from reportlab.lib import colors
from reportlab.lib.enums import TA_LEFT, TA_CENTER
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, KeepTogether
from reportlab.pdfbase.ttfonts import TTFont
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.pdfmetrics import stringWidth
from reportlab.pdfgen import canvas
from reportlab.lib.colors import HexColor
from reportlab.pdfbase.pdfmetrics import registerFontFamily
from reportlab.lib import utils

OUT = '/tmp/workspace/prehabilitation_quick_reference/output/Prehabilitation_Before_Chemotherapy_Quick_Reference.pdf'

NAVY = HexColor('#123B52')
TEAL = HexColor('#007C7A')
PALE_TEAL = HexColor('#E7F4F2')
PALE_BLUE = HexColor('#EAF2F8')
GOLD = HexColor('#D98B22')
PALE_GOLD = HexColor('#FFF3DF')
INK = HexColor('#18252D')
MUTED = HexColor('#52636E')
LINE = HexColor('#C8D4D9')
RED = HexColor('#A52A2A')
PALE_RED = HexColor('#FBEAEC')

styles = getSampleStyleSheet()
styles.add(ParagraphStyle(name='TitleQR', parent=styles['Title'], fontName='Helvetica-Bold', fontSize=19, leading=22, textColor=colors.white, spaceAfter=0))
styles.add(ParagraphStyle(name='SubQR', parent=styles['Normal'], fontName='Helvetica', fontSize=8.8, leading=11, textColor=colors.white))
styles.add(ParagraphStyle(name='SectionQR', parent=styles['Heading2'], fontName='Helvetica-Bold', fontSize=11.2, leading=13, textColor=NAVY, spaceBefore=7, spaceAfter=4))
styles.add(ParagraphStyle(name='BodyQR', parent=styles['BodyText'], fontName='Helvetica', fontSize=8.5, leading=11, textColor=INK, spaceAfter=3))
styles.add(ParagraphStyle(name='SmallQR', parent=styles['BodyText'], fontName='Helvetica', fontSize=7.3, leading=9, textColor=MUTED))
styles.add(ParagraphStyle(name='CellHead', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=8, leading=9.5, textColor=colors.white))
styles.add(ParagraphStyle(name='Cell', parent=styles['BodyText'], fontName='Helvetica', fontSize=7.7, leading=9.4, textColor=INK))
styles.add(ParagraphStyle(name='CellBold', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=7.7, leading=9.4, textColor=INK))
styles.add(ParagraphStyle(name='Callout', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=9.1, leading=12, textColor=NAVY))
styles.add(ParagraphStyle(name='Ref', parent=styles['BodyText'], fontName='Helvetica', fontSize=6.6, leading=8, textColor=MUTED))

class NumberedCanvas(canvas.Canvas):
    def __init__(self, *args, **kwargs):
        canvas.Canvas.__init__(self, *args, **kwargs)
        self.pages = []
    def showPage(self):
        self.pages.append(dict(self.__dict__))
        self._startPage()
    def save(self):
        page_count = len(self.pages)
        for state in self.pages:
            self.__dict__.update(state)
            self.setStrokeColor(LINE)
            self.line(15*mm, 13.5*mm, 195*mm, 13.5*mm)
            self.setFont('Helvetica', 7)
            self.setFillColor(MUTED)
            self.drawString(15*mm, 9*mm, 'Clinical quick reference | Prehabilitation before chemotherapy')
            self.drawRightString(195*mm, 9*mm, f'Page {self._pageNumber} of {page_count}')
            canvas.Canvas.showPage(self)
        canvas.Canvas.save(self)

def P(text, style='BodyQR'):
    return Paragraph(text, styles[style])

def box(items, bg=PALE_TEAL, border=TEAL, padding=6):
    tbl = Table([[items]], colWidths=[180*mm])
    tbl.setStyle(TableStyle([
        ('BACKGROUND',(0,0),(-1,-1),bg), ('BOX',(0,0),(-1,-1),0.7,border),
        ('LEFTPADDING',(0,0),(-1,-1),padding), ('RIGHTPADDING',(0,0),(-1,-1),padding),
        ('TOPPADDING',(0,0),(-1,-1),padding), ('BOTTOMPADDING',(0,0),(-1,-1),padding),
    ]))
    return tbl

def header(canvas, doc):
    canvas.saveState()
    canvas.setFillColor(NAVY)
    canvas.rect(0, 267*mm, 210*mm, 30*mm, fill=1, stroke=0)
    canvas.setFillColor(TEAL)
    canvas.rect(0, 264*mm, 210*mm, 3*mm, fill=1, stroke=0)
    canvas.restoreState()

doc = SimpleDocTemplate(OUT, pagesize=A4, rightMargin=15*mm, leftMargin=15*mm, topMargin=36*mm, bottomMargin=19*mm)
story=[]

story.append(P('PREHABILITATION BEFORE CHEMOTHERAPY', 'TitleQR'))
story.append(P('A practical quick-reference for oncology teams | Adults receiving cytotoxic, targeted or immunotherapy regimens', 'SubQR'))
story.append(Spacer(1, 6))
story.append(box(P('<b>Use the pre-treatment window:</b> Start assessment and support as soon as treatment is planned. Do not delay indicated systemic therapy solely to complete prehabilitation. Continue and adapt the plan during treatment.', 'Callout'), PALE_TEAL, TEAL))

story.append(P('1. Who should be offered it?', 'SectionQR'))
story.append(P('<b>Offer universal brief advice and screening to all patients before chemotherapy.</b> Prioritise rapid referral to physiotherapy/exercise oncology, dietetics and psychosocial support when one or more of the following is present:'))
who = [
    ['Functional / physical', 'Low activity, impaired mobility or balance, frailty, falls, poor performance status, planned major surgery after neoadjuvant therapy.'],
    ['Nutrition', 'Unintentional weight loss, poor intake, dysphagia, nutrition-impact symptoms, sarcopenia risk, GI or head-and-neck cancer.'],
    ['Psychological / behavioural', 'Clinically important distress, anxiety, depression, tobacco use, excess alcohol, poor sleep, limited social support.'],
    ['Treatment-related risk', 'Anthracycline or other cardiotoxic therapy, neurotoxic therapy, high emetogenic risk, prolonged or intensive regimen, significant comorbidity.'],
]
t=Table([[P('<b>Domain</b>','CellHead'),P('<b>Triggers for targeted/specialist prehabilitation</b>','CellHead')]]+[[P(a,'CellBold'),P(b,'Cell')] for a,b in who], colWidths=[38*mm,142*mm], repeatRows=1)
t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),NAVY),('GRID',(0,0),(-1,-1),0.35,LINE),('VALIGN',(0,0),(-1,-1),'TOP'),('BACKGROUND',(0,1),(0,-1),PALE_BLUE),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)]))
story.append(t)

story.append(P('2. Baseline assessment and plan: at diagnosis or treatment decision', 'SectionQR'))
assessment = [
    '<b>Record:</b> diagnosis, treatment intent and timing; performance status; comorbidities; medications; treatment-specific risks; falls, neuropathy and cardiovascular symptoms.',
    '<b>Measure where feasible:</b> weight and recent weight change; nutrition screening; fatigue/distress; physical activity; simple functional test such as sit-to-stand or 6-minute walk; grip strength if available.',
    '<b>Agree a written plan:</b> patient goals, exercise prescription or referral, nutrition actions, psychological/behavioural support, safety instructions, monitoring and contact routes.'
]
story.append(box([P('• '+x) for x in assessment], PALE_BLUE, HexColor('#6BA2C8')))

story.append(P('3. Core prescription: individualise, start low, progress as tolerated', 'SectionQR'))
rx = [
    ['Exercise', '<b>Aerobic:</b> regular moderate-intensity activity in short bouts if needed. <br/><b>Strength:</b> progressive resistance exercise for major muscle groups, adjusted for function and symptoms. <br/><b>Balance/mobility:</b> add when frailty, falls risk, neuropathy or deconditioning is present. <br/><b>Referral:</b> supervised cancer-exercise professional for complex patients or uncertainty.'],
    ['Nutrition', '<b>Screen early and repeat.</b> Refer urgently for significant weight loss, inadequate intake or nutrition-impact symptoms. Dietitian-led strategy may include symptom control, food fortification, oral nutrition supplements and protein/energy targets tailored to renal function, metabolic status and cancer site. Do not apply fixed protein or supplement doses without assessment.'],
    ['Psychological & behaviour', 'Assess distress and practical barriers. Offer self-management education, sleep support, relaxation/stress-management approaches and stepped referral to counselling/mental-health services. Offer evidence-based smoking cessation and alcohol-reduction support.'],
]
t=Table([[P('<b>Component</b>','CellHead'),P('<b>Practical approach</b>','CellHead')]]+[[P(a,'CellBold'),P(b,'Cell')] for a,b in rx], colWidths=[34*mm,146*mm], repeatRows=1)
t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),TEAL),('GRID',(0,0),(-1,-1),0.35,LINE),('VALIGN',(0,0),(-1,-1),'TOP'),('BACKGROUND',(0,1),(0,-1),PALE_TEAL),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)]))
story.append(t)

story.append(P('4. Safety screen before exercise or escalation', 'SectionQR'))
story.append(box([P('<b>Pause exercise and obtain clinical review urgently</b> for acute chest pain, syncope/presyncope, new severe dyspnoea at rest, fever or suspected infection, uncontrolled pain, acute neurologic symptoms, or other acute deterioration.', 'Callout'), Spacer(1,3), P('<b>Modify or seek specialist input</b> for severe anaemia or thrombocytopenia, unstable bone metastases or high fracture risk, significant cardiopulmonary disease, severe neuropathy/falls risk, uncontrolled nausea/vomiting/diarrhoea, active line/device issues, or marked treatment toxicity. Follow local protocols and the treating oncology team’s thresholds.', 'BodyQR')], PALE_RED, RED))

story.append(P('5. Deliver around chemotherapy cycles', 'SectionQR'))
cycle = [
    ['Before cycle 1', 'Screen, establish baseline, identify red flags, begin feasible activity/nutrition/distress interventions, arrange referrals.'],
    ['Each cycle', 'Review symptoms, weight/intake, fatigue, function and adherence. Adjust intensity and goals. Reinforce hydration, infection precautions and symptom reporting.'],
    ['Low-symptom days', 'Use for planned exercise progression, meal preparation and appointments.'],
    ['High-symptom days', 'Use flexible lower-intensity movement, symptom-directed nutrition strategies and rest. Avoid all-or-nothing messaging.'],
    ['Before surgery, if planned', 'Reassess function, nutrition and treatment toxicities; continue tailored prehabilitation up to surgery as appropriate.'],
]
t=Table([[P('<b>When</b>','CellHead'),P('<b>Team action</b>','CellHead')]]+[[P(a,'CellBold'),P(b,'Cell')] for a,b in cycle], colWidths=[40*mm,140*mm], repeatRows=1)
t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),NAVY),('GRID',(0,0),(-1,-1),0.35,LINE),('VALIGN',(0,0),(-1,-1),'TOP'),('BACKGROUND',(0,1),(0,-1),HexColor('#F6F9FA')),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)]))
story.append(t)

story.append(P('Evidence summary for discussion and service design', 'SectionQR'))
story.append(P('Evidence is <b>promising but not definitive</b> for chemotherapy-specific outcomes. A 2024 systematic review of cancer prehabilitation RCTs found improved functional capacity and reduced anxiety/depression, but studies were heterogeneous and frequently at high risk of bias. Direct studies most often begin at or during neoadjuvant chemotherapy and continue through it. In breast cancer, RCTs report better functional capacity, less fatigue and favourable quality-of-life signals. There is not yet a universal chemotherapy-specific protocol or proven survival benefit.'))

story.append(P('Clinical take-home', 'SectionQR'))
story.append(box(P('<b>Start early, individualise, and continue through treatment.</b> The main current goal is to preserve function, nutritional status and wellbeing, while maintaining safe and timely delivery of anti-cancer treatment. Escalate support for patients with frailty, malnutrition, distress or complex comorbidity.', 'Callout'), PALE_GOLD, GOLD))

story.append(P('Selected sources', 'SectionQR'))
refs = [
    'Gennuso D, et al. Efficacy of prehabilitation in cancer patients: an RCTs systematic review with meta-analysis. <i>BMC Cancer</i>. 2024. PMID: 39438910. https://pubmed.ncbi.nlm.nih.gov/39438910/',
    'Casanovas-Álvarez A, et al. PREOptimize trial: exercise and education-based prehabilitation during neoadjuvant chemotherapy in breast cancer. <i>Physical Therapy</i>. 2024. PMID: 39423256. https://pubmed.ncbi.nlm.nih.gov/39423256/',
    'Brahmbhatt P, et al. Multimodal prehabilitation during neoadjuvant chemotherapy for breast cancer: feasibility RCT. <i>Annals of Surgical Oncology</i>. 2024. PMID: 38219003. https://pubmed.ncbi.nlm.nih.gov/38219003/',
    'Pietrakiewicz K, et al. Prehabilitation prior to chemotherapy in humans: current evidence and future directions. <i>Cancers</i>. 2025. PMID: 40867298. https://pubmed.ncbi.nlm.nih.gov/40867298/',
    'Macmillan Cancer Support. Principles and guidance for prehabilitation within the cancer care pathway. Accessed 21 Oct 2026. https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/13225-source/prehabilitation-for-people-with-cancer'
]
for r in refs: story.append(P(r, 'Ref'))
story.append(Spacer(1,3))
story.append(P('<b>Scope note:</b> Educational aid for clinicians. It does not replace tumour-specific guidance, local protocols, contraindication assessment or clinical judgement.', 'Ref'))

doc.build(story, onFirstPage=header, onLaterPages=header, canvasmaker=NumberedCanvas)
print(OUT)

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