Prehabilitation Practices for Patients Undergoing Cancer Surgery-An International Survey

The aging population's increased need for surgical capacity, the rise in modifiable risk factors such as deconditioning and malnutrition linked to postoperative complications, and deconditioning from cancer therapies highlight the crucial role of prehabilitation. Growing evidence supports the effectiveness of multimodal prehabilitation programs, which include preoperative physical exercise, nutrition, and psychological support for patients undergoing cancer surgery. Despite this, definitive recommendations on the optimal prehabilitation intervention remain elusive. Therefore, the primary objective of this study is to describe current prehabilitation practices for patients undergoing cancer surgery across international cancer centers.

In this cross-sectional study, an online survey was conducted between November 2023 and February 2024 to gather information from international, multidisciplinary participants with knowledge of or interest in prehabilitation. The survey included questions about prehabilitation uptake, current prehabilitation practices, and barriers to implementation. The responses were categorized by World Bank region and bank income class to provide insights into prehabilitation practices across international cancer centers.

A total of 1409 respondents, representing 663 hospitals across South Asia, East Asia and Pacific (n = 40, 6%), Europe and Central Asia (n = 134, 20.2%), North America, Latin America and Caribbean (n = 19, 2.9%), Middle East and North Africa (n = 380, 57.3%), and Sub-Saharan Africa (n = 90, 13.6%), completed the survey. Prehabilitation was described as the standard of care for all cancer patients in 21.1% of the surveyed hospitals, whereas 29.9% of the hospitals provided prehabilitation only to a selected cohort of patients with cancer. The main barriers to implementing prehabilitation as standard of care were lack of institutional funding and resources (39.4%) and low institutional interest (10.6%). The most frequently provided types of prehabilitation included nutrition (36.2%), physical exercise (29.7%), and psychological interventions (23.8%).

This study identified significant variation in prehabilitation practices across hospitals globally. Among the surveyed hospitals, 21.1% reported providing prehabilitation as standard of care for all cancer patients. The main barriers to the widespread adoption of prehabilitation are the lack of institutional funding and resources. Evidence from future prehabilitation trials and the establishment of international guidelines and recommendations may enhance the uptake of prehabilitation globally.