A Service Evaluation of the Active Together Multi-Modal Cancer Prehabilitation and Rehabilitation Service

BackgroundActive Together is a clinician-led cancer prehabilitation and rehabilitation service for adults with colorectal, lung, or upper gastrointestinal (GI) cancer receiving curative treatment in Sheffield, UK. This service evaluation assessed the feasibility, engagement, and impact of a multimodal intervention--combining exercise, dietetic, and psychological support-- delivered across four phases: prehabilitation (pre-treatment), maintenance rehabilitation (during treatment), restorative rehabilitation (up to 12 weeks post-treatment), and supportive rehabilitation (12 to 24 weeks post-treatment). MethodsBetween March 2022 and May 2024, 847 patients were referred; 685 enrolled (80.9%), and 649 consented to evaluation (mean age 68). Outcomes included six-minute walk test (6MWT), sit-to-stand (30s/60s), handgrip strength, EQ-5D-5L index and visual analogue scale (VAS), FACIT-Fatigue, PHQ-9, and GAD-7. Wilcoxon signed-rank tests were used to assess change scores across each service phase. ResultsNinety-three percent completed prehabilitation, and 62% completed the full programme (median duration 44 weeks). After prehabilitation, improvements were observed for 6MWT (+27m, p<0.001), 30s sit-to-stand (+2 reps, p<0.01), EQ-5D VAS (+7.5 points, p<0.01), fatigue (+2.5 points, p<0.01), and PHQ-9 scores (-1 point, p<0.01). Following rehabilitation, 6MWT improved by +20m above baseline, EQ-5D VAS increased +7.5-10 points, and PHQ-9 and GAD-7 scores reduced by {approx}2 points (all p<0.01). Recovery trajectories differed by sex and cancer type, with males and individuals with upper GI cancer experiencing greater post-treatment decline and less complete recovery. ConclusionActive Together demonstrated high engagement and clinically meaningful improvements in cardiorespiratory fitness, and quality of life. While the absence of a control group limits conclusions about effectiveness, the findings suggest that multimodal prehabilitation and rehabilitation in routine cancer care is feasible, supports functional recovery, and improves wellbeing.