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A new report and guidance from Macmillan Cancer Support shows prehabilitation before cancer treatment enables empowerment, resilience and long-term health and well-being

Recently launched in Wales at an event in Cardiff, Macmillan Cancer Support, the Royal College of Anaesthetists (RCoA) and the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration called for changes to the delivery of cancer care across the UK, with a greater focus on prehabilitation.

Prehabilitation allows people with cancer to prepare for treatment by promoting healthy behaviours, and through needs-based prescribing of exercise, nutrition and psychological support. It aims to empower and optimise patients for cancer treatment and improve their long-term health and well-being prospects.

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. Macmillan’s report and guidance, Prehabilitation for people with cancer, promotes cancer service redesign in order to integrate prehabilitation into the cancer pathway. Evidence tells us that prehabilitation contributes to:

  • patients feeling empowered and improved quality of life
  • improved long-term health and well-being..
  • the maximisation of physical and psychological resilience to cancer treatments, and

There is no need to wait for a secondary care cancer diagnosis to start prehabilitation. It is entirely possible to start this approach much earlier at the point of referral to a fast track cancer pathway. This is a ‘teachable moment’ and a study undertaken in Wales has shown advice and signposting for prehabilitation interventions at time of referral is feasible and effective. Although many of these patients will not turn out to have cancer at this time, making lifestyle changes at this point will reduce their future risk of developing cancer and other long-term conditions.

In Wales pre-treatment health optimisation and prehabilitation are explicitly mentioned in the Cancer Delivery Plan for Wales 2016- 2020. This gives Wales the strongest policy platform of all the UK nations for the widespread delivery of prehabilitation. At the time our report was published, discussions are ongoing with Welsh Government about the long term sustainable funding and delivery of prehabilitation.. No matter what happens in the immediate future, prehabilitation is likely to become a permanent fixture of cancer policy in Wales.

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)
  • 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
Former prehabilitation patient, Phil Jones talks about his experience

All of the above recommendations will empower patients and allow them to take ownership of their cancer experience, leading to increased resilience to treatment and improvement of long-term health.

Greg Pycroft, Policy and Public Affairs Officer