Cancer prehabilitation survey: findings report

1 Background

This analysis reports on findings from a survey about cancer prehabilitation and rehabilitation services which was undertaken by the Scottish Government (SG) on behalf of Scotland's Cancer Prehabilitation Implementation Steering Group (CPISG).

In 2019, Macmillan Cancer Support published new guidance on Prehabilitation for People with Cancer. This outlined the principles of prehabilitation and offered advice on how this could be achieved in practice. A Prehabilitation Short Life Working Group was then established in Scotland. The group initiated a survey of prehabilitation services in Scotland, which was undertaken in November-December 2019, before the onset of the COVID-19 pandemic. In September 2020, the group published a report on Prehabilitation Services in Scotland for People with Cancer, which included the survey findings. This work informed a commitment in the Scottish Government's Action Plan for Cancer Services published in December 2020, to implement a programme of prehabilitation work in Scotland.

CPISG was convened and tasked with developing and supporting effective national roll-out of cancer prehabilitation across Scotland. (See Appendix B for CPISG membership). To date CPISG have developed several outputs including, in April 2022, publication of the eight Key Principles for Implementing Cancer Prehabilitation across Scotland, based on the Macmillan principles. CPISG are also supporting a pilot prehabilitation programme being delivered by Maggie's centres across the country. However, to deliver their objective of effective national roll-out, it was considered important for CPISG to re-assess the current and planned prehabilitation position within Scotland, to help inform the incorporation of evaluation findings into everyday practice. This survey aimed to support that objective, and to help CPISG to identify future requirements, thereby also informing Scotland's new Cancer Strategy which is expected in Spring 2023.

The survey whose findings are reported below built on the 2019 survey, repeating some of its questions. It added new questions to seek, among other things, an understanding of the impact of the COVID-19 pandemic on prehabilitation in Scotland. Some comparisons with 2019 findings are shown but it is important to note their limitations. Respondents to the 2019 and 2022 surveys were not necessarily the same people; and perceptions of what constitutes prehabilitation could differ between the two surveys.

For the purposes of the survey the following definitions were provided to respondents:

Prehabilitation "constitutes nutrition, physical activity/exercise and psychological support and the associated interventions delivered before definitive cancer treatment. You may consider individual services or multi-modal programmes."

Rehabilitation "constitutes nutrition, physical activity/exercise and psychological support and the associated interventions delivered after definitive cancer treatment. Rehabilitation is proactive and personalised."