Comprehensive Multimodal Prehabilitation for Lung Cancer: A Systematic Review of Randomized Controlled Trials.

Introduction: Surgical resection is a cornerstone of curative treatment for early-stage lung cancer. Multimodal prehabilitation, a comprehensive, patient-centered program integrating physical exercise, nutritional status, and psychological support, has emerged as a promising approach to enhance patients' physiological and psychological resilience prior to surgery. While multimodal prehabilitation is valuable for optimizing patients' tolerance of oncological treatment, there is a scarcity of studies incorporating multimodal interventions, likely due to the absence of clear guidelines for lung cancer patients. This systematic review aimed to assess the comprehensiveness and effectiveness of prehabilitation activities for lung cancer patients undergoing thoracic surgery. Evidence Acquisition: A systematic literature search was conducted according to PRISMA guidelines. The search was performed in PubMed, Google Scholar, PEDro, and Cochrane Library, with additional publications identified from reference lists. The search was completed on February 27, 2024. Studies published between 2019 and 2024 were included to capture the most recent evidence. The study was registered in PROSPERO (registration number CRD42024499622). Evidence Synthesis: Out of 1233 identified studies, 10 randomized controlled trials were included. Prehabilitation programs varied in duration and setting. Only three studies (Liu et al, 2020; Yao et al, 2022; Ferreira et al, 2021) employed a comprehensive multimodal approach integrating physical exercise, psychological care, and nutrition interventions. Prehabilitation was associated with improved exercise capacity (eg, increased 6MWT distance), reduced postoperative complications, and potential benefits for quality of life and psychological well-being. However, the impact on length of stay and cognitive function remains unclear. Conclusion: This review highlights a significant gap in the implementation of comprehensive multimodal prehabilitation for lung cancer patients. While physical exercise is widely adopted, psychological and nutritional components are often overlooked. Further research is needed to establish clear guidelines and elucidate the full benefits of a comprehensive multimodal prehabilitation approach, particularly regarding its impact on mental health, quality of life, and long-term outcomes in lung cancer patients.