Multimodal prehabilitation in patients with advanced ovarian cancer

Prehabilitation is increasingly used to enhance fitness and postoperative outcomes in surgical oncology, yet supporting evidence in patients with advanced ovarian cancer remains limited.

PHOCUS (Prehabilitation in gynaecological Cancer patients; NCT04789694) was a prospective, multicentre, randomised trial evaluating multimodal prehabilitation-including physical-activity/nutritional/psychological counselling. Advanced ovarian cancer patients (18-80 years) undergoing neoadjuvant-chemotherapy (NACT) followed by interval debulking surgery, all treated under a standardised enhanced-recovery-after-surgery (ERAS) protocol, were randomised 1:1 to structured multimodal prehabilitation (Arm B) or standard care (Arm A). The primary endpoint was improvement in preoperative physiological capacity, measured by 6-Minute-Walk-Test (6MWT).

Of the 103 patients randomised to Arms A and B, 72 completed presurgical assessments and formed ITT population, with attrition mainly due to disease progression and withdrawal of consent. From baseline to presurgery, 6MWT distance increased significantly in the prehabilitation arm (mean + 36.0 ± 11.8 m, P = 0.002), whereas the increase in the standard-care arm was not statistically significant (+22.6 ± 9.2 m, P = 0.083). The between-group difference did not reach statistical significance (P = 0.236). For secondary outcomes, prehabilitation arm demonstrated significantly greater improvements in the 5-times sit-to-stand test, respiratory quotient, and PONS score compared to standard care (all P < 0.05). No significant differences were observed in surgical outcomes, length of hospital stay, or postoperative complications.

Multimodal prehabilitation during NACT was associated with improvements in functional, nutritional, and metabolic parameters. Although we did not find significant between-group difference of the primary endpoint, consistent benefits across selected secondary outcomes support the integration of structured prehabilitation into ERAS pathways for advanced ovarian cancer.