Long-term lifestyle effects of prehabilitation in colorectal cancer

BACKGROUND AND PURPOSE: Prehabilitation-a multimodal intervention aimed at optimizing patients' physical, nutritional and psychological status prior to surgery-has been shown to improve postoperative outcomes. However, the long-term impact of such programs on lifestyle remains poorly understood. Aim is to evaluate long-term lifestyle changes following a 4-week prehabilitation program prior to elective colorectal cancer (CRC) surgery and to compare patient-reported outcomes over a 24-month postoperative period between prehabilitation and control groups. Patient/material and methods: This single-center cross-sectional study combined a prehabilitation specific questionnaire with longitudinal data from the Prospective Dutch Colorectal Cancer (PLCRC) cohort. Questionnaires were distributed to CRC patients who underwent prehabilitation between 2021 and 2023. Longitudinal data-including validated measures of physical activity and quality of life-were compared between prehabilitation and control groups at 6, 12, and 24 months post-surgery. RESULTS: A total of 137 prehabilitation questionnaires were completed. Over half of the patients reported sustained lifestyle changes, including increased physical activity, healthier dietary habits and smoking cessation. However, longitudinal analyses of the PLCRC cohort (n=140) showed no significant differences in physical activity or quality of life between the prehabilitation and control groups. INTERPRETATION: Patients reported perceived meaningful, sustained, long-term lifestyle improvements following prehabilitation. The positive patient perspective may help support the broader implementation of prehabilitation in CRC care and highlights its potential to facilitate long-term lifestyle changes. However, these improvements were not reflected in the PLCRC data, likely due to high variability and the limited sample size of the dataset.