Prehabilitation

Scottish Cancer Network: Clinical Management Pathways
NHS National Services Scotland
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This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of these guidelines, taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols.  

Prehabilitation allows patients to be optimised for treatment. This is not only to improve patients’ fitness for surgery but to allow patients to maintain fitness through their cancer treatment, including patients undergoing radiotherapy, systemic anti-cancer treatments and best supportive care. 

Pillars of prehabilitation

There are five areas that should be focussed on to optimise patients for treatment. The levels of support can be divided into 3 levels: universal (generic information provision), targeted (by trained AHPs) and specialist (by specialists). 

Nutrition

Nutritional screening, assessment and intervention with dietary advice +/- dietetic supplements

Activity

Fitness assessment and patient-specific intervention

Psychological support

Opportunity to engage with lung cancer nurse specialists and introduction of third-sector support

Symptom control

Screening and assessment of symptoms and appropriate treatment, including referral to palliative care services for symptom management if appropriate. Optimisation of comorbidities

 

Smoking cessation

Introduction of smoking cessation, referral to local smoking cessation services

Other important resources include “Key Principles for Implementing Cancer Prehabilitation across Scotland” and “Prehabilitation guidance for people with cancer” [1, 2]. There is also a website (https://www.prehab.nhs.scot/) providing resources for patients and health professionals in Scotland, which has recently been launched. 

References

1.Macmillan. Prehabilitation Guidance for people with cancer. 2019; 

2.Scottish Government, Key principles for implementing cancer prehabilitation across scotland. 2022  [cited 2022 October 5th]; 

Editorial Information

Last reviewed: 20/09/2023

Next review date: 20/09/2026

Author(s): Iain Phillips.

Version: 1

Reviewer name(s): John Maclay.