Prehabilitation for cancer surgery: a systematic review of qualitative literature from experienced stakeholders

PURPOSE: Multimodal prehabilitation for cancer surgery is increasingly being used in cancer care to improve patient outcomes. Despite the benefits of such programs on patient and health service metrics, many services and research trials report challenges with patient uptake and adherence as well as implementation into existing services. This systematic review sought to better understand the key enablers and barriers to participant uptake and adherence, to inform future service adoption recommendations. METHODS: MEDLINE, CINAHL, Scopus and PsycInfo were systematically searched for qualitative and mixed-methods studies from January 2010 to July 2025. Two reviewers independently screened, extracted and conducted critical appraisal. A customised data extraction tool was developed, and study quality was critically appraised via the Mixed Methods Appraisal Tool (MMAT). Data were thematically synthesised into patient, clinician and system level factors influencing engagement. RESULTS: Twenty-five studies were identified. Patient engagement factors included the importance of relationships (clinician-patient, family and patient peer groups), acknowledging individual circumstances with the need for individualised content, and the belief of the benefit of participation. Implementation factors included workforce capacity and capability, organisational system support, and utilising the preoperative window effectively. Combined factors were the delivery method and clinician awareness and attitudes towards prehabilitation. CONCLUSION: Engagement with prehabilitation is shaped by interconnected patient and system factors. Successful implementation requires addressing both individual patient needs and organisational infrastructure. Future research should expand beyond proving effectiveness to real-world integration. IMPLICATIONS FOR CANCER SURVIVORS: Survivors benefit from tailored prehabilitation programs that consider personal circumstances and provide strong relational support. Embedding prehabilitation into standard care pathways promotes equitable access and empowers survivors to participate actively.