Delivering Prehabilitation in Cancer Surgery: A Service Evaluation at Nottingham University Hospitals

Abstract

Abstract Background: Cancer surgery carries high risks, with complications linked to delayed recovery and poorer outcomes. Prehabilitation aims to optimise patient fitness before surgery, yet evidence from real-world NHS settings remain limited. In 2022, Nottingham University Hospitals NHS Trust introduced a multimodal prehabilitation service, developed in line with Macmillan Cancer Support guidance. Methods: This service evaluation included 1,720 patients triaged to Specialised (n = 329), Targeted (n = 943), or Universal (n = 448) prehabilitation pathways. Outcomes assessed pre- and post-programme included functional capacity (incremental shuttle walk test [ISWT], 60-second sit-to-stand [STS] test, grip strength), psychological health (GAD-7, PHQ-9), and physical activity. Analyses used paired t-tests, ANOVA, and effect size calculations. Results: Significant improvements were observed across outcomes. ISWT increased by 57 m (p < 0.001, d = 0.6), STS by 6 repetitions (p < 0.001, d = 0.9), and grip strength modestly (p < 0.001). Anxiety (Δ –1.9) and depression (Δ –2.0) scores decreased (both p < 0.001, d ≈ –0.5). Weekly physical activity more than doubled (+142 min/week), and strength sessions increased by 2.4 sessions (both p < 0.001, d > 1.0). Between-group differences were limited, although PHQ-9 scores improved more in the Specialised than the Targeted pathway and strength sessions more in the Universal than the Targeted pathway. Conclusion: A multimodal prehabilitation programme delivered within routine cancer care was associated with meaningful functional, psychological, and behavioural gains. However, barriers to engagement highlight the need for flexible delivery models and systematic follow-up to maximise accessibility and sustainability.