Cancer prehabilitation, Northumbria Healthcare Trust

The Northeast of England has some of the countries’ most deprived communities coupled with some of the highest cancer rates.

The increased prevalence of conditions such as obesity and type 2 diabetes undoubtedly promotes our regions’ poor health statistics and yet is essentially preventable. Stress and inactivity levels are becoming endemic.

An added challenge includes the size and spread of our Trust, covering some 2,500 square miles and incorporating busy urban areas, rural and coastal communities.

From modest beginnings, our pilot service finally crystallised in February 2023 utilising a single Band 4 Health Coach. Health coaches, having been employed by the trust just before Covid hit, were funded by Public Health and had been largely underutilised. We began by inviting our colorectal cancer patients, early in the pathway, to attend for either a face to face, virtual or telephone consultation. We offered, at that time, two half day clinics on separate sites with the Health Coach trained to promote M.E.C.C. (make each contact count). The offer was for six one-hour appointments in total, either pre or post operatively, at the patient’s direction.

Through our Lead Cancer nurse, we applied and were successful in obtaining interim funding from Cancer Alliance. This allowed us to employ a second part time Band 4 Health Coach and a full time Band 7 Physio, who became our clinical lead. Our physio joined us in October 23 and admin input was secured through one of our anaesthetic secretaries. Further interim funding has now secured a Band 6 dietician (0.6 WTE) and further admin time. We operate the service in several hospital and community settings with funding secure until October 2025.

We aim to offer support to all our cancer patients and have been gradually adding specialities as we are able. First colorectal, then gynae and most recently breast. These are the main surgical cancer specialties that we have. We have looked closely at each very individual pathway to ascertain the earliest appropriate point to contact patients. This is not infrequently before a formal diagnosis is confirmed so we are careful not to assume a cancer diagnosis till then. We are also happy to take referrals from other cancer pathways where patients may not be undergoing surgery in our trust (or at all) but may be facing gruelling neoadjuvant or adjuvant chemotherapy.

Triage is currently undertaken by our physio looking at electronic patient records or the Somerset register. The higher risk patients are seen by her, and the lower risk are seen by the health coaches.

We have developed a quick tool for triage through DrDoctor, a health technology firm, which could go out to a patient’s phone being relatively quick and simple to complete - we are not yet in a position to roll this out.

Currently we see around 40-45 patients per week.

Setting up a steering group with a wide array of interested parties such as a dietician, personalised care team, physio, pre-assessment, lay person, public health etc has afforded us the ability to work through ideas quickly and secure swift resolution to problems. We are extremely fortunate to have a public health team embedded within the trust.

Going forward, we are working on a business case for the summer of ‘24. We are collecting data on standard metrics such as LOS and complications etc, but also looking at IMD’s, location, rurality, ethnicity and gender. We hope to show our services’ worth from both a financial perspective and from that of patient well-being.

Into the future, if successful, we have the ambition to promote the principles of our prehabilitation service into our non-cancer pathways too.

Dr. Karin Ingram, Consultant Anaesthetist, Prehabilitation Lead, Northumbria Trust CPOC lead.

I began my anaesthetic career in 1989, taking up a consultant post 10 years later. Having worked for 15 years in anaesthesia and intensive care, I changed tack to concentrate more on major colorectal surgery. During COVID, I developed an interest in Prehabilitation and Peri-Operative Care and pushed for the service to be considered within our Trust.