A growing body of evidence supports prehabilitation in cancer patients, but the findings have been inconsistent. This overview aimed to identify, evaluate and summarise the effect of prehabilitation on the clinical outcomes of cancer patients.

Overview of systematic reviews.

PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and the JBI Evidence Synthesis database (Joanna Briggs Institute, University of Adelaide, Australia; hosted on Ovid) were searched from inception to January 2025. The search was updated in May 2026, and no new articles were included.

We included systematic reviews of randomised controlled trials (RCTs) involving adult cancer patients with a clinically established diagnosis who received prehabilitation interventions prior to surgical treatment. We excluded abstract-only citations, narrative reviews and scoping reviews. Reviews were excluded if ≥50% of the included studies were postoperative interventions, or if preoperative subgroup data could not be extracted.

Two reviewers independently extracted data on participants’ characteristics, types of interventions, outcomes, synthesising methods and pooled anticipated absolute/relative effects for outcomes meta-analysed. Two reviewers assessed methodological quality using the A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) tool and assessed the certainty of evidence for prehabilitation using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Overlap among included systematic reviews was quantified using the corrected covered area (CCA).

Twenty systematic reviews (137 RCTs and 18 941 participants) were included. Low- to moderate-certainty evidence indicated that prehabilitation may improve preoperative physical fitness (eg, 6-minute walk test, preoperative cardiopulmonary function, preoperative lung function), reduce surgical complications and shorten the length of hospital stay. None of the included systematic reviews demonstrated a statistically significant effect on preoperative handgrip strength, 30-day readmission, mortality, anxiety or depression. Findings regarding physical activity and quality of life remained inconsistent. Overlap among included reviews was slight (CCA=4.15%).

Low- to moderate-certainty evidence suggests that prehabilitation may improve preoperative physical fitness, reduce surgical complications and shorten the length of hospital stay in adult cancer patients undergoing surgery, whereas current evidence does not support a beneficial effect on 30-day readmission, mortality, quality of life or psychological status. Given the predominantly low-to-moderate certainty of the evidence and the methodological heterogeneity across the included systematic reviews, these findings should be interpreted with caution. Methodologically robust and transparently reported RCTs and systematic reviews are needed to strengthen the certainty of evidence and to inform clinical implementation of prehabilitation.

CRD 42024533214.

Retinal vein occlusion (RVO), a common retinal vascular disease, is frequently treated with anti-vascular endothelial growth factor (anti-VEGF) agents as first-line therapy. However, anti-VEGF monotherapy lacks neuroprotective effects, primarily targets vascular leakage and neovascularisation, and requires frequent long-term injections that impose substantial economic burdens. Therefore, combined therapeutic strategies that address both vascular pathology and neural damage are being explored. This article describes the protocol for evaluating mecobalamin (a widely used neuroprotective drug) in combination with anti-VEGF for the treatment of macular edema (ME).

The study is a randomised, double-blind, placebo-controlled clinical trial that will enrol 120 patients with RVO from the First Affiliated Hospital of Chongqing Medical University. Participants will be randomly assigned (1:1) to an experimental group and a control group. The experimental group will receive intravitreal injections of conbercept plus oral mecobalamin for 6 months, while the control group will receive the same conbercept regimen plus a placebo for 6 months. All patients will undergo 1 year of follow-up after initial treatment, with visits at 1, 3, 6, 9 and 12 months. The primary outcome is the change in central subfield thickness from baseline to 1 year post initial treatment. Secondary outcomes consist of change in the best-corrected visual acuity from baseline over time, capillary density, cone photoreceptor distribution characteristics, mean light sensitivity and fixation stability, serum vitamin B12 levels, the number of treatments, frequency of injection (times per year), interval time, incidence and severity of adverse events (AEs) and serious AEs. Statistical analyses will use appropriate parametric and non-parametric tests for group comparisons, correlation analyses, and multivariate modelling.

This study has been approved by the Research Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (No. 2025–387-01). The results will be disseminated through conference presentations and publication in peer-reviewed international journals.

NCT07133438.

Postoperative depressive symptoms are common after breast cancer surgery and can adversely affect recovery and quality of life. This multicentre trial aims to determine whether a single intraoperative subanaesthetic dose of esketamine, as an adjunct to antidepressant therapy, improves postoperative depressive outcomes at postoperative day (POD) 30.

This multicentre, prospective, randomised, triple-blind, placebo-controlled trial will enrol 824 women aged 18–80 years with stage I–III breast cancer (American Society of Anesthesiologists physical status I–III) who are scheduled to undergo surgery. Participants will be randomised 1:1 to receive 0.2 mg/kg esketamine or an equivalent volume of normal saline after anaesthesia induction and before surgical incision. The primary outcome is the incidence of depressive symptoms at POD 30, assessed using the Hospital Anxiety and Depression Scale Depression (score ≥8). Secondary outcomes include acute and chronic pain, and anxious symptoms, etc. Primary analysis will use a generalised linear mixed model with a logit link on an intention-to-treat basis.

The study protocol has been formally approved by the institutional ethics committee of the National Cancer Center (Approval No.25/483-5429). Written informed consent will be obtained from all participants prior to enrolment. Results will be disseminated through peer-reviewed journals and international scientific conferences.

ChiCTR2600117573.