Cancer prehabilitation in Scotland: 2025 survey findings report

1. Executive summary

This report summarises the findings from a survey undertaken in Spring 2025 about the views of professionals working in cancer prehabilitation and rehabilitation services in Scotland. Its findings were analysed and reported by Scottish Government (SG) social researchers, on behalf of Scotland’s Cancer Prehabilitation Oversight Group (CPOG).

The survey had two purposes: first, to understand progress toward achieving the long-term ambition of “Best Preparation for Treatment” (‘Pre-treatment’) outlined in the Cancer Strategy for Scotland 2023 – 2033. This ambition is that every person diagnosed with cancer in Scotland is provided with timely, effective and individualised care to best prepare them for treatment. Second, to help shape future actions in the current and future Cancer Action Plans, by identifying what new or continuing actions may be needed to realise this ambition for people with cancer.

The online survey included closed and open questions about prehabilitation as a core component of preparation for treatment, and rehabilitation as part of the continuum of care. A survey link was emailed by members of CPOG to their professional networks in cancer prehabilitation. 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.”

A total of 302 staff responded to the survey, compared with 187 respondents to the survey in 2022. 71% were employed by an NHS Board. The large majority were Allied Health Professionals (AHPs), Physicians (secondary or tertiary care), or Nurses. There were contributions from all 14 NHS Health Boards and all 3 Cancer Network Areas but not in a representative way, with 40% of respondents from West of Scotland Cancer Network (40%), followed by South East Cancer Network (35%) and North Cancer Alliance (24%).

The sampling approach was convenience sampling. This means we cannot be certain of the representativeness of views across professions or networks since some groups or areas may be over- or under-represented due to the accessibility of the sample. The report acknowledges limitations in comparing groups and survey years, as some variation is expected due to the convenience sampling approach used in 2019, 2022 and in this survey.

Survey findings have been summarised thematically as presented below, and comparisons have been made with the analysis reported in 2023 to understand progress since 2022 towards embedding the eight Key Principles for Implementing Cancer Prehabilitation across Scotland (‘Key Principles’) in practice.

Attitudes and awareness

Most respondents attached high importance to prehabilitation, with 60% rating it as a crucial component of care before cancer treatment. Two fifths (41%) indicated a high awareness of the eight ‘Key Principles’, with a similar proportion (38%) indicating low or no awareness of these principles. There were no clear differences in ratings of importance of preparation for treatment and awareness of the Key Principles of prehabilitation observed between the 2022 and 2025 surveys. Respondents emphasised the benefits of prehabilitation for patient outcomes and expressed the need to continue to raise awareness amongst staff of different professions about what prehabilitation entails, what activities are available locally, and how to access them.

Service availability and resourcing

Half of respondents (50%) indicated that prehabilitation activities were offered in their local area. A wide range of professionals were identified as contributing to the delivery of prehabilitation. Most commonly these were Nurses, Dietitians and Physiotherapists. A quarter of respondents (25%) indicated plans to introduce or add to local prehabilitation activities in their local area. These results are unchanged from the previous survey.

Respondents described a mixed picture of progress in service development over the last 18 months, with some areas expanding prehabilitation activities, while others scaled them back. Some attributed changes in local prehabilitation activities to reliance on temporary funding. Just over a quarter of respondents (27%) reported receiving temporary funding, much of which was expected to end within the year. Respondents emphasised the desire for sustainable funding models, including resource to be able to deliver a full range of prehabilitation modes, dedicated staff capacity to deliver prehabilitation, and for targeted and specialist prehabilitation where there are gaps in provision.

Service delivery and pathways

Agreement with statements about the extent to which delivery is underpinned by the Key Principles of prehabilitation has increased between 2022 and 2025. The highest level of agreement was for the statement that activities are multi-modal (69%). Agreement was around two thirds that, in local service delivery: prehabilitation starts as early as possible (64%); runs in parallel with usual decision-making processes (66%), and; is part of the rehabilitation continuum (64%). Fewer than half agreed with statements about: using screening to determine interventions (32%); recording screening by the cancer multidisciplinary team (MDT) (46%), and; using validated tools for assessment and outcomes measurement (34%). Around a quarter of respondents (26%) agreed that all patients have co-produced personalised care plans.

In line with 2022, three fifths (63%) of respondents with local services either referred to or provided prehabilitation services. Timeliness of referrals was highlighted as an issue. Some suggested that automated referrals could improve early screening and timely onward referral. Some also suggested that coordinator roles or prehabilitation clinics (already in place in some areas) could improve local care pathways and collaboration and help reduce unnecessary burden for people.

Of those with local activities, two thirds (66%) indicated screening or triaging for at least one mode of prehabilitation support in their area. This figure is comparable with 71% in 2022. Perceived nutritional risk was the mode most likely to be screened for. Across all three modes of prehabilitation, a variety of screening methods were described, ranging from tools-based and routinised measures, to methods with a greater emphasis on discussion and professional judgement.

Access to services

The availability of locally accessible services, and appointments that are aligned with patient needs and activities delivered through appropriate modes, were seen as enablers of prehabilitation. Some groups were identified as having inequitable access to prehabilitation, such as people with Stage 1 or Stage 2 cancers, those with co-morbidities, those receiving palliative care, and service offerings varying by cancer diagnoses or treatment types. While video consultations were reported to enable remote connections for prehabilitation, people living in remote and rural areas and those at risk of digital exclusion were noted as groups with barriers to access.

Communication and collaboration

There were three main ways of working described by respondents: close working within an MDT, variable relationships within an MDT, and areas where prehabilitation is delivered by a range of separate services. Across these differences in structure of care teams delivering activities, many respondents described positive relationships and collaboration to deliver prehabilitation and support patients. Respondents also emphasised the need for better collaboration and coordination across different organisations, specifically the NHS and Third Sector. These improvements were seen as essential to ensuring patients receive early, appropriate and joined up pre-treatment care.

Monitoring, evaluation and outcome measurement

As in 2022, many respondents in 2025 were uncertain about whether and how monitoring was undertaken. Recording patient referrals, uptake and attendance, and feedback forms or questionnaires were common responses. A third of respondents (34%) reported using outcome measures to determine the effectiveness of interventions, including a variety of standardised measures and subjective questionnaires, such as quality-of-life measures, tests of functional outcomes, and assessment of post-operative complications. Some felt that better systems, aligned with current IT infrastructure, are needed to monitor patient progress and record patient outcomes.

Learning resources

Around one fifth of respondents (19%) reported using the national prehabilitation website, Prehab and Me. This was largely for their own development or to signpost patients to information to inform and engage them in prehabilitation. Lack of awareness was the primary barrier to using the website. Respondents had varying levels of awareness of other frameworks and e-learning resources related to prehabilitation, with the Enhanced Recovery After Surgery (ERAS) in Scotland module on TURAS being the most widely recognised e-learning resource (by 42% respondents). Linking to existing online resources about prehabilitation and integrating prehabilitation into online health and care training programmes, were suggested as ways to enhance local pathways.

Rehabilitation

Around one in three respondents (33%) reported cancer rehabilitation activities in their local area in 2025, which is down from over half of respondents (53%) reporting rehabilitation activities in 2022. A quarter of respondents (26%) rated their awareness of the Once for Scotland approach to Rehabilitation as high, suggesting the importance of increasing awareness. Most respondents agreed that local cancer rehabilitation services are realistic and meaningful to the individual, and delivered by a flexible and skilled workforce, in accordance with the ‘Once for Scotland’ principles. Ease of access to rehabilitation services and integration across services, sectors and agencies were highlighted as areas for improvement.

Key findings and recommendations

Overall, 2025 survey findings reaffirm support for prehabilitation amongst staff, and a stronger perception that the ‘Key Principles for Implementing Cancer Prehabilitation across Scotland’ underpin delivery of local prehabilitation activities. Awareness of the Key Principles, the availability of prehabilitation activities locally, and the accessibility of activities show few changes from 2022. However, there have been examples of local service improvements over the past 18 months, for example, in reaching patients with a wider variety of cancer types, trialling screening tools, and developing leadership roles to embed prehabilitation in ways of working.

To further advance the adoption of prehabilitation across Scotland, several actions are recommended from the analysis. Namely, continued awareness-raising, establishing forums to share learning from pilot projects and partnerships, providing support to co-design services to improve access, providing guidance on using data to measure outcomes and demonstrate impact, and integration with rehabilitation along the continuum of care. Areas for follow-up conversations with staff to gain further insights are highlighted. These include perspectives on: multi-modal staffing, screening practices, funding models, and the prehabilitation-rehabilitation continuum.