# Feasibility and Effects of Implementing Multimodal Prehabilitation Before Cytoreductive Surgery in Patients with Ovarian Cancer: The Gynofit Multicenter Study

## TL;DR

This study shows that pre-surgery training programs can be successfully used for ovarian cancer patients and may improve their fitness and chemotherapy tolerance.

## Contribution

The study demonstrates the feasibility and effectiveness of multimodal prehabilitation in ovarian cancer patients before surgery.

## Key findings

- High eligibility and participation rates were observed in two Dutch hospitals.
- Prehabilitation improved functional capacity and chemotherapy tolerance in patients.
- No significant differences in postoperative outcomes were found between prehabilitation and control groups.

## Abstract

Multimodal prehabilitation is an emerging approach to optimize patients’ conditions before surgery but has not yet been studied extensively in patients with ovarian cancer. This study evaluated the feasibility and effects of two different multimodal prehabilitation programs implemented before cytoreductive surgery in ovarian cancer patients in two Dutch hospitals. We observed high eligibility and participation rates, along with improved functional capacity following prehabilitation. These findings suggest that prehabilitation is both feasible and effective for patients with ovarian cancer, even during neoadjuvant chemotherapy.

Background: Cytoreductive surgery (CRS), in combination with chemotherapy, is the main treatment for advanced-stage ovarian cancer. In vulnerable patients, this extensive surgery has a high complication risk and may lead to clinical decline. There is emerging evidence that prehabilitation could be valuable in optimizing the patient’s condition prior to cytoreductive surgery, as is shown in colorectal surgery. However, there is limited evidence in gynecologic oncology. The objective of this study is to evaluate the feasibility and effects of implementing multimodal prehabilitation before cytoreductive surgery in patients with ovarian cancer. Methods: In two Dutch hospitals, 46 patients with ovarian cancer were included during the study period, of whom 32 participated in a multimodal prehabilitation program before CRS. The programs included at least physiotherapy, dietary advice and intoxication cessation. The timing, extent and content of the programs differed. Feasibility was assessed by eligibility and participation rates and adherence to the physiotherapy program. Effectiveness was measured by differences in functional capacity, postoperative outcomes and tolerance to adjuvant chemotherapy. Results: Eligibility rates in both hospitals were 83% and 89%, and participation rates were 68% and 72%. Adherence to the physiotherapy program was moderate and only satisfactory in 55% and 63% of the patients. All fitness endpoint measurements improved compared to the baseline. No significant differences in postoperative outcomes were found between prehabilitation and control patients. Prehabilitation patients appeared to have better tolerance to adjuvant chemotherapy, with fewer dose reductions (21% vs. 73%, p = 0.017) and dose deferrals (39% vs. 46%, not significant) compared to the control group. Conclusions: The implementation of multimodal prehabilitation before CRS is feasible and effective in patients with ovarian cancer with respectable eligibility and participation rates, along with improved functional capacity, even during neoadjuvant chemotherapy.