Feasibility, acceptability and effectiveness of digitally delivered multimodal prehabilitation for cancer patients: A mixed-methods systematic review

Multimodal prehabilitation, which encompasses physical, nutritional, and psychological strategies, is increasingly recognised for its potential to prepare cancer patients holistically for their treatment journey. This mixed-methods systematic review assessed the feasibility, acceptability, and effectiveness of digitally delivered multimodal prehabilitation interventions for cancer patients. A systematic search was conducted in Embase, PubMed, Scopus, PsycINFO, and Web of Science for studies published from January 2008 onwards. Eligible studies included quantitative, qualitative, and mixed-methods designs reporting on digital multimodal prehabilitation interventions (encompassing physical, nutritional, and psychological components) for adult cancer patients in the pre-treatment phase. Screening, data extraction, and quality appraisal were performed independently by two reviewers, with disagreements resolved through discussion. Data were synthesized narratively using a convergent segregated approach. Twelve studies (n = 602 participants) met the inclusion criteria, with most focusing on gastrointestinal, gynaecological, urologic/genitourinary, and breast cancer. Most interventions utilized wearable fitness trackers, telehealth platforms, alongside mobile health applications to deliver prehabilitation. Feasibility and acceptability were generally high, with positive patient feedback and good adherence. Consistent improvements in physical function (e.g., walking capacity, strength) were observed across studies, but psychological outcomes were mixed and nutritional status was underreported. Five studies (qualitative) highlighted patient satisfaction but noted barriers such as digital literacy. Limited evidence suggested possible reductions in hospital stays and complications. The findings suggest that digitally delivered multimodal prehabilitation is feasible and can enhance physical preparedness for cancer treatment, with high patient satisfaction. However, standardization of interventions and further research on psychological and nutritional outcomes are needed to optimize effectiveness and ensure equitable access across diverse cancer populations. Future research should focus on diverse cancer populations and use co-design to ensure interventions are tailored to their needs.