Psychological interventions in prehabilitation randomized controlled trials for patients undergoing cancer surgery: sufficient or suboptimal?

The effectiveness of multimodal prehabilitation programs in improving surgical outcomes following surgery for cancer is increasingly recognized. These programs consist of a “multi-pronged” approach to patient preoperative optimization, including exercise, nutrition, and psychological interventions. The inclusion of psychological interventions within multimodal prehabilitation trials for patients undergoing cancer surgery has become popular over the last decade. This is largely owing to the increased recognition that the impact of poor preoperative mental health may have on post- operative surgical outcomes, quality of life, and postoperative recovery. Psychological prehabilitation interventions alone have demonstrated improvements in psychological outcomes and quality of life, however, the current evidence does not support consensus of clinical significance regarding the impact on surgical outcomes such as postoperative complications or length of stay. While the incorporation of psychological prehabilitation into trimodal programs has become increasingly popular, most current trials consist of inadequate intervention descriptions, poor reporting of adherence, and large heterogeneity of intervention type, duration, and associated outcome measures.