Abstract / Summary
Neoadjuvant chemotherapy (NACT) followed by cytoreductive surgery (CRS) is the standard of care for advanced ovarian cancer and is associated with deconditioning and a high burden of perioperative morbidity. Multimodal prehabilitation may attenuate physiological decline during NACT; however, real-world clinical and economic evidence in this population remains limited. We explored associations between participation in a multimodal prehabilitation pathway and postoperative clinical and economic outcomes. We conducted a STROBE- and CHEERS-compliant exploratory retrospective cohort study with a cost-consequence economic evaluation using patient-level (PLICS) costing incorporating programme delivery costs. Patients completing the My Integrated Lifestyle and Exercise (MILE) prehabilitation programme were compared with a contemporaneous cohort of non-participants undergoing NACT and CRS. The primary measure of complication burden was the Comprehensive Complication Index (CCI); the Clavien–Dindo (CD) distribution and ICU and hospital length of stay (LOS) were also assessed. Surgical complexity was quantified using the validated Aletti Surgical Complexity Score (SCS), and inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Seventy-three patients were included (37 MILE, 36 non-MILE). MILE participation was associated with a lower Comprehensive Complication Index (median 20.9 vs 29.6; p < 0.001), fewer major complications (CD = III: 13.5% vs 36.1%; p = 0.03), and shorter ICU (1 vs 2 days; p = 0.02) and hospital LOS (6 vs 8 days; p = 0.03). Surgical complexity was comparable (Aletti SCS median 4 vs 4; SMD 0.13). After IPTW including complexity, the weighted mean CCI difference was - 12.9 (95% CI - 19.5 to - 6.7). In the economic cohort (34 MILE vs 32 non-MILE), including programme delivery costs (£1,715 per patient), mean total cost was lower for MILE (£29,804 vs £36,259; difference - £6,456, BCa 95% CI - £12,462 to - £196); median costs were £26,051 vs £32,940 (difference - £6,889, 95% CI - £12,593 to - £1,471). Participation in multimodal prehabilitation was associated with reduced postoperative morbidity, shorter length of stay and lower hospital costs in women undergoing cytoreductive surgery for advanced ovarian cancer. These exploratory, hypothesis-generating findings from a non-randomised cohort cannot establish effectiveness; they support prospective randomised evaluation, including a formal economic evaluation with prospectively collected utilities, and align with the prehabilitation priorities of the 2026 National Cancer Plan for England.