Prehabilitation: Empowering Gynaecological Cancer Patients Undergoing Radiotherapy

The Burden of Radiotherapy and the Promise of Prehabilitation

Radiotherapy, a cornerstone in gynaecological cancer treatment, can significantly impact patients' physical and psychological well-being. From fatigue and gastrointestinal issues to psychosexual challenges, the side effects can be debilitating and long-lasting. Prehabilitation offers a proactive approach to mitigating these effects and empowering patients to navigate their treatment journey with improved resilience.

Prehabilitation programs aim to optimize patients' physical and psychological health before and during radiotherapy. While the benefits of prehabilitation for surgical patients are well-documented, its application in radiotherapy remains relatively unexplored. This scoping review delves into the existing literature to understand the current landscape of prehabilitation interventions for gynaecological cancer patients undergoing radiotherapy.

Unveiling the Current Landscape of Prehabilitation Interventions

Our comprehensive review, guided by the Joanna Briggs Institute guidelines, identified 56 studies spanning 66 years. These studies explored various prehabilitation interventions, ranging from multimodal programs to unimodal interventions focusing on nutrition, psychological support, or physical exercise. Cervical cancer, being the most common gynaecological cancer treated with radiotherapy, was predominantly represented in the included studies.

Multimodal interventions often involved a multidisciplinary team of dieticians, physiotherapists, radiation oncologists, and mental health professionals. Unimodal interventions varied widely, with nutritional interventions being the most common, followed by psychological support. Physical exercise interventions were comparatively underrepresented, potentially due to the physical limitations and fatigue associated with radiotherapy.

The Rationale Behind the Interventions

The rationale behind these diverse interventions stemmed from a desire to address the unique challenges faced by radiotherapy patients. Nutritional interventions aimed to alleviate gastrointestinal side effects and prevent malnutrition, while psychological support focused on stress reduction and coping mechanisms.

Prophylactic physiotherapy interventions sought to mitigate the risk of lymphoedema and pelvic floor dysfunction. Physical exercise programs, though less common, emphasized tailored, home-based activities that accommodated patients' energy levels and treatment schedules. The interventions often incorporated patient education and peer support to enhance engagement and preparedness.

Timing and Duration of Interventions: A Varied Approach

The timing and duration of prehabilitation interventions varied considerably across the studies. Some interventions began before radiotherapy, while others were initiated concurrently with or shortly after treatment commenced. The duration ranged from short-term interventions during brachytherapy to longer-term programs spanning the entire radiotherapy period.

Measuring the Impact: Outcome Measures and the Need for Standardization

A wide array of outcome measures were used across the studies, reflecting the multifaceted nature of prehabilitation. Quality of life, assessed using tools like the EORTC QLQ-C30, was the most consistently measured outcome. Other common measures included toxicity assessments, physical function tests, and psychological well-being scales.

The heterogeneity of outcome measures and reporting methods hinders comparison between studies and underscores the need for standardized outcome sets. A core outcome set, consistently measured using validated tools, would facilitate future research and enable more robust evaluation of prehabilitation effectiveness.

Looking Ahead: The Future of Prehabilitation in Radiotherapy

This scoping review underscores the potential of prehabilitation to improve the lives of gynaecological cancer patients undergoing radiotherapy. However, further research, particularly larger randomized controlled trials, is crucial to establish the efficacy of various interventions. Future studies should prioritize comprehensive reporting of interventions, adopt standardized outcome measures, and incorporate the perspectives of patients with lived experience.

The emerging concept of multiphasic prehabilitation, which involves tailored interventions at multiple time points throughout cancer care, holds promise for addressing the evolving needs of patients. As the field of prehabilitation advances, continuous evaluation and refinement are essential to ensure that these interventions truly empower patients and enhance their quality of life.