Systematic review of the efficacy of pre and post-habilitation interventions in radical cystectomy pathways on health related quality of life and physical function.

Radical cystectomy (RC) is the first line treatment when patients are diagnosed with muscle invasive bladder cancer (MIBC), which includes T2-T4aN0M0 or high grade non-MIBC. RC is a highly complex procedure and includes removal of the bladder together with the prostate and seminal vesicle in me, and anterioer vaginal wall, uterus and adnexae in women and extended lymph node dissection and subsequently establishment of a urinary diversion. The procedure is associated with a high rate of postoperative morbidity and at least one
complication experienced in 60% of the patients within 90 days post-surgery. The population is characterized by a mean age of 68 years and a high comorbidity index. Preoperatively approximately 27% of the patients
are at severe nutritional risk, 70% are former smokers, wheras 30% are current smokers. Across Europe 30 -40 % have undergone neoadjuvant chemotherapy if tolerated. In total the candidates for RC are considered frail.The increased clinical interest in systematic prehabilitation interventions (including nutritional and physical optimisation, smoking/alcohol cessation, psycho-social support) on health related quality of life and objective functional outcomes are not clearly understood in the exiting evidence base.