referral to appropriate health professionals or organisations is required to meet the identified needs of an individual, their carer and family.

In addition to the common issues outlined in the Appendix, specific needs that may arise at this time include:

• treatment for physical symptoms such as fatigue and pain
• malnutrition (as identified using a validated malnutrition screening tool or presenting with unintentional weight loss)
• help with psychological and emotional distress while adjusting to the diagnosis, treatment phobias, existential concerns, stress, difficulties making treatment decisions, anxiety/ depression, psychosexual issues such as potential loss of fertility and premature menopause, and interpersonal problems. Women diagnosed with cervical cancer may experience a unique emotional and psychological burden because it is largely a preventable cancer, as well as being associated with a sexually transmitted virus, raising the spectre of guilt and blame (Hobbs 2008)
• appropriate assistance for women with mental illness, women in residential care facilities, women in custodial care and women who are financially disadvantaged to access care
• guidance for financial and employment issues (such as loss of income, travel and accommodation requirements for rural women and caring arrangements for other family members)
• guidance for smoking cessation
• appropriate information for women from culturally and linguistically diverse backgrounds, including Aboriginal and Torres Strait Islander people.

The lead clinician should:

• establish if the woman has a regular or preferred general practitioner
• discuss a timeframe for diagnosis and treatment with the woman and her carer
• discuss issues regarding fertility and early menopause
• discuss the benefits of multidisciplinary care and make her aware that her health information will be available to the team for discussion at the multidisciplinary team meeting
• offer individualised cervical cancer information that meets the needs of the woman and her carer (this may involve advice from health professionals as well as written and visual resources)
• offer advice on how to access information and support from websites and community and national cancer services and support groups (for example, Cancer Council)
• use a professionally trained interpreter when communicating with women from culturally or linguistically diverse backgrounds (NICE 2004)
• if the woman is a smoker, provide information about smoking cessation.

The lead clinician should:

• ensure regular and timely (within a week) communication with the woman’s general practitioner regarding the treatment plan and recommendations from multidisciplinary team meetings and should notify the general practitioner if the woman does not attend appointments
• gather information from the general practitioner, including their perspective on the woman (psychological issues, social issues and comorbidities) and locally available support services
• contribute to the development of a chronic disease and mental healthcare plan as required
• discuss shared care arrangements, where appropriate
• invite the general practitioner to participate in multidisciplinary team meetings (consider using video or teleconferencing).