Last updated: November 2022
Just imagine a program being available when you are newly diagnosed with cancer that got you fitter before surgery or treatment, helped you with nutritional advice, and supported your emotional wellbeing. And one that was co-designed by patient representatives who understood the challenges of cancer.
Well, that’s exactly what we imagined here in Greater Manchester (GM) in the UK. GM consists of 10 Boroughs. Health is poorer than the UK average, with more people suffering heart disease and cancer. One in five people in GM live in one of the UK’s most disadvantaged areas. Many early deaths in GM are caused by smoking or poor diet, among other things.2
Supporting cancer patients better
In GM we had a vision of how we could support cancer patients better, in partnership with the boroughs, leisure service providers, and personal trainers. The program is called Prehab4Cancer.
What exactly is prehabilitation? The best answer we came up with was: “the preparation for the physiological and psychological challenges of cancer treatment.”
What exactly are the benefits? We hoped that our program would achieve:
- Shorter recovery times
- Reduced treatment-related complications
- Improved adherence to and completion of treatment
- Improved quality of life
- Transition to a lifelong habit of physical activity (after all, if exercise were a pill we’d all be taking it!)
The vision became a reality when a pilot scheme was agreed, commencing in April 2019 with the aim of getting 2,000 patients through the program in the two-year pilot window.
Of course COVID came along in the spring of 2020, which required face-to-face delivery to be abandoned. However, no patients were abandoned! In the space of less than one week the scheme was completely re-designed for virtual delivery, either one-to-one online or by delivery of group classes online. The target of 2,000 patients was comfortably met.
Clearly some patients required much greater support, and the scheme was designed to deliver just that.
How the program works
A three-tier approach was adopted with patients at the top of the pyramid receiving the greatest level of support, and other patients being supported with 1-2-1 exercise prescription, weekly progress updates, and independent exercise at local leisure centers.
Slightly different programs were adopted for surgery and treatment (chemo, etc.) pathways.
Each patient entering the program was assessed by a CanRehab expert in order to establish what would be the best approach for them, and to enable base levels to be established so that progress could be monitored.
The program was constantly assessed to ensure it was delivering on its targets and, at the end of the two-year program, permanent funding was achieved to secure the future of the program. It was based on preliminary outcome measures, which showed:1
- Cardio vascular function improvement, such as an increase of 50m on a six-minute walk test
- Improvement for lower body strength
- Increased sense of wellbeing and quality of life
- Post-op fitness assessment showing improvement on base levels
Like everything else, though, it was important to prove to our paymasters that they were getting value for money. So an independent evaluation was commissioned that confirmed that patients who went through the Prehab program spent less time in hospital and recovered more quickly. The evaluation also suggests improvement on survival rates one-year post-surgery. Savings were also seen in critical care bed takeup.1
Ultimately one of the best arbiters will be the patients, and we've heard various success stories, such as from those patients who appreciated having someone check up on them to do exercises, and those who felt better prepared for cancer treatment as a result.
We believe that Prehab4Cancer is a world-leading program supporting cancer patients, and we hope to see it copied worldwide so that cancer patients everywhere get the support that they need.
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