Overview
Advanced ovarian cancer is often treated with neoadjuvant chemotherapy, or NACT, before surgery. The goal is to shrink the tumor burden first so that surgeons can perform interval debulking surgery, a procedure designed to remove as much visible cancer as possible. However, not every patient tolerates chemotherapy equally well, and some become too frail or develop complications that prevent them from reaching surgery.
This study examined whether a structured prehabilitation program during NACT could improve chemotherapy delivery and help more patients remain eligible for surgery. Prehabilitation refers to supportive interventions given before treatment or during treatment to improve physical function, nutrition, and resilience. In this case, it involved a multimodal program rather than a single intervention, meaning it likely combined several supportive strategies such as exercise guidance, nutrition support, symptom management, and functional optimization.
Why Prehabilitation Matters
Patients with advanced ovarian cancer are often older and may already have reduced physical reserve because of cancer-related weight loss, fatigue, reduced activity, anemia, or other medical conditions. Chemotherapy can intensify these problems. If treatment doses are delayed, reduced, or stopped early, the chance of effective tumor control may decrease. In addition, if a patient becomes too weak, surgery may no longer be safe or beneficial.
Prehabilitation aims to address these risks early. The idea is similar to building strength before a major challenge: by improving fitness, nutrition, and symptom control during treatment, patients may be better able to complete chemotherapy and reach surgery in a stronger condition.
Study Design
This was a matched-cohort study conducted at a single tertiary center. The researchers included patients with stage IIIC or stage IV ovarian cancer who received neoadjuvant chemotherapy. The intervention group participated in a prospective multimodal prehabilitation trial during NACT, while the control group came from historical records and was matched one-to-one based on age, FIGO stage, and the reason chemotherapy was given before surgery.
The main outcomes were chemotherapy delivery and surgical candidacy. Chemotherapy delivery was assessed using relative dose intensity, or RDI, which measures how much of the planned chemotherapy a patient actually receives over time. An RDI of 85% or higher is often considered a clinically meaningful threshold. The study focused on carboplatin and paclitaxel, the standard drug combination commonly used in advanced ovarian cancer.
Main Findings in the Overall Group
A total of 116 patients were included. In the overall cohort, the prehabilitation group had a higher median RDI for paclitaxel, 99% compared with 92% in the control group, which reached borderline statistical significance. Carboplatin RDI was similar between groups, 93% versus 91%.
The proportion of patients who achieved an RDI of at least 85% was also numerically higher in the prehabilitation group for both drugs, although these differences were not statistically significant in the full cohort. For paclitaxel, 84.0% of the prehabilitation group reached this benchmark compared with 75.4% of controls. For carboplatin, the rates were 74.1% versus 65.5%.
One of the most important findings was that fewer patients in the prehabilitation group failed to proceed to interval debulking surgery. This is clinically meaningful because completing surgery after chemotherapy is a major treatment milestone in advanced ovarian cancer. In the prehabilitation group, 6.9% did not reach surgery, compared with 22.4% in the control group.
Findings in Patients Aged 70 Years and Older
The benefits appeared even more pronounced in older adults. Among patients aged 70 years or older, prehabilitation was associated with a clearly higher median RDI for both chemotherapy drugs. Paclitaxel RDI was 98% in the prehabilitation group versus 86% in controls. Carboplatin RDI was 92.5% versus 87%.
Older patients in the prehabilitation group were also more likely to maintain an RDI of at least 85% for paclitaxel: 88.5% versus 59.3% in the control group. In this age group, the risk of not proceeding to surgery was substantially lower as well, with failure to reach interval debulking surgery occurring in 12.5% of the prehabilitation group compared with 42.9% of controls.
These results suggest that older adults, who are often at greater risk for treatment-related decline, may benefit the most from structured supportive care during chemotherapy.
What the Results Mean
The findings support the idea that prehabilitation can help patients tolerate treatment more effectively. Better chemotherapy delivery may reflect fewer dose reductions, fewer delays, improved symptom control, or better overall physical resilience during treatment. Lower rates of missed surgery suggest that patients were more likely to remain fit enough to undergo the next step of care.
In practical terms, this matters because treatment success in advanced ovarian cancer depends on two linked goals: giving effective chemotherapy and then performing surgery when the patient is still a good candidate. If either part is compromised, outcomes may worsen.
It is important to note that this study was not a randomized trial, so it cannot prove that prehabilitation alone caused the improvement. Other factors may have contributed, including differences in supportive care, patient motivation, or changes in treatment practice over time. Still, the results are encouraging and suggest that this approach deserves further study.
Clinical Background: Advanced Ovarian Cancer Treatment
Ovarian cancer is frequently diagnosed at an advanced stage because early symptoms can be vague or absent. Standard management of advanced disease often includes surgery and platinum-based chemotherapy. In some patients, primary surgery is too risky or unlikely to remove enough disease, so clinicians begin with neoadjuvant chemotherapy and then reassess for interval debulking surgery.
The drugs used in this study, carboplatin and paclitaxel, are a common first-line combination. Carboplatin is a platinum agent that damages cancer cell DNA, while paclitaxel interferes with cell division. Both are effective, but they can cause side effects such as fatigue, neuropathy, low blood counts, nausea, and weakness. For older patients, even modest toxicity can affect daily functioning and treatment continuity.
Why Multimodal Support May Help
Prehabilitation is usually most effective when it addresses several needs at once. Exercise can preserve muscle strength and endurance. Nutrition support can reduce the impact of weight loss and poor intake. Medication review and symptom management can reduce treatment interruptions. Emotional support and counseling may also improve adherence and coping.
In older adults especially, these factors are interconnected. A patient who feels weaker may move less, eat less, and recover more slowly from chemotherapy side effects. Breaking that cycle early may help maintain enough functional reserve to complete treatment.
Limitations
This study has several limitations. It was single-center, which may limit how broadly the results apply. It used a historical control group, so the comparison may be influenced by differences in care over time. The sample size was modest, especially for subgroup analysis. The article also reports associations rather than definitive proof of causation.
In addition, the exact components of the prehabilitation program, the degree of adherence, and which elements were most effective would need further clarification in future studies. Randomized controlled trials would be the best way to determine whether prehabilitation truly improves outcomes and which patients benefit most.
Practical Takeaway
For patients with advanced ovarian cancer, especially those aged 70 and older, structured prehabilitation during neoadjuvant chemotherapy may help them receive more of the planned chemotherapy and improve the likelihood of reaching surgery. While these findings are preliminary, they point toward a promising strategy to strengthen treatment tolerance in a vulnerable population.
As oncology care continues to move toward more personalized and supportive approaches, prehabilitation may become an important part of the treatment pathway for advanced ovarian cancer. The study suggests that improving a patient’s physical and functional readiness during chemotherapy could be just as important as choosing the right drugs.
Reference
Suleiman R, Mokshagundam S, Block MS, Wahner Hendrickson AE, Bruce KH, Cliby WA, Langstraat CL, Weroha SJ, Yadav S, Kumar A. Prehabilitation during neoadjuvant chemotherapy in advanced ovarian cancer is associated with improved surgical candidacy and chemotherapy outcomes. Gynecologic oncology. 2026-06-15;211:9-16. PMID: 42296695.
