RCoA, Macmillan and NIHR launch Prehabilitation report for people with cancer

Published: 02/07/2019

The Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration have today launched a report calling for changes to the delivery of cancer care across the UK, with a greater focus on prehabilitation including nutrition, physical activity and psychological support.

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, released today 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.

Professor Mike Grocott, RCoA council member and Joint Project leader, said:
“Prehabilitation offers people with cancer personal empowerment at a time when they often feel that they have little control over what is happening to them.  As a consequence, we see better quality of life as well as improved resilience to the effects of cancer treatments resulting in fewer complications.  All this adds up to   happier patients experiencing real health benefits.

“As a Consultant Anaesthetist working in Southampton, my patients tell me how prehabilitation offers them the opportunity to take control of their own care. We all see the improved resilience that prehabilitation brings, not only enabling more rapid recovery following treatment, but on occasions opening the possibility of receiving treatments that were previously out of reach. The potential value of long-term behavioural change and the positive health impact this change may deliver is enticing to all involved – patients and professionals alike.”

June Davis, Advisor for Allied Health Professionals at Macmillan Cancer Support, said:
“Being diagnosed with cancer can turn life upside down and many people experience anxiety and uncertainty whilst they wait to start treatment. Prehabilitation supports people during this difficult time to prepare both physically and mentally for treatment, reclaim a sense of control and improve their health in the long-term.

“We want to see prehabilitation implemented soon after diagnosis so that people living with cancer feel empowered to improve their health and get the personalised care they need. To make this a reality we urgently need the Government to invest in the NHS workforce so that there are enough professionals with the right skills and resources to deliver this care now and in the future.”

Dr Lucy Allen, Head of Collaborations, National Institute of Health Research, said: 
“On receiving a diagnosis, people with cancer face many challenges. For some, the cancer may already have affected their physical and nutritional state, and their psychological wellbeing before treatment starts. Individually and collectively, such changes can decrease resilience to the cancer and affect the response to surgery or systemic anti-cancer treatment. Put simply, being physically, nutritionally and psychologically ‘unfit’ is associated with increased risks and complications during treatment. The challenge therefore is to identify those who are at risk and prepare them ahead of their treatment in an attempt to reduce their risks and complications, and improve their response to treatment.”