Prehabilitation Programs For Cancer Patients: A Systematic Review Of Randomized-controlled Trials

PURPOSE: To determine the effects of prehabilitation programs for cancer patients. METHODS: Systematic review and meta-analysis conducted according to the Cochrane Handbook. We included randomized controlled trials (RCTs) in adults with any type of cancer, where the prehabilitation programs included preoperative exercise training as the main component. Two independent reviewers critically appraised the included studies by using the Cochrane Risk of Bias tool. Effect estimates were calculated through a random-effects model of meta-analysis. RESULTS: We included 14 RCTs (N = 1044 participants). On average, the prehabilitation programs were implemented for 3 weeks (SD 2 weeks, ranging from 1 to 8 weeks), and each session had a mean duration of 38 minutes (SD 24 minutes). Prehabilitation programs did not improve neither the physical component (Standardized mean difference (SMD) 0.15, 95% confidence interval (CI) -0.08 to 0.39) nor the mental component (SMD -0.10, 95%CI -0.45 to 0.26) of participants’ health-related quality of life at 4 weeks after surgery. Participants in the prehabilitation programs reported higher levels of moderate physical activity than those in the rehabilitation groups (MD 13.9 kcal/kg/wk, 95%CI 11.3 to 16.5) before surgery; however, these effects disappeared at 4 weeks after surgery (MD 0.28 kcal/kg/wk, 95%CI -3.03 to 3.58). Lung cancer patients in prehabilitation programs had 51% lower risk of postoperative complications compared to those who did receive usual care within 30 days after surgery (Risk Ratio 0.49, 95%CI 0.32 to 0.76). Hospital length of stay did not differ between prehabilitation programs and usual care during the postoperative period (MD -0.01 days, 95%CI -0.61 to 0.59). CONCLUSIONS: Prehabilitation programs may reduce the risk of postoperative complications and improve physical activity levels before surgery compared to usual care in participants undergoing surgery for cancer treatment. The evidence about the effects on health-related quality of life or hospital length of stay is inconclusive. Further well-conducted RCTs are warranted.