Prehabilitation in adult cancer patients: an overview of systematic reviews.

Authors

Zhao-Yu Xiong, Zhong-Rong Fu, Ji-Yun Chen, Ting Chen, Sai Yang

Published in

BMJ open. Volume 16. Issue 8. Pages e116006. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

A growing body of evidence supports prehabilitation in cancer patients, but the findings have been inconsistent. This overview aimed to identify, evaluate and summarise the effect of prehabilitation on the clinical outcomes of cancer patients.
Overview of systematic reviews.
PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and the JBI Evidence Synthesis database (Joanna Briggs Institute, University of Adelaide, Australia; hosted on Ovid) were searched from inception to January 2025. The search was updated in May 2026, and no new articles were included.
We included systematic reviews of randomised controlled trials (RCTs) involving adult cancer patients with a clinically established diagnosis who received prehabilitation interventions prior to surgical treatment. We excluded abstract-only citations, narrative reviews and scoping reviews. Reviews were excluded if ≥50% of the included studies were postoperative interventions, or if preoperative subgroup data could not be extracted.
Two reviewers independently extracted data on participants' characteristics, types of interventions, outcomes, synthesising methods and pooled anticipated absolute/relative effects for outcomes meta-analysed. Two reviewers assessed methodological quality using the A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) tool and assessed the certainty of evidence for prehabilitation using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Overlap among included systematic reviews was quantified using the corrected covered area (CCA).
Twenty systematic reviews (137 RCTs and 18 941 participants) were included. Low- to moderate-certainty evidence indicated that prehabilitation may improve preoperative physical fitness (eg, 6-minute walk test, preoperative cardiopulmonary function, preoperative lung function), reduce surgical complications and shorten the length of hospital stay. None of the included systematic reviews demonstrated a statistically significant effect on preoperative handgrip strength, 30-day readmission, mortality, anxiety or depression. Findings regarding physical activity and quality of life remained inconsistent. Overlap among included reviews was slight (CCA=4.15%).
Low- to moderate-certainty evidence suggests that prehabilitation may improve preoperative physical fitness, reduce surgical complications and shorten the length of hospital stay in adult cancer patients undergoing surgery, whereas current evidence does not support a beneficial effect on 30-day readmission, mortality, quality of life or psychological status. Given the predominantly low-to-moderate certainty of the evidence and the methodological heterogeneity across the included systematic reviews, these findings should be interpreted with caution. Methodologically robust and transparently reported RCTs and systematic reviews are needed to strengthen the certainty of evidence and to inform clinical implementation of prehabilitation.
CRD 42024533214.

PMID:
42562585
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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