Multimodal Prehabilitation in Indian Women with Advanced Ovarian Cancer: Enhancing Nutritional, Psychological, and Surgical Recovery

Rajan, Saroj; Yadav, Raj Kumar; Kaur, Parmeet; Dhamija, Ekta; Deb, Koushik Sinha; Malhotra, Neena; Singh, Nilanchali; Khurana, Sachin; Bhatla, Neerja; Upadhyay, Ashish Datt; Singhal, Seema

doi:10.31557/APJCP.2025.26.12.4575

Multimodal Prehabilitation in Indian Women with Advanced Ovarian Cancer: Enhancing Nutritional, Psychological, and Surgical Recovery

Document Type : Research Articles

Authors

¹ Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India.

² Department of Physiology, AIIMS, New Delhi, India.

³ Department of Dietetics, AIIMS, New Delhi, India.

⁴ Department of Oncoradiology, AIIMS, New Delhi, India.

⁵ Department of Psychiatry, AIIMS, New Delhi, India.

⁶ Department of Medical Oncology, AIIMS, New Delhi, India.

⁷ Department of Biostatistics, AIIMS, New Delhi, India.

10.31557/APJCP.2025.26.12.4575

Abstract

Background: Malnutrition is common among women with gynecologic cancers, particularly advanced ovarian cancer, and adversely impacts treatment tolerance, surgical recovery, and quality of life. The neoadjuvant chemotherapy (NACT) phase provides a unique opportunity to introduce prehabilitation interventions to improve perioperative outcomes. Objective: To evaluate the feasibility and impact of a culturally tailored, home-based multimodal prehabilitation program on perioperative outcomes in Indian women with advanced ovarian cancer undergoing NACT. Methods: Sixty women planned for NACT were enrolled and allocated to either a prehabilitation group (n = 30) or control group (n = 30). The intervention include yoga-based physiotherapy, individualized nutritional counseling, and psychological support. Outcomes assessed pre- and post-NACT included body mass index (BMI), hemoglobin, serum albumin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), skeletal muscle index (SMI), Hospital Anxiety and Depression Scale (HADS) scores, in each group and between group comparisons of perioperative outcomes. Results: Both groups showed significant within-group improvements in nutritional and inflammatory markers. Between-group comparisons revealed a smaller decline in BMI (–1.29 vs. –4.51; p < 0.001) and a greater reduction in HADS scores (–4.5 vs. –1.5; p =0.013) in the prehabilitation group. Hospital stay was significantly shorter in the prehabilitation group (median: 4 vs. 5.5 days; p = 0.005), while reductions in intraoperative blood loss and postoperative complications did not reach statistical significance. Greater physiotherapy session attendance correlated with reduced BMI loss (ρ = –0.4187, p = 0.022). Multivariable analysis showed that prehabilitation and physiotherapy adherence were associated with smaller BMI declines, and prehabilitation reduced the odds of prolonged hospitalization. Conclusion: Implementing a culturally adapted multimodal prehabilitation program is feasible and improves short-term nutritional, psychological, and perioperative outcomes in women undergoing NACT for advanced ovarian cancer.

Keywords