**Background:** Cancer prehabilitation, defined as interventions between diagnosis and acute treatment, aims to improve functional and psychological outcomes. While evidence supports its benefits, the optimal delivery model remains debated. Home-based programs offer convenience but often require large multidisciplinary teams and multiple visits, posing logistical challenges. This study evaluates a 'one-stop', hospital-associated home-based prehabilitation model led by a small core team (physiatrist and coordinator) for newly diagnosed gastrointestinal and urological cancer patients undergoing surgery.
**Methods:** This retrospective study at a tertiary public hospital included patients from January 2020 to February 2022. Referral criteria were newly diagnosed colorectal, hepato-pancreato-biliary (HPB), upper gastrointestinal (GI), or urological cancer planned for surgery. Patients were screened for frailty using Fried's phenotype; frail and pre-frail patients were prioritized, but non-frail could also participate. The intervention comprised a single visit with the coordinator (baseline measures: 6MWT, STS, TUG, HADS, EQ-5D) and physiatrist (medical optimization, individualized exercise prescription, nutrition advice targeting 1.2–2.0 g/kg/day protein, mental health support). Patients performed home exercises (strengthening and aerobic) with phone follow-up every 1–2 weeks. A pre-operative visit 1–3 days before surgery repeated functional and psychological measures. Post-operative inpatient review and a 3-month outpatient visit repeated all measures. Primary outcome was 6MWT distance. Secondary outcomes included STS, TUG, HADS, EQ-5D, patient satisfaction (Likert scale), post-operative length of stay, 30-day major complications, readmission, and mortality. Statistical analysis used paired t-tests or Wilcoxon signed-rank tests and multivariable linear regression.
**Key Results:** Of 211 referred patients, 182 enrolled (86.3% enrolment). Mean age was 70.43±10.64 years; 59.3% male; 50.5% frail, 26.4% pre-frail, 23.1% non-frail. Cancer types: 65.9% colorectal, 24.7% HPB, 7.1% urological, 2.2% upper GI. Mean prehabilitation duration was 19.29±14.87 days. Compliance: 65.6% reported doing minimum sets; 65.9% demonstrated all exercises correctly. Referral to additional services was low (physiotherapist 1.4%, dietician 1.4%, medical social worker 2.1%).
From baseline to pre-operative, significant improvements were seen: 6MWT improved by 21.52 m (95% CI not provided for change, p<0.001); STS by 1.08 repetitions (p<0.001); TUG by 0.83 seconds (p=0.014); HADS total score by 1.77 points (29% improvement, p<0.001); HADS depression by 0.99 points (34%, p<0.001); HADS anxiety by 0.71 points (22%, p=0.027). EQ-5D health score improved from baseline to 3 months post-operatively by 7.04 points (p=0.001).
Comparing pre-operative to 3-month post-operative, functional gains were sustained: 6MWT changed by -0.22 m (p=0.964); STS by 0.08 repetitions (p=0.863); TUG by 0.04 seconds (p=0.939). Psychological measures further improved: HADS total score improved by 2.06 points (47%, p=0.003); HADS anxiety by 1.36 points (48%, p=0.001); HADS depression by 0.52 points (23%, p=0.117). Patient satisfaction was high: >90% agreed/strongly agreed they were satisfied with interactions with the doctor and coordinator; close to 90% agreed they benefitted from the program.
Multivariable regression showed that older age (β=0.01, p=0.009) and higher frailty score (β=0.14, p=0.003) were independently associated with longer post-operative length of stay. Lower baseline HADS scores were associated with greater improvement in HADS scores (p<0.001). Better baseline TUG was associated with greater improvement in TUG (β=-0.37, p<0.001).
**Clinical Implications:** This study demonstrates that a streamlined, hospital-associated home-based prehabilitation model, delivered by a small core team, can significantly improve functional capacity, psychological well-being, and quality of life in cancer patients awaiting surgery, with benefits sustained at 3 months post-operatively. The high patient satisfaction and low referral rates to additional services suggest this model is feasible, cost-effective, and well-accepted. The findings support prioritizing frail and older patients, who may derive greater benefit in terms of reducing post-operative length of stay. Limitations include the retrospective, single-arm design, predominance of colorectal cancer patients, and lack of a control group. Future randomized controlled trials are needed to validate these results and explore generalizability to other cancer types.