'I was eager to do anything I could to improve the situation': a qualitative study of patients' experiences and views of prehabilitation for ovarian cancer surgery.

Background: Prehabilitation has shown promise in improving post-operative outcomes for several solid tumour groups. However, prehabilitation programmes are not widely established. Patients with advanced ovarian cancer experience life changing debulking surgery and could benefit from prehabilitation. This study aims to explore the views, experiences, facilitators and barriers surrounding prehabilitation in a demographically diverse cohort of advanced ovarian cancer patients. This would help to inform an acceptable patient-centred working programme model for a diverse group of patients.

Methods: Purposive, maximum variation sampling was used to recruit a diverse sample of women, due to undergo or following primary debulking surgery for advanced ovarian cancer, from two cancer centres in London. Semi-structured interviews were either conducted face to face or by telephone. All recordings were transcribed verbatim and analysed using thematic analysis.

Results: Twenty-one participants were interviewed. Twelve were prehabilitation 'naïve' and nine had participated in the Marsden Integrated Lifestyle and Exercise programme (MILE). The age range was 46-76 years and 8/21 participants were of Black, Asian or Mixed heritage. Factors influencing engagement with prehabilitation can be categorised under four major emerging themes [1] Mindset [2] Actual preparation [3] Support system [4] Delivery of prehabilitation.

Conclusion: Patients with ovarian cancer welcome the concept of prehabilitation, however a blanket approach is not suitable to meet the needs of a demographically diverse cohort. The components of prehabilitation must be tailored to individual needs, with attention to existing mindset and support systems, building on preparations that women are already making for surgery and offering flexible delivery options.