Prehabilitation in patients with frailty undergoing cancer-related surgery: a systematic review

Prehabilitation, a multidisciplinary approach to optimise patients pre-surgery, aims to reduce frailty and enhance surgical outcomes. However, limited evidence exists on the effectiveness of improving clinical outcomes in patients with frailty undergoing cancer-related surgery. This systematic review assessed whether prehabilitation enhanced clinically relevant outcomes for patients with frailty undergoing cancer-related surgery. We conducted a systematic review and meta-analysis, reviewing four databases from January 2000 through April 2024 for studies examining the association between prehabilitation before elective cancer surgery and clinical outcomes. The primary outcome was hospital length of stay (LOS). Secondary outcomes included functional status, complication rates and readmission rates. We performed a random-effects meta-analysis, estimating associations for binary outcomes using relative risks (RRs) and continuous outcomes using mean differences (MDs). Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool for randomised clinical trials and Joanna Briggs Institute for observational cohort studies. We included 15 studies (1955 patients); 67.7% (657 of 970) were frail. The hospital LOS was comparable between the prehabilitation and control groups (MD = -0.29 (95% confidence interval (CI): -0.89 to 0.30); P = 0.34). No significant improvements were noted in post-operative functional status (MD = 29.95 (95% CI: -11.24 to 71.14); P = 0.15), complication rates (RR = 0.76 (95% CI: 0.56-1.04); P = 0.085) or readmission (RR = 1.23 (95% CI: 0.84-1.81); P = 0.29). Prehabilitation approaches and frailty assessments were notably heterogeneous and inconsistently reported. Prehabilitation did not reduce hospital LOS or major postoperative complications in patients with frailty undergoing cancer-related surgery. Heterogeneity in prehabilitation protocols and reporting limited the interpretation of results and highlights a critical gap in research methodologies.