An innovative project led by NHS Lothian has found that simple measures put in place as soon a lung cancer is suspected in a patient has benefits including a significantly reduced time spent in hospital.
The Early Prehabilitation in Lung Cancer project (EPIC project) looked at ways to minimise the impact of cancer and the difficult side effects often experienced by people undergoing gruelling cancer treatments, by aiming to improve physical and mental health. This was through early interventions focusing on symptom control, nutrition, and physical activity.
The project suggested that patients who received these early interventions, also known as prehabilitation, lived longer than patients who had not received any prehabilitation, when compared to a previous group of lung cancer patients acting as historical controls.
The project also showed patients had a reduced time spent in hospital in six weeks from diagnosis by 75%.
The project, led by Dr. Iain Phillips, Consultant in Oncology at NHS Lothian, was carried out at St John’s Hospital, Livingston. Patients were assessed by a consultant in palliative medicine, a registered dietitian, and a rehabilitation physiotherapist.
Picture – Chris Watt Photography
The interventions were made for patients early on, even before a formal diagnosis of lung cancer had been made. The three routine interventions were offered to all patients being investigated for locally advanced and metastatic (stage 3 and 4) lung cancer.
As patients in the EPIC project spent less time in hospital compared to a matched cohort, it also means that beds can be made available for other NHS patients. The results suggest it has the potential help health boards better meet the needs of people and to significantly impact lung cancer care in Scotland.
It is estimated that if the project is scaled up across Scotland, an additional 10,000 bed/days a year would be made available.
Dr. Iain Phillips, Consultant in Oncology, Edinburgh Cancer Centre, NHS Lothian said: “Approximately half of patients have lung cancer that is incurable at diagnosis, meaning it has spread outside the lung. Many people who are diagnosed with lung cancer have a lot of symptoms, are older, frailer and have other medical conditions. All these factors make giving treatment for lung cancer more challenging.
“By routine screening and expert intervention for symptom control, nutrition, and an individualised exercise programme, we reduce the amount of time patients spend in hospital whilst they are being investigated for lung cancer by 75%. It also appeared to increase how long patients lived. As well as this being positive for patients, it has a potential significant cost saving for the NHS.
“We hope that with an increasing number of new drugs available to treat lung cancer, further future work will assess whether prehabilitation may improve treatment rates and overall survival for our patients.”
The project, published in The BMJ (British Medical Journal) Supportive and Palliative Care Journal, was a joint working project between NHS Lothian and the pharmaceutical company Merck, Sharp and Dohme (MSD).
Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation, commented: “Being told you have lung cancer is devastating, and this heart-breaking situation is often compounded by lengthy stays in hospital, when all a person wants is to be at home with their loved ones.
“The results from the EPIC project are really encouraging and could dramatically improve a patient’s experience. By reducing how long a person is in hospital, we can help ease any immediate additional stress as well as potentially lengthening their life.”
The project was Highly Commended at the HSJ (Health Service Journal) Partnership Awards in the ‘Best Pharmaceutical Partnership with the NHS’ category. This was announced in March 2025.
Simplified Summary
An innovative project - The Early Prehabilitation in Lung Cancer project (EPIC project) - led by NHS Lothian has found that simple measures put in place as soon a lung cancer is suspected in a patient has benefits including a significantly reduced time spent in hospital.
