# Prehabilitation in Adult Cancer Patients Undergoing Chemotherapy or Radiotherapy: A Scoping Review

## TL;DR

This review explores whether pre-treatment programs can help cancer patients undergoing chemotherapy or radiotherapy by improving their physical and mental health before treatment.

## Contribution

The study is the first comprehensive scoping review examining prehabilitation programs specifically for non-surgical cancer treatments like chemotherapy and radiotherapy.

## Key findings

- Most prehabilitation programs included exercise, with some also incorporating nutrition, psychological, and educational components.
- Feasibility studies showed that prehabilitation is generally acceptable and implementable for cancer patients.
- Long-term trials in diverse and older cancer populations remain limited.

## Abstract

Individuals undergoing cancer treatment often experience side effects like fatigue, muscle loss, and mood changes that can reduce their ability to carry out daily activities. In surgical settings, giving patients a prehabilitation program involving exercise, nutrition, and psychological support prior to treatment helps preserve their strength and quality of life, yet its use for non-surgical treatments remains largely unexamined. Our review therefore examines research on prehabilitation before non-surgical treatments, such as chemotherapy and radiotherapy, to see what kinds of programs exist, how feasible they are, and which patient groups benefit. By mapping the evidence and identifying gaps, we aim to guide clinicians and researchers toward designing better pre-treatment support programs and highlight the need for longer-term trials in diverse and older populations.

Purpose: The effectiveness and feasibility of cancer prehabilitation have been well-validated in surgical settings, but its role in non-surgical treatments, such as chemotherapy and radiotherapy (RT), remains unclear. This scoping review aims to systematically explore the existing literature on prehabilitation programs for non-surgical cancer treatments. Methods: Following the scoping review methodology developed by the Joanna Briggs Institute, seven databases were systematically searched from their inception to October 2024 for peer-reviewed studies involving prehabilitation prior to non-surgical treatment. Data were extracted and reported adhering to PRISMA-ScR guidelines, using a convergent synthesis design to present qualitative and quantitative evidence. No formal risk-of-bias or quality appraisal was conducted. Results: Of 22,122 studies, 39 met the inclusion criteria, yielding a combined sample of 6073 patients and thirty-four unique interventions. Sample sizes ranged from 9 to 1992, with randomized control trials being the most common (16). Head and neck cancer was the most frequently studied, followed by breast, esophageal/gastric, and lung cancer. Of the included interventions, 23 were unimodal and 16 were multimodal. Exercise was the most common component (30), with nutrition (13), psychosocial (10), and educational (8) components also present. Most efficacy studies (84%) reported improved outcomes and nearly all (93%) feasibility studies found prehabilitation acceptable and implementable. Conclusions: This review highlights a growing body of literature examining prehabilitation prior to chemotherapy or RT in adult cancer patients, with studies suggesting potential benefits and feasibility. However, long-term trials, especially in diverse cancers and older populations, remain scarce. Our results provide insight into future implementation, evaluation of outcomes, and directions for future prehabilitation research.