Effect of a Structured Psychosocial Prehabilitation Program on Postoperative Psychological Distress and Recovery Outcomes Among Women Undergoing Gynecologic Cancer Surgery: A Quasi- Experimental Study

Abstract Background Women undergoing gynecologic cancer surgery frequently experience substantial psychological distress, which may negatively affect postoperative recovery, particularly in resource-limited settings. This study aimed to evaluate the effect of a structured psychosocial prehabilitation program on postoperative psychological distress, perceived social support, and clinical recovery outcomes. Methods A quasi-experimental, controlled before-and-after study was conducted among 140 women undergoing gynecologic cancer surgery at Assiut University Hospital. Participants were non-randomly allocated via sequential enrollment into either a control group receiving routine perioperative care (n = 70) during the initial phase, followed by a psychosocial prehabilitation intervention group (n = 70). Primary outcomes included psychological distress (Depression Anxiety Stress Scale-21, DASS-21) and perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS) assessed preoperatively (T1), 15 days postoperatively (T2), and at 30-day follow-up (T3). Secondary outcomes were postoperative pain, length of hospital stay (LOS), readmission, and re-exploration rates. Results Baseline demographic characteristics were comparable between groups. At 30-day follow-up (T3), the intervention group demonstrated statistically significant and clinically meaningful reductions in anxiety (8.70 ± 2.37 vs. 14.41 ± 6.70, p < 0.001, Cohen’s d = 2.41), depression (7.91 ± 3.45 vs. 14.09 ± 6.49, p < 0.001, Cohen’s d = 1.76), and stress (9.19 ± 2.84 vs. 14.10 ± 7.12, p < 0.001, Cohen’s d = 2.63). In multivariable ANCOVA models adjusting for baseline scores, age and cancer type, the intervention effect remained statistically significant across all psychological domains (p < 0.001). The intervention group also experienced lower postoperative pain scores (p < 0.001), shorter mean LOS (5.57 ± 1.81 vs. 11.30 ± 4.18 days, p < 0.001), and lower 30-day readmission (0% vs. 14.3%, p < 0.001) and re-exploration rates (1.4% vs. 15.7%, p = 0.003). Conclusion Nurse-led psychosocial prehabilitation is associated with substantial improvements in postoperative psychological distress and clinical recovery parameters in women undergoing gynecologic cancer surgery. Given the non-randomized sequential design, causality cannot be definitively established, and findings should be confirmed in randomized controlled trials. Trial Registration: ClinicalTrials.gov NCT07188662 (retrospectively registered the registration date '2025-09').