Optimizing Breast Cancer Surgery Recovery: A Real-World Comparative Effectiveness Study of Prehabilitation and Delayed Rehabilitation Care

BACKGROUND: Prehabilitation is recommended to reduce surgery-related functional decline but is not routinely integrated into presurgical breast cancer care, often resulting in rehabilitation being delayed until after surgery. We conducted a retrospective comparative effectiveness study evaluating outcomes associated with real-world prehabilitation versus delayed rehabilitation care models. METHODS: Women who began rehabilitation before (prehabilitation; n=416) or after breast cancer surgery (delayed rehabilitation; n=232) were identified from the electronic medical record. Upper extremity function and health-related quality of life (HRQoL) outcomes were extracted presurgery, postsurgery, and at final evaluation. Adjusted linear mixed-effect models examined change over time and between-group differences, and logistic regression estimated likelihood of achieving normal limits. Analyses were conducted overall and stratified by surgery type. Rehabilitation utilization and recovery to baseline levels among patients who received prehabilitation were summarized descriptively. RESULTS: Prehabilitation was associated with superior postsurgery function and HRQoL, as well as higher odds of achieving normal limits, compared with delayed rehabilitation. Both groups improved during postoperative rehabilitation; however, functional outcomes and strength remained superior among patients who received prehabilitation at final evaluation. Benefits of prehabilitation were most pronounced among women undergoing mastectomy or bilateral mastectomy, although meaningful benefits were also observed following lumpectomy. All patients who received prehabilitation recovered to baseline levels on at least one outcome. Across the perioperative period, patients who received prehabilitation attended fewer visits than those who received delayed rehabilitation (median, 5 vs 7; P=.008). CONCLUSIONS: Both prehabilitation and delayed rehabilitation supported recovery of upper extremity functioning and HRQoL following breast cancer surgery. However, prehabilitation may represent a more effective and efficient care model-particularly for women undergoing more extensive surgical procedures-achieving comparable or better outcomes with fewer visits. These findings support integration of prehabilitation into breast cancer surgical care pathways.