Psychological prehabilitation before cancer surgery: a systematic review

Research output: Contribution to journalArticle


  • Sandro Pasquali
  • Anant Desai
  • David Gourevitch
  • Inigo Tolosa
  • Ravinder Vohra

Colleges, School and Institutes

External organisations

  • Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust


Cancer patients experience anxiety and depression after diagnosis and during treatment. A wide range of psychological interventions have been proposed to alleviate distress, but the evidence about the perioperative effectiveness of such interventions is not clear. This systematic review examined the effect of preoperative psychological interventions or prehabilitation on the postoperative outcomes of patients undergoing surgery for cancer.
A systematic review of the published data was performed using Embase, Medline, and PsycInfo for the period from 1946 to February 2014. A total of 951 publications (case series, single case reports, and reviews) were found. Only seven of these studies included patients undergoing an operation for cancer and a preoperative psychological intervention.
Six of the seven studies were randomized controlled trials. Four were conducted with patients who had breast cancer (n = 356). The other studies included patients with gynecologic cancer (n = 30), colorectal cancer (n = 60), and prostate cancer (n = 159). Assessment of the studies showed four to be of good quality, two to be of moderate quality, and one to be of poor quality. Interventions did not affect traditional surgical outcomes (e.g., length of hospital stay, complications, analgesia use, or mortality) but positively affected patients’ immunologic function. However, psychological interventions appeared to have an impact on patients’ reported outcome measures including psychological outcomes, quality of life, and somatic symptoms.
Available data suggested that preoperative psychological prehabilitation may have a role for cancer patients undergoing surgery. Further evidence is needed to evaluate its role.


Original languageEnglish
Pages (from-to)4117-4123
JournalAnnals of Surgical Oncology
Issue number13
Early online date14 Apr 2015
Publication statusPublished - Dec 2015