Bridging the gap between prescription and participation: a systematic review and meta-analysis of factors influencing adherence to prehabilitation in gastrointestinal cancer surgery.

Kristy-Lee Raso, Michael David, Alice Melton, Sim Yee Cindy Tan, Janette L Vardy

Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2025;33(11):973

PMID: 41125800

Full Text on Springer View on PubMed

Abstract

PURPOSE

Adherence plays a critical role in determining the effectiveness of prehabilitation; however, achieving and maintaining it remains challenging. This systematic review and meta-analysis examined adherence rates and factors influencing participation in prehabilitation for gastrointestinal cancer surgery.

METHODS

Six databases (Embase, Medline, Web of Science, CINAHL, PsycINFO, and Cochrane) were searched to September 2024 for studies reporting prehabilitation interventions (unimodal or multimodal) and adherence. Data extraction, risk of bias, and certainty assessment were undertaken. Pooled adherence rates were analysed using random-effects meta-analysis, with meta-regression exploring determinants. The protocol was registered with PROSPERO (CRD42022301626).

RESULTS

Forty studies were included: 22 multimodal and 18 unimodal. Data from 32 studies (n = 1619; mean age 69 ± 6.8 years) revealed a pooled mean adherence rate of 75% (95% CI 66-84%). Adherence was higher for exercise (82%) and nutrition (83%) interventions but substantially lower for psychological support (42%). Multimodal programmes showed reduced adherence (67%) compared to unimodal approaches (83%). Meta-regression identified intervention duration as the only significant predictor, with a 2.6% decrease per additional day (p = 0.0046). Common barriers to adherence included logistics, exercise intensity, time constraints, and tolerance to nutritional supplements. Study-level limitations included inconsistent definitions and measurements of adherence, reliance on self-reported measures, and low certainty of evidence.

CONCLUSIONS

Adherence to prehabilitation in gastrointestinal cancer surgery is generally moderate to high but lower in multimodal programmes and declines as the duration of the intervention increases. Standardising adherence reporting and integrating behavioural strategies and digital tools could improve adherence, equity, and outcomes.

PROTOCOL REGISTRATION

The protocol for this systematic review and meta-analysis was registered with the PROSPERO database (CRD42022301626): https://www.crd.york.ac.uk/PROSPERO/view/301626 .

Address: Sydney Medical School, University of Sydney, Sydney, NSW, Australia. [email protected].; Department of Nutrition and Dietetics, Concord Repatriation General Hospital, Sydney, NSW, Australia. [email protected].; The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, NSW, Australia.; School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.; Department of Nutrition and Dietetics, Concord Repatriation General Hospital, Sydney, NSW, Australia.; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.; Department of Nutrition and Dietetics, Concord Repatriation General Hospital, Sydney, NSW, Australia.; Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia.; Sydney Medical School, University of Sydney, Sydney, NSW, Australia. [email protected].; Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia. [email protected].

DOI: 10.1007/s00520-025-10032-8

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Full Text Sources:

https://dx.doi.org/10.1007/s00520-025-10032-8

MeSH Terms: Humans, Gastrointestinal Neoplasms, Patient Compliance, Preoperative Care, Preoperative Exercise