Implementation and challenges of prehabilitation in gastrointestinal oncology: a national cross-sectional survey in France.

Abstract

Purpose: To explore the implementation, structure, and challenges of multimodal prehabilitation programs in gastrointestinal (GI) oncology across France, in a context where evidence supports its benefits but national standardization is lacking.

Methods: A national cross-sectional survey was conducted from April to July 2024. The 54-item questionnaire, developed by a multidisciplinary group, assessed team demographics, patient selection, intervention modalities, pathway coordination, and barriers to implementation. Descriptive statistics were used for data analysis.

Results: Among 92 respondent teams, 19 (20.7%) reported having a structured prehabilitation pathway. Most included nutritional (94.7%) and physical activity (74%) interventions, while only 5.3% provided systematic psychological support. Program eligibility was generally based on nutritional risk, surgical magnitude, and patient frailty, but varied widely. Prehabilitation was most often coordinated by surgeons (40%) and dietitians (78.9%), and typically delivered in day-hospital settings. Key challenges included insufficient human resources (60%), coordination issues (49%), and funding limitations (35%). Despite these barriers, perceived utility and satisfaction with prehabilitation programs were high (median scores of 8/10 and 8.6/10, respectively).

Conclusion: Prehabilitation in GI oncology is emerging but remains inconsistently applied across France. To scale these interventions equitably and effectively, national guidelines, enhanced coordination and institutional support are essential. Integration with existing perioperative pathways like ERAS and increased psychological support are also needed to improve patient outcomes. Only one center in our sample offered systematic psychological support.