Prehabilitation promotes healthy lifestyle behaviours for people living with cancer to reduce their risk factors to health; including exercise, nutrition, smoking cessation, psychological and wellbeing interventions.
Prehabilitation (prehab) is a patient-centred, evidence-based and multidisciplinary team developed pathway which is part of a continuum to rehabilitation. It aims to enable people affected by cancer to prepare for their treatment, reduce their surgical stress response and optimise their physiological function in order to support their recovery and improve their quality of life post treatment.
The implementation of prehab services in Cheshire and Merseyside supports the delivery of Personalised Care and Personalised Stratified Follow Up for people diagnosed with cancer, both of which are key components in the NHS Long Term Plan.
The NHS long term plan highlights that:
- An extra 55,000 people each year will survive for five years or more following their cancer diagnosis; and
- By 2021, where appropriate every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support
Prehabilitation aims to empower people to take control of their health and preparation for treatment, instilling physical and psychological resilience and providing opportunities to reflect on the importance of healthy lifestyle behaviours to improve long term health.
This is a relatively new area of work for Cheshire and Merseyside Cancer Alliance, but with a successful service based in Aintree Hospital, expansion is planned for 2021/22 which will take the Aintree service across the whole Liverpool University Hospitals NHS Foundation Trust (LUHFT) footprint and see new prehab services develop for the Wirral and Mid and East Cheshire.
In 2018/19 Liverpool John Moores University (LJMU) were funded to complete a research study on the alliance funded prehabilitation service at Aintree University Hospitals Trust (AUHT) which was the basis for further development.
In this service model prehabilitation was defined as occurring between the time of a cancer diagnosis and the beginning of treatment, as the implementation of a pre-surgical intervention to enhance a patient’s post-surgery functional capacity, recovery and quality of life.
The LJMU study of the Aintree model highlighted:
- An increase in the evidence regarding the potential benefits of preoperative exercise for patients with cancer
- A positive association between higher preoperative exercise capacity and improved surgical outcomes
- Rigorous risk assessment (e.g. assessing a Rockwood score at the time of referral and use of the Comprehensive Geriatric Assessment (CGA) with the elderly [70% of cancer patients are 65yrs and above]), will promote improved decision making, inform triage to the right test, reduce DNA’s and ultimately improve the quality of patient experience
- These measures also contribute to the rationale for conversations with patients and carers about not proceeding with cancer investigations and supporting the smooth transition to involve other health and support teams including community palliative care
- Relationships have been established through working closely across primary and secondary care, to support patients with cancer having a community HNA assessment and access to prehab lifestyle support locally
- A combination of the above efforts are of particular significance to older patients, and/or those living with co-morbidities/vulnerabilities
This review also highlighted that prehabilitation for individuals undergoing surgery for abdominal and pelvic cancer is beneficial for improving functional exercise capacity. However the translation of these benefits, in terms of quality of life and surgical outcomes, are less apparent and additional research is needed to better understand how improvements in exercise capacity associated with prehabilitation, can be translated into improvements in quality of life and surgical outcomes.
Using information from the LJMU review of the Aintree prehab service, literature and research on other prehab services, the development of existing and new prehabilitation models in Cheshire and Merseyside will include:
- Clear referral pathways
Joint working across the system – primary, secondary and community care
- Holistic assessment of individual patient needs
- An individual care plan for patients
- Opportunities for physical activity, nutrition, psychological, social and wellbeing support interventions
- Effective monitoring to support service improvement
For further information about prehabilitation please see:
- Principles and guidance for prehabilitation within the management and support of people with cancer (Macmillan Cancer Support)