Macmillan Cancer Support commissioned M·E·L Research to carry out an independent evaluation of the Northern Ireland Regional Integrated Cancer Prehabilitation Programme. The programme was designed as a test of change to embed personalised, early-intervention support into cancer pathways across Northern Ireland, bringing together all five Health and Social Care Trusts and 11 local councils. Its focus was on supporting adults diagnosed with cancer before treatment, through physical activity, nutrition and emotional wellbeing interventions, primarily via the Macmillan Move More Programme and Trust-based prehabilitation support.
The wider context was a strategic ambition to make prehabilitation a core part of cancer care in Northern Ireland. Prehabilitation was positioned as support offered between diagnosis and treatment, helping patients establish baseline physical, nutritional and psychological needs, identify impairments and access interventions that could improve readiness for treatment and recovery. The programme aimed to establish a more standardised approach for colorectal cancer, while developing prototypes for other tumour groups including lung, head and neck, upper gastrointestinal and hepatobiliary, breast and gynaecological cancers.
The evaluation needed to assess how the programme was implemented, what was learned across Trusts and partners, and what impact the programme had on patients, staff and the wider system. It also needed to explore whether universal and targeted interventions were effective and how prehabilitation could be delivered sustainably and equitably across Northern Ireland. This was a complex evaluation because the programme operated in a live healthcare environment, with multiple partners, different local delivery models, variable resources, changing personnel and different levels of maturity across Trusts.
Approach
M·E·L Research designed and delivered a mixed-methods evaluation, combining primary qualitative and quantitative research with analysis of secondary monitoring data provided by Trusts and local councils. The evaluation framework and research tools were developed by M·E·L Research in collaboration with Macmillan and Macmillan Prehabilitation Clinical Project Managers, ensuring they aligned with the agreed research questions. A Theory of Change was also developed jointly with Macmillan to structure the evaluation around outcomes for patients, staff and the wider system.
The evaluation included several distinct strands:
Rapid literature review: M·E·L Research carried out a rapid review to understand the wider evidence base and policy context for cancer prehabilitation, including impacts on patients, secondary care, wider healthcare systems and cost effectiveness. A total of 124 abstracts were screened and 44 sources were included and reviewed.
Programme and monitoring data analysis: The team analysed prehabilitation referral data reported by Trusts, including tumour site, intervention level and service type. Monitoring data covered colorectal, lung, head and neck and haematology referrals, although the completeness of data varied by Trust. By the end of the monitoring period, over 1,300 patients had been referred across the four Trusts that provided data.
Secondary data review: M·E·L Research reviewed patient outcome data and analysis, presentations, internal reports and patient feedback supplied by individual Trusts. This included outcome measures such as the 6-Minute Walk Test, 30-Second Sit to Stand Test, grip strength, Self-Efficacy for Exercise scale, Health Thermometer, EQ-5D-5L, nutritional measures and smoking cessation outcomes.
Patient survey: A postal survey was distributed by Clinical Project Managers to patients who had been referred to prehabilitation and had enough time since diagnosis to reflect on their experience. Patients could also complete the survey online or by telephone. M·E·L Research received 142 surveys, of which 138 were included in the analysis.
Patient interviews and online community: M·E·L Research followed up with patients who agreed to further research. In total, 28 patients took part in follow-up activity, including 26 in-depth interviews and two participants in an online community. Interviews were mainly conducted by telephone, recorded with consent and entered into a thematic analysis grid. Eight patient stories were created from the interviews to illustrate individual experiences and impacts.
Professional stakeholder interviews: The evaluation included 51 interviews with 45 professional stakeholders involved in planning, implementing or delivering the programme. These included senior managers, Clinical Project Managers, Clinical Nurse Specialists, Allied Health Professionals, support staff, Macmillan Move More Coordinators, council representatives, funders and wider stakeholders.
Quantitative findings were analysed using descriptive statistics and, where appropriate, statistical testing of outcome measures. The report noted that subgroup analysis was indicative because of relatively small sample sizes. Qualitative interviews were analysed thematically, with findings triangulated across patient survey results, interviews, online community feedback, programme monitoring data and stakeholder evidence.
Outputs and Use
M·E·L Research produced a full written evaluation report for Macmillan Cancer Support, including an executive summary, background and context, evaluation approach, detailed findings, conclusions and recommendations. The report also included appendices covering the evidence review, evaluation activities, Theory of Change, Trust-level programme overview, screening and intervention details, patient stories, patient quotes, the regional model in development and cited literature.
The evaluation provided Macmillan and partners with evidence on programme implementation, patient outcomes, patient experience, staff experience and system-level learning. It identified what had worked well, including the importance of Clinical Project Managers, multi-disciplinary delivery, community-based support and strong local partnerships. It also highlighted implementation challenges, including delayed recruitment, role instability, lack of standardisation, resource constraints, data-sharing barriers and concerns around equitable access.
The evaluation demonstrated positive patient outcomes where data was available. For example, Trust outcome data showed that many patients improved or maintained performance on physical outcome measures such as the 6-Minute Walk Test and 30-Second Sit to Stand Test. Patient feedback also showed that most respondents felt prehabilitation helped them prepare for treatment and improve recovery, with reported improvements in physical activity, quality of life and diet.
The findings were used to inform future planning for cancer prehabilitation in Northern Ireland. The recommendations focused on sustainable funding and resource allocation, integration into routine cancer care, workforce development and knowledge sharing, earlier intervention, community engagement and improved performance monitoring. The report also emphasised the need for an agreed outcome data framework and consistent regional monitoring to support future funding and service development decisions.
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