Delivering prehabilitation in cancer surgery: a service evaluation at Nottingham University Hospitals

Abstract Purpose To evaluate outcomes of a multimodal prehabilitation service for cancer surgery patients delivered through three pathways (Specialised, Targeted, Universal) within routine NHS care at Nottingham University Hospitals NHS Trust. Methods This was a retrospective observational service evaluation of routine care data collected between 2022 and 2025. Of 1961 referred patients, 1720 were analysed: Specialised ( n = 329), Targeted ( n = 943), and Universal ( n = 448). Multimodal prehabilitation included exercise, nutrition, and psychological support, stratified by risk. Functional capacity was assessed using the Incremental Shuttle Walk Test (ISWT), 60-s Sit-to-Stand (STS), and grip strength. Psychological well-being was measured using the Generalised Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Physical activity behaviour was also recorded. Results All pathways showed significant within-group improvements. ISWT increased by 57 m ( p < 0.001, d = 0.6) and STS by 6 repetitions ( p < 0.001, d = 0.9). Anxiety (Δ –1.9) and depression (Δ –2.0) scores decreased (both p < 0.001, d ≈ –0.5). Weekly physical activity rose by 142 min ( d = 1.07), and strength sessions increased by 2.4 per week ( d = 1.1). Between-group differences were limited: PHQ-9 improved more in Specialised versus Targeted, and strength sessions increased more in Universal versus Targeted. Conclusion A tiered, multimodal prehabilitation service integrated into cancer pathways produced meaningful functional, psychological, and behavioural benefits, supporting broader implementation and improved patient access.