Understanding Equity in Cancer Prehabilitation Services in Wales: A Medical Record Review

Cancer prehabilitation prepares people for cancer treatment by promoting physical activity, eating well and emotional wellbeing. Evidence shows that prehabilitation before and during cancer treatment reduces treatment complications and improves outcomes, including survival. However, the availability of and patient engagement with prehabilitation is variable. People from lower socioeconomic and minority ethnic backgrounds are at greater risk of poor health outcomes from diseases like cancer and are less likely to engage with prehabilitation services. Access, acceptance and adherence to prehabilitation for all cancer patients is important for progress towards equity in treatment outcomes. Understanding how prehabilitation services are currently delivered is an important first step in improving cancer health equity. The medical record review reported here was conducted as part of case study research on equity of cancer prehabilitation services in Wales.

To describe cancer prehabilitation services delivered across the National Health Service (NHS) in Wales, with a view to understanding issues related to health equity.

Data were collected from medical records for all patients who attended an initial cancer prehabilitation consultation over a four-week period at each of seven NHS providers. Patients were included if they were adults referred for prehabilitation with a confirmed or suspected diagnosis of upper gastrointestinal, colorectal, lung, prostate or breast cancer and were awaiting active or palliative treatment. Data extracted for each patient included demographics, cancer site and the components of prehabilitation received. The Charlson Comorbidity Index and Index of Multiple Deprivation were calculated. Descriptive statistics and correlational analysis were used. A total of 134 individual patient cases were included. Of these, 63% had colorectal cancer, 22% upper gastrointestinal cancer and 12% lung cancer. Mean age was 68 years, with 56% men and 44% women. Forty-two percent were from the two most deprived quintiles, whilst 100% of patients with a recorded ethnicity were White-neither figure is representative of cancer cases in Wales. There was wide variability across services in the type and duration of prehabilitation received. An estimated 14% of patients newly diagnosed with the included cancers in Wales accessed prehabilitation.

The findings demonstrate a highly variable prehabilitation offer in Wales. Targeted efforts are required to improve uptake among socioeconomically disadvantaged groups to enhance cancer treatment outcomes.