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Patient and Doctor

Prehabilitation in Practice: Evaluating the barriers and facilitators to participation in the Cancer Treatment Outcomes Prehabilitation and Rehabilitation Programme

Dr Katie Di Sebastiano, and her collaborators, Dr Toni Williams, from the Department of Sport and Exercise Sciences, and Joanne Peacock, Clare Doney, Jo Meynell, and Andrew Mishreki, from the County Durham and Darlington NHS Foundation Trust, have received pilot funding from the North Cancer Alliance to support their work evaluating the barriers and facilitators to participation in Cancer Treatment Outcomes Prehabilitation and Rehabilitation Programme.

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 any sort of intervention that occurs after a cancer diagnosis, but before someone undergoes their primary treatment.  Historically, this has 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 Cancer Treatment Outcomes Programme is a multimodal prehabilitation and rehabilitation programme for 4 cancer groups: colorectal, lung, gynaecological, and head and neck cancers.  Participants 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 and 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.  

This pilot funding will support the identification of barriers and facilitators to participation in the Cancer Treatment Outcomes programme, from both the participants perspective as well as through the perspectives of the clinicians who refer participants to the programme.  The goal of the evaluation will be to identify ways someone may or may not engage with the programme and ultimately remove the barriers to participation for more individuals. 

If you are interested in finding out more about this project, please contact Dr Katie Di Sebastiano at