Screening for the needs of individuals with cancer in prehabilitation occurs at a number of levels. This section will outline the role of medical, allied health and additional screening in the prehabilitation setting.
Role of screening
Screening is a critical component of cancer prehabilitation, helping to identify individual needs and guide the delivery of appropriate interventions to optimise surgical recovery. Screening also enables patient stratification, ensuring that the intensity of support provided is aligned with each individual’s needs and preferences.1 Furthermore, it supports the efficient allocation of resources by targeting services to those most likely to benefit.
The key purposes of screening are to:
- Identify patients who may benefit from prehabilitation interventions.
- Determine the nature and extent of support required across relevant domains.
- Stratify patients according to their level of need and risk.
- Match intervention intensity to individual needs, goals, and preferences.
- Support efficient and equitable allocation of healthcare resources.
To date, there is no strong consensus regarding the specific screening tools that should be used within prehabilitation programs.2,3 Consequently, the recommendations provided here are informed by:
- The broader oncology literature.
- Current evidence and best practice in cancer prehabilitation.
- Clinical experience from established prehabilitation services.
Screening across all disciplines may be undertaken by:
- A registered healthcare professional; or
- An appropriately trained healthcare worker who has demonstrated competency in the administration, scoring, and interpretation of the relevant screening measures.
Individuals conducting screening should complete training in the relevant procedures and demonstrate competency prior to administering screening assessments.
Considerations when selecting screening tools
When selecting prehabilitation screening tools, health services should select and prioritise measures with consideration of their desired target population to adequately screen for their specific clinical needs. The optimal screening tools should also be:
- Reliable
- Validated, ideally in this patient population
- Quick and easy to administer
- Can be completed by a range of staff to enable flexible service delivery. See Delivering section for disciplines involved in screening
- Easily integrated with existing screening tools and electronic systems.
How to stratify risk in people with cancer
Medical/surgical risk stratification
All people with cancer referred to prehabilitation should be screened for modifiable risk factors to identify those at higher risk of postoperative complications and poor recovery. Individuals with cancer at higher risk include those who are older, deconditioned, sarcopenic, malnourished, frail and cachexic4,5. See Risk stratification in Medical optimisation section for a detailed overview of medical and surgical risk stratification for people with cancer.
Allied health screening
Screening for exercise capacity and function, nutrition issues and psychological concerns is recommended.
- Exercise screening aims to identify those with lower exercise capacity
- Nutritional screening aims to identify if an individual has or is at risk of malnutrition
- Psychology screening aims to identify individuals that may have psychological risk factors for poorer physical or psychological surgical outcomes.
Screening allows stratification into one of three zones. Screening using this stepped care model in prehabilitation involves escalating interventions individualised to the severity of risk and to the individual with cancer’s response to screening. As shown below the three levels of stepped multimodal prehabilitation: Universal, targeted and specialist care prehabilitation6.
Modified from MacMillan prehabilitation interventions triangle6
Additional screening
Depending on your service, available disciplines and individual needs, individuals with cancer may also be screened by a range of other medical (e.g. pain physician, geriatrician) and allied health professionals (e.g. social work, occupational therapy). See section on Who is involved?