Necessity and advisability of pre-rehabilitation in cancer patients before planned surgery: a rationale for the approach

Background. Pre-rehabilitation improves surgical outcomes in cancer patients; however, its necessity for different stages of cervical cancer (CC) remains insufficiently justified. Thus, a comprehensive assessment of the preoperative status of patients is required.

Objective: To evaluate various quality of life (QoL) components and objective health indicators in CC patients prior to surgical intervention, thereby substantiating the necessity for pre-rehabilitation.

Material and methods. The single-point interventional study included 199 patients with verified cervical cancer in situ or stages I or II (Groups 0, 1, and 2, respectively). QoL was assessed using the Functional Assessment of Cancer Therapy – General/Cervix (FACT-G/Cx) questionnaire; distress level was evaluated using the adapted International Psycho-Oncology Society (IPOS) methodology. Body Mass Index (BMI), vaginal pH, human papillomavirus 16/18 viral load, blood levels of glucose, insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index, as well as leptin, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and magnesium concentrations were determined.

Results. A significant decrease in QoL across all FACT-G/Cx domains was revealed, most pronounced in patients with stage II CC (total score 100 [95.5;104.0]). The IPOS distress level was ≥6 points in all groups. BMI ranged from pre-obesity (Group 0) to class I obesity (Groups 1 and 2). Insulin resistance was registered in all patients: HOMA-IR was 2.98±0.40 (Group 0), 4.09±0.81 (Group 1), and 5.34±0.80 (Group 2). Elevated TNF-α and IL-6 concentrations were observed in all groups, peaking in patients with stage II CC. Serum magnesium deficiency (<0.80 mmol/l) was present in all cases.

Conclusion. Prior to surgery and regardless of stage, CC patients experience a significant decrease in QoL, elevated levels of psychoemotional distress, overweight, insulin resistance, systemic inflammation, and magnesium deficiency. The severity of these impairments increases with more advanced stages of CC. These findings substantiate the need for the early initiation of multimodal pre-rehabilitation in the period from diagnosis until surgical intervention.

1. Soh N.H., Yau C.R.Z., Low X.Z., et al. Prehabilitation outcomes in surgical oncology patients undergoing major abdominal surgery: a meta-analysis of randomized control trials. Ann Surg Oncol. 2025; 32 (2): 1236–47. https://doi.org/10.1245/s10434-024-16527-8.

2. Li N., Liu X., Wang Y., et al. Multimodal prehabilitation is an effective strategy to reduce postoperative complications and improve physical function and anxiety in patients with colorectal cancer undergoing elective surgery: a systematic review and network meta-analysis. Front Med. 2025; 12: 1619959. https://doi.org/10.3389/fmed.2025.1619959.

3. Bai Z., Koh C., Solomon M., et al. Prehabilitation in frail patients undergoing cancer surgery: a systematic review and meta-analysis. Ann Surg Oncol. 2025; 32 (10): 7707–22. https://doi.org/10.1245/s10434-025-17589-y.

4. Blinov D.V., Solopova A.G., Gameeva E.V., et al. Effect of the rehabilitation on distress levels among patients undergoing surgical treatment for cervical cancer: a comparative randomized trial. Bulletin of Rehabilitation Medicine. 2025; 24 (1): 120–7 (in Russ.). https://doi.org/10.38025/2078-1962-2025-24-1-120-127.

5. Blinov D.V., Solopova A.G., Gameeva E.V., et al. Resumption of employment after cervical cancer surgery: a 3-year follow-up study of long-term outcomes. Bulletin of Rehabilitation Medicine. 2024; 23 (6): 54–61 (in Russ.). https://doi.org/10.38025/2078-1962-2024-23-6-54-61.

6. Blinov D.V., Solopova A.G., Gameeva E.V., et al. Restoring sexual function in womenwith early-stage cervical cancer. Vrach / The Doctor. 2024; 35 (10): 5–10 (in Russ.). https://doi.org/10.29296/25877305-2024-10-01.

7. Blinov D.V., Solopova A.G., Gameeva E.V., et al. Impact of various rehabilitation programs on anxiety and depression after surgery of early-stage cervical cancer. Problems of Balneology, Physiotherapy and Exercise Therapy. 2024; 101 (5): 40–4 (in Russ.). https://doi.org/10.17116/kurort202410105141.

8. Akavova A.A., Solopova A.G., Blinov D.V., et al. Treatment and rehabilitation for cervical cancer: the experience of patient journey management. Obstetrics, Gynecology and Reproduction. 2023; 17 (5): 625–37 (in Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2023.461.

9. Akavova S.A. Patient routing system in rehabilitation after treatment for oncogynecological pathologies. Reabilitologia / Journal of Medical Rehabilitation. 2024; 2 (1): 158–72 (in Russ.). https://doi.org/10.17749/2949-5873/rehabil.2024.21.

10. Belyaev A.M., Chulkova V.A., Semiglazova T.Yu., Rogachev M.V. (Eds) Oncopsychology for oncologists and medical psychologists. Manual. Saint Petersburg: Lyubavich; 2017: 352 pp. (in Russ.).

11. On the Plenum of the Presidium of the Russian Society of Obstetricians and Gynecologists. Obstetrics and Gynecology. 2015; 5: 113–5 (in Russ.).

12. Resolution III of the International Expert Council on Magnesium Deficiency in Obstetrics and Gynecology. Obstetrics and Gynecology. 2015; 12: 152 (in Russ.).

13. Makatsariya A.D., Bitsadze V.O., Solopova A.G., et al. Female magnesium deficiency and its management: review of current knowledge. Obstetrics, Gynecology and Reproduction. 2024; 18 (2): 218–30 (in Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.512.

14. Carter J., Huang H., Monk B., et al. Evaluation of physical function and quality of life before and after nonradical surgical therapy for stage IA1 and IA2-IB1 cervical cancer (GOG-0278). Gynecol Oncol. 2025; 195: 50–8. https://doi.org/10.1016/j.ygyno.2025.02.023.

15. Dos Santos L.N., Castaneda L., de Aguiar S.S., et al. Health-related quality of life in women with cervical cancer. Rev Bras Ginecol Obstet. 2019; 41 (4): 242–8. https://doi.org/10.1055/s-0039-1683355.

16. Kjaerulff I., Soyster Heinz S.A., Fuller M., et al. Mixed-methods analysis of preoperative distress and postoperative outcomes in a prospective, observational cohort of older adults. Anesthesiology. 2026; 144 (1): 77–89. https://doi.org/10.1097/ALN.0000000000005780.

17. Min L., Jiang S., Lu Y., Zhang X. Impact of preoperative psychological support on outcomes in pancreatic cancer surgery: a propensity score-matched cohort study. Front Oncol. 2025; 15: 1631842. https://doi.org/10.3389/fonc.2025.1631842.

18. Schmitt F., Najjari L., Kupec T., et al. Predictors of significant distress in cervical cancer patients: a cross sectional study. Arch Gynecol Obstet. 2024; 310: 551–560. https://doi.org/10.1007/s00404-024-07505-2.

19. Andersen B.L., DeRubeis R.J., Berman B.S., et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol. 2014; 32 (15): 1605–19. https://doi.org/10.1200/JCO.2013.52.4611.

20. Khandekar M.J., Cohen P., Spiegelman B.M. Molecular mechanisms of cancer development in obesity. Nat Rev Cancer. 2011; 11 (12): 886–95. https://doi.org/10.1038/nrc3174.

21. Yang Z., Wang D., Yang M., et al. Risk factors for surgical site infection in patients undergoing obstetrics and gynecology surgeries: a metaanalysis of observational studies. PLoS One. 2024; 19 (3): e0296193. https://doi.org/10.1371/journal.pone.0296193.

22. Wang Y., Qi C., Hao M. Development of a prognostic model for cervical cancer based on inflammation-related gene signatures and immune microenvironment regulation. Am J Cancer Res. 2025; 15 (9): 3933–46. https://doi.org/10.62347/NOXW2192.

23. Obeagu E.I. Modulation of chronic cytokine dysregulation in cervical cancer: potential biomarkers and therapeutic targets. Cancer Manag Res. 2025; 17: 1113–26. https://doi.org/10.2147/CMAR.S527913.

24. Urbute A., Frederiksen K., Thomsen L.T., et al. Overweight and obesity as risk factors for cervical cancer and detection of precancers among screened women: a nationwide, population-based cohort study. Gynecol Oncol. 2024; 181: 20–7. https://doi.org/10.1016/j.ygyno.2023.12.002.

25. Sand F.L., Urbute A., Ring L.L., et al. The influence of overweight and obesity on participation in cervical cancer screening: a systematic review and meta-analysis. Prev Med. 2023; 172: 107519. https://doi.org/10.1016/j.ypmed.2023.107519.

26. McIsaac D.I., Kidd G., Gillis C., et al. Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials. BMJ. 2025; 388: e081164. https://doi.org/10.1136/bmj-2024-081164.

27. Verma M., Kharb S., Soni A., et al. Magnesium imbalance before and during concomitant chemoradiation in cervical cancer patients: a prospective interventional study. J Clin Diagn Res. 2024; 18 (12): BC15–9. https://www.doi.org/10.7860/JCDR/2024/76536/20414.

28. Blinov D.V., Solopova A.G., Malykh-Bakhtina М.P., et al. The role of magnesium deficiency control in recovery after treatment for oncogynecological diseases. Reabilitologia / Journal of Medical Rehabilitation. 2024; 2 (2): 186–96 (in Russ.). https://doi.org/10.17749/2949-5873/rehabil.2024.19.

29. Widanage N., Almonib A., Gunathilaka K. The effects of multimodal prehabilitation on postoperative outcomes in colorectal surgery: a systematic review and meta-analysis. Cureus. 2025; 17 (10): e95032. https://doi.org/10.7759/cureus.95032.

30. Kim J., Lee C.H., Yim G.W. Multimodal prehabilitation for gynecologic cancer surgery. Curr Oncol. 2025; 32 (2): 109. https://doi.org/10.3390/curroncol32020109.

31. Ehrlich A.L., Owodunni O.P., Mostales J.C., et al. Early outcomes following implementation of a multispecialty geriatric surgery pathway. Ann Surg. 2023; 277 (6): e1254–61. https://doi.org/10.1097/SLA.0000000000005567.