# Feasibility, acceptability and effectiveness of digitally delivered multimodal prehabilitation for cancer patients: A mixed-methods systematic review

## TL;DR

This review finds that digital prehabilitation for cancer patients is feasible and well-accepted, especially for physical improvements, but needs better design for psychological and nutritional aspects.

## Contribution

This is the first comprehensive mixed-methods review examining digital multimodal prehabilitation for cancer patients.

## Key findings

- Digital prehabilitation showed high feasibility and acceptability with positive patient feedback and good adherence.
- Physical function improved consistently, but psychological outcomes were mixed and nutritional status was underreported.
- Barriers included digital literacy and technology issues, with limited co-design involving patients or professionals.

## Abstract

Multimodal prehabilitation, which encompasses physical, nutritional, and psychological strategies, is increasingly recognised for its potential to prepare cancer patients holistically for their treatment journey. This mixed-methods systematic review assessed the feasibility, acceptability, and effectiveness of digitally delivered multimodal prehabilitation interventions for cancer patients. A systematic search was conducted in Embase, PubMed, Scopus, PsycINFO, and Web of Science for studies published from January 2008 onwards. Eligible studies included quantitative, qualitative, and mixed-methods designs reporting on digital multimodal prehabilitation interventions (encompassing physical, nutritional, and psychological components) for adult cancer patients in the pre-treatment phase. Screening, data extraction, and quality appraisal were performed independently by two reviewers, with disagreements resolved through discussion. Data were synthesized narratively using a convergent segregated approach. Twelve studies (n = 602 participants) met the inclusion criteria, with most focusing on gastrointestinal, gynaecological, urologic/genitourinary, and breast cancer. Most interventions utilized wearable fitness trackers, telehealth platforms, alongside mobile health applications to deliver prehabilitation. Feasibility and acceptability were generally high, with positive patient feedback and good adherence. Consistent improvements in physical function (e.g., walking capacity, strength) were observed across studies, but psychological outcomes were mixed and nutritional status was underreported. Five studies (qualitative) highlighted patient satisfaction but noted barriers such as digital literacy. Limited evidence suggested possible reductions in hospital stays and complications. The findings suggest that digitally delivered multimodal prehabilitation is feasible and can enhance physical preparedness for cancer treatment, with high patient satisfaction. However, standardization of interventions and further research on psychological and nutritional outcomes are needed to optimize effectiveness and ensure equitable access across diverse cancer populations. Future research should focus on diverse cancer populations and use co-design to ensure interventions are tailored to their needs.

In recent years, digital health interventions have shown promise in supporting cancer patients before treatment. In this review, we examined studies delivering multimodal prehabilitation, combining exercise, nutrition, and psychological support, through digital platforms. We found that these interventions often achieved high patient engagement, especially when content was personalised and easily accessible. However, some participants expressed dissatisfaction with psychological components, highlighting the need for user-friendly design across all programme aspects. Notably, only few of the studies we reviewed involved patients or healthcare professionals in co-designing these programmes, a step we believe is crucial for improving their usefulness and appeal. While most participants who started these programmes maintained adherence, technology issues and varying digital literacy led to some dropouts. Our review is the first to examine digital, multimodal prehabilitation in cancer care through a comprehensive, multidisciplinary lens. We conclude that while digital prehabilitation shows promise for improving patient outcomes and reducing hospital stays, future efforts should focus on standardising programme features, including diverse patient populations, and ensuring equitable access to these innovations.