Evidence has shown that cancer prehabilitation can yield the following benefits;
- Better response to treatment
- Quicker recovery
- Reduced incidence and severity of treatment side effects
- Reduced risk of post-operative complications
- Reduced anxiety and improved mood
- Improved energy levels
- Patients take an active role in their cancer care
- Lower chance of cancer recurrence
- Improves general fitness and can lessen severity of other health conditions
- Improves ability for patient to fulfil normal activities of daily living
- Greater sense of empowerment over their treatment experience
As such, cancer prehabilitation, as a component of rehabilitation, should underpin the whole cancer pathway and is an approach we seek for all patients with cancer.
Implementing cancer prehabilitation
Insights form those with a lived experience of cancer
The Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration report that a greater focus on prehabilitation including nutrition, physical activity and psychological support, is required.
Seventy per cent of the 1.8 million people in the UK living with cancer are also living with one or more other long-term health conditions. The guidance report, Prehabilitation for people with cancer, promotes evidence that when services are redesigned so that prehabilitation is integrated into the cancer pathway:
- patients feel empowered and quality of life is improved
- physical and psychological resilience to cancer treatments is maximised
- long-term health is improved.
Teams from Macmillan Cancer Support, RCoA and NIHR have worked together to develop these principles and guidance together with an action plan. This sets out how NHS organisations across the UK can replicate some of the pioneering work already taking place at a limited number of Trusts – all of which have demonstrated how prehabilitation has improved outcomes and reduced the risk of disease progression.
Report recommendations:
- interventions targeted at improving physical and/or mental health should start as early as possible and in advance of any cancer treatment (not just the first cancer treatment)
- prehabilitation, as a component of rehabilitation, should underpin the whole cancer pathway and is an approach that should be adopted for all people with cancer
- all cancer treatments should be led through cancer multidisciplinary teams (MDT) which should have representation from those delivering prehabilitation, therefore providing oversight of the prehabilitation needs of the person to ensure prehabilitation is taking place
- all people with cancer should have a co-developed personalised prehabilitation care plan as part of their overall care
- education in nutrition, exercise, psychology and behavioural change, should be integrated throughout the undergraduate and postgraduate training of health and care professionals
- services delivering prehabilitation should be co-designed and produced with patients and carers
- implementation and effectiveness of prehabilitation should be audited as part of a quality assurance and improvement framework delivered and reported according to recognised standards
- the Professional Standards Authority, Chartered Institute for the Management of Sport and Physical Activity and the British Association of Sport and Exercise Sciences should work together to define an approach to achieving accreditation and/or regulation for exercise professionals in prehabilitation.
Reducing variation
To address unwarranted variation and ensure quality of care a series of resources have be created to support the sustained development and implementation of cancer prehabilitation across Scotland.
Resources:
- Key Principles for Implementing Cancer Prehabilitation across Scotland
- Psychological Therapies and Support Framework for People Affected by Cancer
- Nutrition Framework for People with Cancer
The image opposite explains how these resources can be used alongside this website and e-learning opportunities to improve service provision.
Scotland’s Cancer Prehabilitation Implementation Steering Group would also recommend use of Macmillan’s ‘cancer and physical activity standard evaluation framework‘ to aid evaluation of impact with respect to physical activity/exercise.
Further resources and training opportunities
PRosPer – Prehabilitation, Rehabilitation and Personalised care for people living with cancer – elearning programme and ‘How to Guide’ for professionals PRosPer - Cancer Prehabilitation and Rehabilitation - elearning for healthcare (e-lfh.org.uk)
South East London Cancer Alliance have created tumour specific 'top tips' resource for professionals to use when giving advice and information to patients around physical activity.
These information sheets are able to be individually downloaded using the links below!
