Prehabilitation in Scotland

Cancer prehabilitation is an emerging field, with a growing evidence base that requires further evaluation in a Scottish context. As a result, the Scottish Government has convened a group of experts to form the Cancer Prehabilitation Steering Group (CPISG), and 3 subgroups: Digital, Psychological Well-being and the Nutritional Care Advisory Board.

The CPISG (Chaired by Prof. Annie Anderson) will support and oversee the implementation and evaluation of a comprehensive cancer prehabilitation offer in Scotland by March 2023. The subgroups will look to:

• Develop a digital offer that will support the delivery of tri-modal prehabilitation, improve access to education and training, and support measurement to improve understanding of what works and in what context (Digital – Chaired by Dr David McDonald);
• Scale up the West of Scotland’s Psychological Therapies and Support Framework to the whole of Scotland, thereby improving access to psychological care and support (Psychological Wellbeing – Co-Chaired by Dr Helen Moffat and Ms Gillian Hailstones); and
• Develop and implement a nutrition framework for prehabilitation (Nutrition – Chaired by Ms Debbie Provan).

This focus was determined by a scoping exercise carried out in Scotland during 2019/2020. Scoping revealed an enthusiasm for prehabilitation with some established services already in existence. However, there was a great deal of variation, services were vulnerable to the COVID-19 pandemic and very few services were able to provide a comprehensive (tri-modal) offer that included physical activity/exercise and nutritional care and well-being support with behaviour change interventions. Nutritional care and support was also identified as a particular gap, with psychological care and support limited in some areas. On the contrary, any work already underway incorporated physical activity and/or exercise, and a range of services were identified as being available within communities that could support that aspect of prehabilitation. Thus, there is not a physical activity/exercise subgroup, but it does remain a firm focus of the CPISG and every effort will be made to ensure tri-modal prehabilitation is developed in Scotland.

Members of the CPISG and its subgroup provide links to a number of established groups and organisations who are able to support the delivery of prehabilitation in Scotland and we hope that by working collaboratively with the wider community we will be able to maximise our impact. The CPISG will also support an innovative pilot project being led by one of our partner organisations; this will see prehabilitation offered across a range of Scottish locations before the end of 2021.

Debbie Provan is a Clinical Advisor to the Scottish Government’s Cancer Policy Team and is responsible for delivering the actions associated with prehabilitation in the latest Cancer Plan (Actions 24-27). A dietitian by background, she is seconded from NHS Ayrshire and Arran and has held a number of relevant roles including Regional Lead for Living With & Beyond Cancer in the West of Scotland Cancer Network and Macmillan National AHP Lead for Cancer Rehabilitation.