Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study

Abstract

Background Cytoreductive surgery followed by systemic chemotherapy is the standard of treatment in advanced ovarian cancer where feasible. Neoadjuvant chemotherapy (NACT) followed by surgery is applicable where upfront cytoreductive surgery is not feasible because of few certain reasons. Nevertheless, surgical interventions and the chemotherapy itself may be associated with postoperative complications usually entailing slow postoperative recovery. Prehabilitation programs consist of the patient’s preparation before surgery to improve the patient’s functional capacity. The aim of this study was to evaluate the impact of a prehabilitation program during neoadjuvant treatment and interval cytoreductive surgery for ovarian cancer patients. Methods A retrospective observational pilot study of patients with advanced ovarian cancer treated with NACT and interval cytoreductive surgery was conducted. The prehabilitation group received a structured intervention based on physical exercise, nutritional counseling, and psychological support. Nutritional parameters were assessed preoperatively and postoperatively, and functional parameters and perioperative and postoperative complications were also recorded. Results A total of 29 patients were included in the study: 14 in the prehabilitation group and 15 in the control group. The patients in the prehabilitation program showed higher mean total protein levels in both preoperative (7.4 vs. 6.8, p = 0.004) and postoperative (4.9 vs. 4.3, p = 0.005) assessments. Up to 40% of controls showed intraoperative complications vs. 14.3% of patients in the prehabilitation group, and the requirement of intraoperative blood transfusion was significantly lower in the prehabilitation group (14.3% vs. 53.3%, p = 0.027). The day of the first ambulation, rate of postoperative complications, and length of hospital stay were similar between the groups. Finally, trends towards shorter time between diagnosis and interval cytoreductive surgery (p = 0.097) and earlier postoperative diet restart (p = 0.169) were observed in the prehabilitation group. Conclusion Prehabilitation during NACT in women with ovarian cancer candidates to interval cytoreductive surgery may improve nutritional parameters and thereby increase postoperative recovery. Nevertheless, the results of this pilot study are preliminary, and further studies are needed to determine the clinical impact of prehabilitation programs.

Prehabilitation in an ERAS program for endometrial cancer patients: impact on post-operative recovery

“…The addition of perioperative nutritional interventions 1–2 weeks before gynecological cancer surgery showed a reduction in length of hospital-stay and post-operative complications 36. Moreover, the addition of multimodal prehabilitation programs with nutritional support during neoadjuvant chemotherapy in ovarian cancer patients undergoing interval cytoreductive improved perioperative nutritional parameters 37…”

Protein Supplementation in a Prehabilitation Program in Patients Undergoing Surgery for Endometrial Cancer

“…Previously, we analyzed the role of nutritional prehabilitation in women with ovarian cancer [ 18 ]. We selected patients undergoing a prehabilitation program during neoadjuvant chemotherapy and interval cytoreductive surgery.…”

Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity?

“…To our knowledge, there has been one further study by Miralpeix et al evaluating a prehabilitation programme after our search was performed. This pilot study also demonstrated the feasibility and safety of a multimodal prehabilitation programme before interval cytoreductive surgery in ovarian cancer patients, with significant improvement of nutritional parameters [ 33 ].…”