The National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration, Macmillan Cancer Support and the Royal College of Anaesthetists are calling for prehabilitation to be given to all newly diagnosed cancer patients, after Southampton research demonstrates its success.
Cancer treatment is notoriously hard – often described as a fight – and can be extremely demanding, both mentally and physically.
Southampton researchers Professor Mike Grocott, Professor Sandy Jack, Dr Steve Wootton, Dr Chloe Grimmett and Professor Denny Levett, alongside June Davis from Macmillan Cancer Support, have led the publication of a new prehabilitation guide for healthcare professionals to support cancer patients.
The new guide, published by the NIHR Cancer and Nutrition Collaboration, Macmillan Cancer Support and the Royal College of Anaesthetists (RCoA), urges healthcare professionals to provide prehabilitation for all newly diagnosed cancer patients to help improve outcomes.
What is prehabilitation?
Prehabilitation uses a combination of nutritional optimisation, structured exercise and psychological support to increase patients’ mental and physical resilience to cancer treatments.
It also empowers patients, improving their quality of life, and could potentially have long-term health benefits by promoting lasting changes in behaviour.
Research across the UK, pioneered by initiatives such as the WesFit clinical trial of prehabilitation before cancer surgery in Southampton, has shown that providing such support leads to better outcomes and reduces the risk of disease progression.
Changing cancer care
The guide recommends that prehabilitation should be adopted as a new approach for all patients with cancer, starting as soon as possible after diagnosis and before any treatment begins.
It places a large emphasis on working with patients and carers, from the initial design of the prehabilitation service to co-developed personalised prehabilitation care plans for each patient.
It also recommends that those delivering the prehabilitation services should be part of multidisciplinary cancer care teams, and that any prehabilitation services provided should be audited to assess their implementation and effectiveness.
Longer term goals
Looking further ahead, they suggest education in nutrition, exercise, psychology and behavioural change should be integrated throughout the training of health and care professionals, to support the delivery of prehabilitation services.
In addition, they recommend that the Professional Standards Authority, Chartered Institute for the Management of Sport and Physical Activity and the British Association of Sport and Exercise Sciences work together to define an approach to achieving accreditation or regulation for exercise professionals in prehabilitation.
Professor Mike Grocott, RCoA Vice President elect and joint project lead, says, “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.”
Posted on Friday 26 July 2019