Cancer Prehabilitation: Staff perspectives on implementation

Introduction

Cancer Prehabilitation, or ‘prehab’ for short, is a needs-based multi-modal intervention before, and during cancer treatment. It involves screening and assessment of physical, nutritional and psychological needs, to enable to prescription of interventions.^[3] These interventions aim to enhance readiness for, and tolerance of, treatments, and improve recovery and/or quality of life. There is growing evidence that cancer prehabilitation has a positive effect on functional outcomes for patients and may be better for patients experientially^{[4] [5]}.

A national online survey of staff^[2] working in cancer prehabilitation and rehabilitation in Scotland, which was a repeat of a survey first conducted in 2022^[6], explored the current and planned position of prehabilitation, to assess progress towards the ambitions of Scotland’s Cancer Strategy (2023-2033)^[1].

This report presents findings from follow-up focus groups to the 2025 survey, which aimed to gather in-depth insights into how cancer prehabilitation is implemented as a core component of treatment preparation, and how rehabilitation is integrated as part of the continuum of care – and what additional support could help.

The analysis presented here forms part of a wider programme of evidence-gathering to evaluate progress on actions relating to prehabilitation in the Cancer Action Plan (2023-2026)^[7], and generate ideas to inform the next Cancer Action Plan.

Policy context

One of the 11 priority ambitions of the Scottish Government’s 10-year Cancer Strategy is ‘Best Preparation For Treatment’; that every person diagnosed with cancer in Scotland is provided with timely, effective and individualised care to best prepare them for treatment. This begins with cancer prehabilitation.

Principles and guidance for prehabilitation^[8] co-produced by Macmillan, the Royal College of Anaesthetists, the National Institute for Health Research Cancer and the Nutrition Collaboration provide a structure for the cancer prehabilitation pathway. Updated clinical and implementation guidelines^[3] were published in 2025. As part of this guidance, screening is the first step and should occur as early as possible after a cancer diagnosis and in advance of each treatment. Where appropriate, screening may precede a confirmed diagnosis. Screening uses validated tools to identify physical, nutritional and psychological support needs. When targeted or specialist support is identified, a formative assessment should be completed; this informs the prescription of interventions.

The Scottish Government’s Key Principles for Implementing Prehabilitation^[9] distils the above guidance for practical use by professionals. It recommends that all patients are screened to identify level of need and that, regardless of the screening outcome, all patients are provided with universal prehabilitation. This should include signposting to NHS Scotland’s Prehab and me website^[10] and referral to a universal prehabilitation workshop, delivered by Maggie’s (in person or online), or another suitable organisation. Where appropriate, cancer prehabilitation also includes assessment and interventions relating to exercise, nutrition, psychological support and assistance, with alcohol and tobacco reduction/ avoidance are part of a prehabilitation to rehabilitation continuum.

In Scotland’s Cancer Action Plan 2023-2026, Actions 47-51 focus on supporting the delivery of cancer prehabilitation in Scotland, specifically to: improve access to high quality training for staff, strengthen partnerships, invest in universal prehabilitation, test prehabilitation approaches, explore digital innovations, and develop tools to assess nutritional needs. Findings from focus groups reported here, together with published survey data, evidence from local pilots such as the evaluation undertaken by Maggie’s^[11], and the wider cancer strategy evaluation^[12], are intended to help assess the extent that these actions have been realised and identify future requirements.

Within a wider policy landscape, cancer prehabilitation exemplifies the types of secondary and tertiary prevention which are the focus of the Health and Social Care Service Renewal Framework^[13] co-produced by Scottish Government and the Convention of Scottish Local Authorities (COSLA). This long-term framework aims to make health and social care more personal, effective and available closer to home. Cancer prehabilitation policy also aligns with Scotland’s Population Health Framework^[14], through its emphasis on preventative investment and action. Therefore, insights from everyday practice in relation to the implementation of cancer prehabilitation, particularly regarding collaboration across multiple organisations, actions to reduce health and care inequalities, and efforts to shift the balance of care toward community‑based approaches, may be of value to other areas of cancer prevention and wider prevention policy.

Objectives

The purpose of focus groups was to deepen our understanding of 2025 national survey results and generate ideas for sustainable delivery of prehabilitation, to inform the next Cancer Action Plan. Focus groups were specifically intended to:

• Provide context to the quantitative survey findings regarding cross‑sector collaboration and prehabilitation pathways,
• Identify barriers to service transformation and redesign, and
• Generate ideas to support long‑term sustainability.

The findings are presented as themes emerging from the focus groups, followed by staff perspectives on future areas of focus. This is followed by a discussion section, which explores the implications of findings under the following headings:

• How do staff think cancer prehabilitation pathways and partnerships should ideally function?
• What are the barriers to effective pathways and partnerships?
• What are staff views on future areas of focus?