This overview synthesised evidence from systematic reviews to evaluate the effect of prehabilitation in adult cancer patients undergoing surgery. The aim was to identify, evaluate and summarise clinical outcomes associated with preoperative prehabilitation, addressing inconsistent findings across existing reviews.
The authors searched PubMed, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the JBI Evidence Synthesis database from inception through January 2025. The search was updated in May 2026; no additional eligible reviews were identified in the update.
Included studies were systematic reviews of randomized controlled trials (RCTs) in adult patients with a clinically established cancer diagnosis who received prehabilitation prior to surgical treatment. Excluded were abstract-only citations, narrative reviews and scoping reviews. Reviews were also excluded if 50% or more of their included studies were postoperative interventions or if preoperative subgroup data could not be extracted.
Two reviewers independently extracted data on participant characteristics, types of prehabilitation interventions, reported outcomes, synthesis methods and pooled anticipated absolute/relative effects for outcomes that were meta-analysed by the reviews. Outcomes of interest included measures of preoperative physical fitness (for example, the 6-minute walk test), cardiopulmonary and lung function, handgrip strength, surgical complications, length of hospital stay, 30-day readmission, mortality, psychological outcomes (anxiety, depression), physical activity and quality of life.
Two reviewers assessed methodological quality of the included systematic reviews using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Certainty of evidence for prehabilitation outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The evidence across reviews was generally rated as low to moderate certainty.
Overlap of primary trials across the included systematic reviews was quantified using the corrected covered area (CCA). Overlap was slight, with a CCA of 4.15%, indicating limited redundancy of the same RCTs across multiple reviews.
Low- to moderate-certainty evidence indicated that prehabilitation may improve preoperative physical fitness. Specific improvements reported across reviews included better performance on the 6-minute walk test, and improvements in preoperative cardiopulmonary and lung function measures. Despite these findings, not all functional measures consistently improved across reviews.
The overview found low- to moderate-certainty evidence that prehabilitation may reduce the rate of surgical complications and shorten length of hospital stay for adult cancer patients undergoing surgery. These outcomes were reported across multiple included systematic reviews and contributed to the synthesized conclusion that prehabilitation can have perioperative benefits.
None of the included systematic reviews demonstrated a statistically significant effect of prehabilitation on preoperative handgrip strength, 30-day readmission, mortality, anxiety or depression. These null findings were consistent across the reviews that reported these outcomes.
Findings regarding changes in physical activity and quality of life were inconsistent across the included systematic reviews. Some reviews reported positive effects while others did not, contributing to uncertainty about the impact of prehabilitation on these patient-centered outcomes.
The authors conclude that low- to moderate-certainty evidence suggests prehabilitation may improve preoperative physical fitness, reduce surgical complications and shorten hospital stay in adult cancer patients scheduled for surgery. However, the evidence does not support benefits for 30-day readmission, mortality, quality of life or psychological status. Given overall low-to-moderate certainty and methodological heterogeneity across systematic reviews, these results should be interpreted with caution before widespread clinical implementation.
The overview highlights the predominantly low-to-moderate certainty of evidence and methodological heterogeneity among included systematic reviews. It calls for methodologically robust, transparently reported RCTs and systematic reviews to increase the certainty of evidence and to inform clinical implementation of prehabilitation in oncology surgical pathways.
This overview was registered in PROSPERO under registration number CRD 42024533214.