SummaryIntroductionPrehabilitation seeks to enhance functional capacity and preparedness before surgery with the aim of improving outcomes; it is generally based on exercise, diet and psychological interventions. While there is obvious appeal to this approach in terms of patient experience and resource use, the interventions are complex and the evidence base for prehabilitation before cancer surgery is heterogeneous. Prehabilitation requires patient understanding and motivation as well as commitment of resources. Programmes are challenging to design and implement, and can generate ‘intervention‐based inequalities’ based on the capacity of patients to engage. We present a narrative review on the inequalities and challenges of prehabilitation before cancer surgery.MethodsWe searched databases of peer‐reviewed research to identify appropriate articles. We used the results in combination with iterative searches based on citation tracking, grey literature (e.g. patient information resources) and articles from personal libraries, to develop our discussion.ResultsWe describe the uncertainties in the evidence base for prehabilitation before cancer surgery, and the challenges and barriers for healthcare providers, systems and patients. Key findings include that prehabilitation is under‐researched in many cancers and that people with lower health literacy, from minority ethnic groups and socio‐economically disadvantaged backgrounds, are less likely to engage, despite often having worse peri‐operative outcomes.DiscussionPrehabilitation must be implemented carefully to avoid widening inequalities. More research is needed, both in terms of the impact of interventions and to understand how prehabilitation should account for the social determinants of health.

中文翻译：

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癌症手术前预康复的不平等和挑战：叙述性回顾


摘要简介预康复旨在提高功能能力和手术前的准备，以改善结果;它通常基于运动、饮食和心理干预。虽然这种方法在患者体验和资源使用方面有明显的吸引力，但干预措施很复杂，而且癌症手术前预康复的证据基础是异质的。预康复需要患者的理解和激励以及资源承诺。计划的设计和实施具有挑战性，并且可能会根据患者的参与能力产生“基于干预的不平等”。我们介绍了癌症手术前预康复的不平等和挑战。方法我们检索了同行评审研究的数据库，以确定合适的文章。我们将结果与基于引文跟踪、灰色文献（例如患者信息资源）和个人图书馆文章的迭代检索相结合，以开展我们的讨论。结果我们描述了癌症手术前预康复证据基础的不确定性，以及医疗保健提供者、系统和患者面临的挑战和障碍。主要发现包括许多癌症的预康复研究不足，并且来自少数族裔和社会经济弱势背景的健康素养较低的人不太可能参与，尽管围手术期结果通常较差。讨论必须谨慎实施 P康复，以避免扩大不平等。需要更多的研究，既要考虑干预措施的影响，也要了解预康复应如何解释健康的社会决定因素。