Prehabilitation in older adults with cancer: scoping review of surgical outcomes

Adults aged ≥65 years constitute a growing proportion of surgical oncology patients and often experience frailty, multimorbidity and reduced physiological reserve, increasing their risk of postoperative complications and functional decline. Multimodal prehabilitation has emerged as a strategy to improve surgical resilience; however, evidence specific to older cancer patients' remains fragmented. This study aimed to map the existing evidence on prehabilitation for older adult patients undergoing cancer surgery, characterise intervention components, summarise functional and surgical outcomes and identify research gaps.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and a protocol registered with the Open Science Framework, searches were conducted in PubMed, Science Direct, the Cochrane Library and Google Scholar up to November 2025. Eligible studies included older adults undergoing cancer-related surgery who received any form of prehabilitation. Two reviewers independently screened studies and extracted data. Due to heterogeneity, findings were synthesised narratively.

Thirteen studies were included, comprised of six randomised controlled trials (RCT), three cohort studies, two quasi-experimental studies, one feasibility study and one RCT protocol. Most interventions were multimodal and delivered over 1 to 6 weeks. Improvements in preoperative functional capacity-particularly 6 min walk distance, aerobic endurance, muscle strength and respiratory function-were consistently reported. High-intensity or supervised programmes were reduced severity of postoperative complications and shorter hospital stay, while low-intensity or minimally supervised interventions showed limited postoperative benefit. Nutritional optimisation improved preoperative nutritional status and supported functional gains. Feasibility and acceptable adherence were reported even among frail and very elderly patients. Evidence gaps included variable intervention dosage, inconsistent adherence reporting, heterogeneous outcome measures and limited long-term follow-up.

Multimodal prehabilitation is feasible, safe and beneficial for older adults undergoing cancer surgery, improving preoperative function and, when sufficiently intensive, reducing postoperative morbidity and hospital stay. Further research should standardise outcomes, define optimal intervention parameters and evaluate long-term recovery using geriatric-focused models.