Baseline Vulnerabilities in Women with Gynecologic Cancer: A Case for Prehabilitation in Resource-limited Settings

Prehabilitation is a proactive strategy aimed at optimizing physical, nutritional, and psychological reserves before initiating cancer treatment. While emerging evidence supports its effectiveness in improving perioperative outcomes in oncology, data specific to gynecologic cancers and low- and middle-income country (LMIC) settings remain limited.

A prospective analytical cohort study was conducted at a tertiary care center in North India from July 2023 to April 2025. A total of 183 women with newly diagnosed or suspected gynecological malignancies were assessed prior to treatment. Parameters included performance status (Eastern Cooperative Oncology Group [ECOG]), frailty (Modified Frailty Index-11), nutritional markers (body mass index [BMI], hemoglobin, and albumin), and psychological well-being (Patient Health Questionnaire-9 depression scale). Time taken from presentation to diagnosis was also recorded and analyzed.

Among 183 women with gynecologic cancers, cervical (45.9%) and ovarian (33.3%) malignancies predominated. Baseline vulnerabilities were highly prevalent: anemia (76.0%), low BMI (40.4%), hypoalbuminemia (31.1%), high frailty (52.5%), and moderate-severe depression (67.2%). The mean hemoglobin was 10.9 g/dL, BMI 22.2 kg/m², and albumin 3.73 g/dL. The mean diagnostic delay was 30.2 ± 7.4 days (range: 12-41). On multivariable regression, higher ECOG status (β =4.44 days per point, P < 0.0001), lower albumin (β = -3.75 days per g/dL, P < 0.0001), and higher frailty (β =0.38 days per unit, P < 0.0001) independently predicted longer delays (R ² = 0.62). Subgroup analysis confirmed significantly prolonged delays among frail patients (P < 0.0001).

A high prevalence of frailty, nutritional risk, and psychological distress was identified among gynecologic oncology patients in this LMIC setting. These domains are interrelated and represent modifiable targets for structured prehabilitation. Future research and policy efforts should prioritize the implementation of cost-effective, multidisciplinary prehabilitation models tailored to resource-constrained environments.