Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity?

Abstract

The literature evaluating the effect of prehabilitation programmes on postoperative outcomes and quality of life of patients with gynaecological cancer undergoing surgery was reviewed. Databases including Pubmed, Medline, EMBASE (Ovid) and PsycINFO were systematically searched to identify studies evaluating the effect of prehabilitation programmes on patients with gynaecological cancer. Both unimodal and multimodal prehabilitation programmes were included encompassing physical exercise and nutritional and psychological support. Primary outcomes were surgical complications and quality of life. Secondary outcomes were anthropometric changes and adherence to the prehabilitation programme. Seven studies fulfilled the inclusion criteria, comprising 580 patients. Included studies were nonrandomised prospective studies (n = 4), retrospective studies (n = 2) and one case report. Unimodal programmes and multimodal programmes were included. In patients with ovarian cancer, multimodal prehabilitation resulted in significantly reduced hospital stay and time to chemotherapy. In patients with endometrial and cervical cancer, prehabilitation was associated with significant weight loss, but had no significant effects on surgical complications or mortality. No adverse events of the programmes were reported. Evidence on the effect of prehabilitation for patients with gynaecological cancer is limited. Future studies are needed to determine the effects on postoperative complications and quality of life.

Feasibility of Introducing a Prehabilitation Program into the Care of Gynecological Oncology Patients—A Single Institution Experience

“…For gynecological oncology, the benefits of prehabilitation programs have not yet been established. Our study group recently performed a systematic review supporting the feasibility and safety of a prehabilitation program in gynecological oncology care [ 32 ]; seven studies were included, and considerable heterogeneity of interventions and outcome measures was observed. Significant improvements in hospital stay and time to adjuvant treatment without impacting surgical complications were reported [ 32 , 42 ].…”

“…Our study group recently performed a systematic review supporting the feasibility and safety of a prehabilitation program in gynecological oncology care [ 32 ]; seven studies were included, and considerable heterogeneity of interventions and outcome measures was observed. Significant improvements in hospital stay and time to adjuvant treatment without impacting surgical complications were reported [ 32 , 42 ]. In two more recent studies, a significant improvement in nutritional parameters, lower intra-operative transfusion rates, and a shortened time to normal diet were also observed [ 50 , 51 ].…”

“…However, within gynecological cancer surgery, prehabilitation remains in its infancy; only a few studies have been performed and these are hampered by poor methodological quality, small study population sizes, and heterogeneity of interventions. The current evidence is insufficient to fully support the feasibility of prehabilitation for this population, and no definitive conclusions have been drawn regarding adherence and postoperative outcomes [ 32 ].…”

Prehabilitation: tertiary prevention matters

“…Studies on prehabilitation in gynaecological oncology surgery are scarce. The results of some of these studies showed a decrease in length of hospital stay and shorter time to adjuvant chemotherapy, but other studies did not show these improvements 18 .…”

Prehabilitation in gynecological oncology – are we ready to implement the program in polish oncological centers?

“…In contrast, most ovarian cancer patients undergoing cytoreductive surgery by laparotomy are over 60 years old and often present multiple comorbidities. In order to reduce peri-and post-surgical complications, the prehabilitation programs have been proposed to enhance overall survival and prepare those women for extensive surgical procedure [1][2][3][4][5][6][7][8][9][10][11][12][13].…”