There are some positive trends in terms of both clinical outcomes and cost generated by several published clinical trials reporting on the economics of prehabilitation for cancer. However, the quality of evidence, low patient numbers, variety of interventions, comparators and study designs limits the conclusions which can be drawn on the value generated.
Prehabilitation service evaluations with results which align with the positive trends in the published literature, provide some supporting information for organisations considering piloting prehabilitation services.
Links to these evaluations are provided below:
- Active Together, Sheffield
- Prehab4Cancer, Greater Manchester
- North East London prehabilitation service evaluation
- Bristol Myers Squibb/Macmillan Cancer Support Prehabilitation report
- Northern Ireland prehabilitation evaluation
- Macmillan South East Scotland Cancer Network (SCAN) Prehabilitation Project Evaluation
- Prehabilitation for people with cancer who live in a remote, rural or island location, University of the Highlands and Islands
Caution should be used as this information may not be transferable and generalisable, nor have these been peer-reviewed.
It is recommended that organisations considering implementing prehabilitation examine available service evaluations for relevance to their particular context, and that these organisations collect robust data when piloting prehabilitation to assess its impact on their outcomes and costs.
Potential outcome categories for prehabilitation and rehabilitation and some examples for each category
- It is important that services choose the outcomes they plan to collect at the outset and review on an ongoing basis
- Outcomes should also pull through from the tools used for screening and assessment of prehabilitation/rehabilitation
- Suggest at least one outcome measure used from each category
- A national prehabiltation outcome data set is under development with planned publication during 2026
- What matters most to you? Please list up to three things that matter most to you right now. These could be physical, emotional, social, or practical
- What matters least to you?
- List up to three things that feel less important or relevant to you right now
- Self rated against concerns e.g. from 0 (major concern) to 5 (no concern) for examples such as pain, finance, work, daily functioning, relationships, social support
- Long Bulls Eye (clarifying a person’s values)
- Sit to stand
- 6-minute walk test (from assessment)
- 30 second chair to stand (from assessment)
- Timed up and Go FACIT fatigue inventory
- Dukes Activity Status Index (DASI) (from screening)
- International physical activity questionnaire (from screening)
- Incremental Shuttle Walk Test
- WHO Disability Assessment Schedule
- Patient Generated Subjective Global Assessment – short form (from screening)
- Patient Generated Subjective Global Assessment – long form (from assessment)
- Malnutrition Universal Screening Tool (MUST)
- Rockwood Clinical Frailty Scale
- Hand Grip Strength
- Sleep
- HADS
- GAD-7 (from screening and assessment)
- PHQ-9 (from screening and assessment)
- Distress thermometer
- Warwick Edinburgh Mental Wellbeing Scale
- EQ-5D-5L
- EORTC-QLQ C30
- Self-efficacy for self-management of chronic disease (Lorig)
- National QoL metric
- Prevention of other long-term conditions
- Tumour down staging
- Reduction in recurrence
- Positive feedback on personalised care and support
- Improved confidence and self-efficacy in managing health
- Satisfaction with access to third sector and community resources
- NCPES
- Days alive and out of hospital at 30 days
- Days alive and out of hospital at 60 days
- Days alive and out of hospital at 90 days
- Readmission
- Length of stay reduction
- Reduction in complications
- Reduction in emergency admissions
- Reduction in outpatient visits
- Reduction in GP out-of-hours calls