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Research Article: Trimodal prehabilitation and psychological outcomes in colorectal cancer surgery: preliminary findings from a single-center randomized trial

Date Published: 2026-07-10

Abstract:
Surgery for colorectal cancer (CRC) entails significant physical and psychological stress. This clinical trial evaluated whether a trimodal prehabilitation program combining exercise, nutritional support, and psychological counseling could reduce anxiety and depression while improving health-related quality of life (HRQoL) within an Enhanced Recovery After Surgery (ERAS) pathway. In this single-blind randomized controlled trial, an interim analysis was conducted on 45 patients undergoing elective CRC surgery, assigned to trimodal prehabilitation ( n =?20) or standard ERAS care ( n =?25). The primary outcome was the longitudinal change in perioperative anxiety severity from baseline (T-4 weeks) to long-term follow-up (T?+?52 weeks post-surgery) assessed via the GAD-7 scale. Secondary outcomes included depressive symptoms (PHQ-9) across five time points (T-4 to T?+?52 weeks), HRQoL (SF-36, EORTC QLQ-C30/CR29), and exploratory correlations between baseline physical performance (6MWT and CPET) and longitudinal psychological trajectories. GAD-7 scores decreased from 6.2?±?5.1 to 2.2?±?3.1 in the intervention group and from 4.7?±?4.8 to 2.9?±?2.8 in controls (between-group p <?0.001). Perceived health improvement (SF-36 “Health Change”) at 52 weeks was 76.6?±?26.6 in the intervention group vs. 74.8?±?29.2 in controls ( p <?0.00001). No significant between-group differences were observed in PHQ-9 scores over time ( p =?0.437). Significant improvements were observed in emotional functioning and cancer-related fatigue domains of the EORTC QLQ-C30 ( p <?0.05). Correlations between physical performance and psychological outcomes were not statistically significant. Trimodal prehabilitation within an ERAS pathway reduces anxiety and improves perceived health status in patients undergoing CRC surgery. Larger multicenter studies are warranted to confirm its effects on depression and long-term outcomes. https://clinicaltrials.gov/study/NCT06443203 , identifier NCT06443203.

Introduction:
Surgery for colorectal cancer (CRC) entails significant physical and psychological stress. This clinical trial evaluated whether a trimodal prehabilitation program combining exercise, nutritional support, and psychological counseling could reduce anxiety and depression while improving health-related quality of life (HRQoL) within an Enhanced Recovery After Surgery (ERAS) pathway.

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