Prehabilitation in Practice

Dr Katie Di Sebastiano is currently working to set up a partnership with the Wellbeing for the Time Being Cancer Prehabilitation and Rehabilitation Programme in Country Durham and Darlington.   Prehabilitation is any sort of intervention before a person undergoes medical or surgical treatment with the goal of reducing side effects and complications and to enhancing recovery.  In the cancer context, this means some sort of intervention that occurs after a cancer diagnosis, but before someone undergoes their primary treatment.  This has historically occurred before surgical treatment, but more often now includes chemotherapy and radiation therapy.  A typical prehabilitation programme focuses on 3 key aspects of health: nutrition and weight management, physical activity and physical functioning, and mental wellbeing.  The idea being to get the participant into the best shape possible before their treatment to improve the treatment effectiveness, reduce side effects of treatments and improve their overall outcomes.

The Wellbeing for the Time Being Prehabilitation and Rehabilitation Programme is a multimodal prehabilitation and rehabilitation programme for 4 cancer groups, including colorectal, lung, gynaecological, and head and neck cancers.  Once a participant has opted-in to the programme, they receive a personal consultation to assess their needs in relation to diet, physical activity and physical function, mental wellbeing, fatigue, alcohol and smoking consumption, and pain.  Following the consultation, an individual prehabilitation programme is devised based on the participant's goals.  This may include referral to the dietitian for nutritional support, exercise prescription, emotional support, referrals to smoking cessation and alcohol reduction programmes, and consultations with additional allied health professionals, including physiotherapists and occupational therapists as appropriate. Over 200 patients have completed the programme so far.  

With this partnership, the current programme will be evaluated to understand the implementation, process, and outcomes of prehabilitation in practice.   This will include an examination of the information collected as part of routine care within the programme to understand what components of the service are most heavily utilised and to investigate the effectiveness of the programme on nutrition, physical activity and function, mental health, fatigue, alcohol and smoking status, and pain.  We hope to link these outcomes to clinical outcomes, including treatment and long-term outcomes as well as examine the role of health inequalities within the programme.  A series of interviews to collect qualitative data from both participants and the programme providers to understand their experiences with the programme is also planned.  This evaluation will allow us to understand the most effective components of the programme as well as identify areas for growth within the offering.  

This work would not be possible without the support of the collaborators, specifically, Joanne Peacock, Clare Doney and Jo Meynell from the Wellbeing for the Time Being Programme, who are eager to establish this link between the programme and DSES.  Additionally, within DSES, Dr Toni Williams, will be supporting the qualitative evaluation of the programme.  If you are interested in finding out more about this emerging partnership, please contact Dr Katie Di Sebastiano at kathleen.di-sebastiano@durham.ac.uk.