Prehabilitation: Stepping beyond exercise in patients with frailty and cancer

Cancer is one of the leading causes of morbidity and mortality. In patients who require oncological surgery, frailty is associated with increased risk of perioperative adverse events, which can lead to delay in subsequent oncological care. Additionally, cancer and neoadjuvant therapy both contribute to diminished physiological reserve and increased incidence of frailty. Prehabilitation involves a bundle of preoperative intervention with the goal of improving patients’ physiological reserve and promoting better recovery after surgery. While prehabilitation is frequently associated with the delivery of preoperative physical exercise interventions, there is increasing recognition that a multimodal approach should be employed to optimize outcomes.

Nutritional, educational and psychobehavioral interventions are commonly employed as components of multimodal prehabilitation. There are also other emerging novel interventions, including cognitive prehabilitation. As with all effective perioperative initiatives, effective implementation of prehabilitation often requires a multidisciplinary effort. This review will discuss both the established and the novel prehabilitation interventions, as well as the interaction between prehabilitation and other perioperative pathways.