Prehabilitation: Transforming cancer care before treatment begins

Over the last decade, I’ve seen prehabilitation gain recognition as a vital component of cancer care. It starts before treatment begins, continues during treatment, and supports patients to manage their cancer journey with greater resilience.

The evidence is clear. Patients who take part in prehabilitation are more likely to experience:

• fewer postoperative complications
• shorter hospital stays
• improved physical function and quality of life
• reduced anxiety and depression
• better treatment tolerance and recovery

For me, prehabilitation is about giving people the best possible chance, not only to complete treatment, but to feel more prepared, informed and in control when many aspects of care can feel overwhelming.

In Macmillan’s new guidelines, we define prehabilitation as:

A needs-based, multi-modal intervention delivered before and during cancer treatment to optimise physical, nutritional, and psychological health, enhance readiness for and tolerance of treatment, and improve recovery and quality of life.

It’s not one-size-fits-all. It’s personalised, inclusive, and multidisciplinary. The goal is simple: help people become active participants in their care, improving their ability to manage treatment and recover more quickly.

The guidelines identify three core components, delivered in a coordinated way based on the individual need:

Exercise

Tailored exercise programmes to improve cardiovascular fitness, muscle strength and functional capacity. These may range from independent walking plans to supervised exercise, depending on baseline health and treatment goals.

Nutrition

Nutritional screening, assessment and support help address malnutrition, weight loss, and treatment-related side effects such as loss of appetite, nausea, vomiting and a sore mouth.

Psychological support

Screening for anxiety and depression is essential. Interventions may include mindfulness, counselling and peer support to build psychological resilience.

Macmillan Cancer Support’s Prehabilitation for People with Cancer: Clinical and Implementation Guidelines were launched in October 2025. They provide a comprehensive evidence-based framework to support embedding a consistent model into routine practice.

The guidelines include:

• 20 statements and 54 recommendations
• eleven topic areas including health inequalities, implementation, health economics, behaviour change, nutrition, psychology, exercise and digital delivery.

I had the pleasure of co-leading this work with Professor Mike Grocott, Director, Southampton NIHR Biomedical Research Centre and Consultant Anaesthetist, University Hospital Southampton NHS Foundation Trust.

Download the full guidelines

The aim of these guidelines is to support implementation across different settings. They offer a clear and practical roadmap, including:

Early identification and referral

Prehabilitation should begin as soon as possible after diagnosis. Screening tools can help identify needs related to exercise, nutrition and psychological health.

Leadership and governance

Identify champions within clinical teams and establish governance structures.

Multidisciplinary collaboration

Effective prehabilitation relies on collaboration across primary and secondary care, alongside the voluntary, community and social enterprise (VCSE) sector. Integrated models and shared records support continuity of care.

Tailored interventions

Interventions should be adaptable to individual needs, cultural contexts and treatment pathways, including community-based and remote options where appropriate. Monitoring and evaluation Services should capture clinical outcomes (such as complication rates, day-of-surgery cancellations and length of stay), patient-reported outcomes, and health economic and service-level data.

Equity and accessibility

Design services to help reach underserved populations, including those with language barriers, disabilities, or socioeconomic challenges. Co-production with patients and carers can help ensure relevance and inclusivity.

Training and education

Equip staff with the skills to deliver prehabilitation, including motivational interviewing, exercise prescription, and psychological first aid.

Workforce and resources

Digital innovation

Digital tools can support screening, remote monitoring, virtual consultations and education, improving reach, scalability and personalisation.

Showcasing the guidelines

On behalf of the team, I had the privilege of presenting the guidelines at the World Prehabilitation Congress in Vancouver in November 2025. Sharing this work with an international audience reinforced the growing global momentum behind prehabilitation and the importance of consistent, evidence-based implementation.

I see prehabilitation as a shift from reactive to proactive cancer care. It creates opportunities to connect clinical pathways with neighbourhood health and community assets, including leisure services, voluntary organisations, peer support and social prescribing.

The guidelines are a call to action. Prehabilitation should be embedded as a standard part of cancer care, not an optional extra. By investing in people before treatment begins, we can improve outcomes, reduce system pressures and enhance experiences for people affected by cancer.

At Macmillan, we are supporting implementation by sharing the guidelines nationally, working with regional and local teams, and continuing to deliver national prehabilitation and rehabilitation webinars.

Use the guidelines in practice

• Use the guidelines to support service design, pathway development and local business cases.
• Consider how prehabilitation could be embedded earlier in your local cancer pathways.

Build shared understanding

• Start conversations within your MDT across oncology, surgery, anaesthetics and allied health professions.

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