Cancer prehabilitation services in Wales are highly variable across providers, with an estimated 14% of newly diagnosed patients accessing prehabilitation, and significant underrepresentation of socioeconomically disadvantaged and minority ethnic groups.
Key Findings
Results
Only an estimated 14% of patients newly diagnosed with the included cancers in Wales accessed prehabilitation services.
134 individual patient cases were included, collected over a four-week period at each of seven NHS providers
Included cancer types were upper gastrointestinal, colorectal, lung, prostate, and breast cancer
This figure represents a small fraction of the total cancer cases in Wales during the study period
Data were collected from medical records for all patients who attended an initial cancer prehabilitation consultation
Results
There was wide variability across services in the type and duration of prehabilitation received across seven NHS providers in Wales.
Seven NHS providers participated in the study
Data were collected over a four-week period at each provider
Variability was observed in both the components of prehabilitation delivered and the duration of services
Prehabilitation components assessed included physical activity, nutrition, and emotional wellbeing
Results
Forty-two percent of patients in the study were from the two most deprived quintiles, a figure described as not representative of cancer cases in Wales.
Deprivation was calculated using the Index of Multiple Deprivation
42% of patients came from the two most deprived quintiles
The authors note this figure is not representative of the broader cancer population in Wales
People from lower socioeconomic backgrounds are noted to be at greater risk of poor health outcomes from cancer and less likely to engage with prehabilitation
Results
100% of patients with a recorded ethnicity were White, which is described as not representative of cancer cases in Wales.
Ethnicity data were extracted from medical records as part of the demographic data collection
All 134 patients with a recorded ethnicity were identified as White
The authors note this is not representative of cancer cases in Wales
People from minority ethnic backgrounds are identified as being less likely to engage with prehabilitation services
Results
The study sample had a mean age of 68 years, was 56% male and 44% female, and was predominantly composed of colorectal cancer patients.
Total sample size was 134 patients
63% had colorectal cancer, 22% upper gastrointestinal cancer, and 12% lung cancer
Mean age was 68 years
56% were men and 44% were women
Patients were included if they had a confirmed or suspected diagnosis of upper gastrointestinal, colorectal, lung, prostate, or breast cancer
Methods
The Charlson Comorbidity Index was calculated for patients as part of the demographic and clinical characterization of the prehabilitation population.
The Charlson Comorbidity Index was extracted or calculated from medical record data
This measure was used alongside the Index of Multiple Deprivation to characterize the patient population
Descriptive statistics and correlational analysis were used to analyze the data
Patients were required to be adults awaiting active or palliative treatment to be included
Background
People from lower socioeconomic and minority ethnic backgrounds are less likely to engage with prehabilitation services, representing a health equity concern.
The study was conducted as part of case study research on equity of cancer prehabilitation services in Wales
Access, acceptance, and adherence to prehabilitation for all cancer patients is described as important for progress towards equity in treatment outcomes
The authors conclude that targeted efforts are required to improve uptake among socioeconomically disadvantaged groups
Evidence cited in the paper indicates that prehabilitation reduces treatment complications and improves outcomes including survival
What This Means
This research suggests that cancer prehabilitation services in Wales — programs designed to help patients prepare for cancer treatment through physical activity, better nutrition, and emotional support — are reaching only a small fraction of eligible patients. Across seven NHS providers studied, only an estimated 14% of newly diagnosed patients with the relevant cancer types were accessing prehabilitation, and the type and length of services varied considerably from one provider to another. This inconsistency means that patients' access to potentially beneficial support before treatment depends heavily on where they receive their care.
The research also highlights important equity concerns. Although 42% of patients in the study came from the most deprived areas of Wales, the authors note this still does not reflect the true proportion of cancer patients from disadvantaged backgrounds in Wales. More strikingly, all patients whose ethnicity was recorded were White, which similarly does not reflect the diversity of cancer patients in Wales. This suggests that people from minority ethnic communities may be largely absent from prehabilitation services altogether.
This research suggests that current cancer prehabilitation services in Wales are not equitably reaching all patients who might benefit from them, particularly those from socioeconomically disadvantaged or minority ethnic backgrounds — groups already known to face worse cancer outcomes. The findings point to the need for targeted efforts to improve how prehabilitation is offered, promoted, and delivered so that it can help reduce rather than widen existing inequalities in cancer treatment outcomes.
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Palmer S, Mitchell A, Ramachandran A, Gale N, Lewis S, Patil M, et al.. (2026). Understanding Equity in Cancer Prehabilitation Services in Wales: A Medical Record Review.. Cancer reports (Hoboken, N.J.). https://doi.org/10.1002/cnr2.70598