Technology-enabled (p)rehabilitation for patients undergoing cancer surgery: A systematic review and meta-analysis

Tiffany R Tsoukalas; Zirong Bai; Claire Jeon; Roy Huynh; Eva Gu; Kate Alexander; Paula R Beckenkamp; Adrian Boscolo; Kilian Brown; Phyllis Butow; Sharon Carey; Fang Chen; Meredith Cummins; Haryana M Dhillon; Vesna Dragoje; Kailey Gorman; Matthew Halpin; Abby Haynes; Ilona Juraskova; Sascha Karunaratne; Jamie Keck; Bora Kim; Cherry Koh; Qiang Li; Lara Lipton; Xiaoqiu Liu; Jaime Macedo; Rebecca Mercieca-Bebber; Renee Moreton; Rachael L Morton; Julie Redfern; Bernhard Riedel; Angus Ritchie; Charbel Sandroussi; Cathy Slattery; Allan Ben Smith; Michael Solomon; Flora Tao; Kate White; Kate Wilson; Kahlia Wolsley; Kun Yu; Daniel Steffens

doi:10.3390/cancers18020296

Technology-enabled (p)rehabilitation for patients undergoing cancer surgery: A systematic review and meta-analysis

Tiffany R Tsoukalas
, Zirong Bai
, Claire Jeon
, Roy Huynh
, Eva Gu
, Kate Alexander
, Paula R Beckenkamp
, Adrian Boscolo
, Kilian Brown
, Phyllis Butow
, Sharon Carey
, Fang Chen
, Meredith Cummins
, Haryana M Dhillon
, Vesna Dragoje
, Kailey Gorman
, Matthew Halpin
, Abby Haynes
, Ilona Juraskova
, Sascha Karunaratne

Jamie Keck, Bora Kim, Cherry Koh, Qiang Li, Lara Lipton, Xiaoqiu Liu, Jaime Macedo, Rebecca Mercieca-Bebber, Renee Moreton, Rachael L Morton, Julie Redfern, Bernhard Riedel, Angus Ritchie, Charbel Sandroussi, Cathy Slattery, Allan Ben Smith, Michael Solomon, Flora Tao, Kate White, Kate Wilson, Kahlia Wolsley, Kun Yu, Daniel Steffens

Research output: Contribution to journal › Review article › Research › peer-review

Abstract

Background/Objectives:
(P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery.

Methods:
Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis.

Results:
Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95% CI: 0.59-2.07; seven trials), and improvements in pain (MD = 6.12; 95% CI: 3.40-8.84; four trials), depression (MD = 2.82; 95% CI: 0.65-4.99; five trials), fatigue (MD = 10.10; 95% CI: 6.97-13.23; three trials) and distress (MD = 1.23; 95% CI: 0.30-2.16; single trial) compared with controls.

Conclusions:
Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies.

Original language	English
Article number	296
Pages (from-to)	1-33
Number of pages	33
Journal	Cancers
Volume	18
Issue number	2
DOIs	https://doi.org/10.3390/cancers18020296
Publication status	Published - 18 Jan 2026
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.3390/cancers18020296Licence: CC BY

Technology-enabled (p)rehabilitation for patients undergoing cancer surgery A systematic review and meta-analysisFinal published version, 1.76 MBLicence: CC BY

Cite this

Tsoukalas, T. R., Bai, Z., Jeon, C., Huynh, R., Gu, E., Alexander, K., Beckenkamp, P. R., Boscolo, A., Brown, K., Butow, P., Carey, S., Chen, F., Cummins, M., Dhillon, H. M., Dragoje, V., Gorman, K., Halpin, M., Haynes, A., Juraskova, I., ... Steffens, D. (2026). Technology-enabled (p)rehabilitation for patients undergoing cancer surgery: A systematic review and meta-analysis. Cancers, 18(2), 1-33. Article 296. https://doi.org/10.3390/cancers18020296

@article{f73e7e3a9441448ba4467bb3bd75a133,

title = "Technology-enabled (p)rehabilitation for patients undergoing cancer surgery: A systematic review and meta-analysis",

abstract = "Background/Objectives: (P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery. Methods: Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis. Results: Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95\% CI: 0.59-2.07; seven trials), and improvements in pain (MD = 6.12; 95\% CI: 3.40-8.84; four trials), depression (MD = 2.82; 95\% CI: 0.65-4.99; five trials), fatigue (MD = 10.10; 95\% CI: 6.97-13.23; three trials) and distress (MD = 1.23; 95\% CI: 0.30-2.16; single trial) compared with controls. Conclusions: Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies.",

author = "Tsoukalas, \{Tiffany R\} and Zirong Bai and Claire Jeon and Roy Huynh and Eva Gu and Kate Alexander and Beckenkamp, \{Paula R\} and Adrian Boscolo and Kilian Brown and Phyllis Butow and Sharon Carey and Fang Chen and Meredith Cummins and Dhillon, \{Haryana M\} and Vesna Dragoje and Kailey Gorman and Matthew Halpin and Abby Haynes and Ilona Juraskova and Sascha Karunaratne and Jamie Keck and Bora Kim and Cherry Koh and Qiang Li and Lara Lipton and Xiaoqiu Liu and Jaime Macedo and Rebecca Mercieca-Bebber and Renee Moreton and Morton, \{Rachael L\} and Julie Redfern and Bernhard Riedel and Angus Ritchie and Charbel Sandroussi and Cathy Slattery and Smith, \{Allan Ben\} and Michael Solomon and Flora Tao and Kate White and Kate Wilson and Kahlia Wolsley and Kun Yu and Daniel Steffens",

year = "2026",

month = jan,

day = "18",

doi = "10.3390/cancers18020296",

language = "English",

volume = "18",

pages = "1--33",

journal = "Cancers",

issn = "2072-6694",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "2",

}

Tsoukalas, TR, Bai, Z, Jeon, C, Huynh, R, Gu, E, Alexander, K, Beckenkamp, PR, Boscolo, A, Brown, K, Butow, P, Carey, S, Chen, F, Cummins, M, Dhillon, HM, Dragoje, V, Gorman, K, Halpin, M, Haynes, A, Juraskova, I, Karunaratne, S, Keck, J, Kim, B, Koh, C, Li, Q, Lipton, L, Liu, X, Macedo, J, Mercieca-Bebber, R, Moreton, R, Morton, RL, Redfern, J, Riedel, B, Ritchie, A, Sandroussi, C, Slattery, C, Smith, AB, Solomon, M, Tao, F, White, K, Wilson, K, Wolsley, K, Yu, K & Steffens, D 2026, 'Technology-enabled (p)rehabilitation for patients undergoing cancer surgery: A systematic review and meta-analysis', Cancers, vol. 18, no. 2, 296, pp. 1-33. https://doi.org/10.3390/cancers18020296

TY - JOUR

T1 - Technology-enabled (p)rehabilitation for patients undergoing cancer surgery: A systematic review and meta-analysis

AU - Tsoukalas, Tiffany R

AU - Bai, Zirong

AU - Jeon, Claire

AU - Huynh, Roy

AU - Gu, Eva

AU - Alexander, Kate

AU - Beckenkamp, Paula R

AU - Boscolo, Adrian

AU - Brown, Kilian

AU - Butow, Phyllis

AU - Carey, Sharon

AU - Chen, Fang

AU - Cummins, Meredith

AU - Dhillon, Haryana M

AU - Dragoje, Vesna

AU - Gorman, Kailey

AU - Halpin, Matthew

AU - Haynes, Abby

AU - Juraskova, Ilona

AU - Karunaratne, Sascha

AU - Keck, Jamie

AU - Kim, Bora

AU - Koh, Cherry

AU - Li, Qiang

AU - Lipton, Lara

AU - Liu, Xiaoqiu

AU - Macedo, Jaime

AU - Mercieca-Bebber, Rebecca

AU - Moreton, Renee

AU - Morton, Rachael L

AU - Redfern, Julie

AU - Riedel, Bernhard

AU - Ritchie, Angus

AU - Sandroussi, Charbel

AU - Slattery, Cathy

AU - Smith, Allan Ben

AU - Solomon, Michael

AU - Tao, Flora

AU - White, Kate

AU - Wilson, Kate

AU - Wolsley, Kahlia

AU - Yu, Kun

AU - Steffens, Daniel

PY - 2026/1/18

Y1 - 2026/1/18

N2 - Background/Objectives: (P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery. Methods: Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis. Results: Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95% CI: 0.59-2.07; seven trials), and improvements in pain (MD = 6.12; 95% CI: 3.40-8.84; four trials), depression (MD = 2.82; 95% CI: 0.65-4.99; five trials), fatigue (MD = 10.10; 95% CI: 6.97-13.23; three trials) and distress (MD = 1.23; 95% CI: 0.30-2.16; single trial) compared with controls. Conclusions: Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies.

AB - Background/Objectives: (P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery. Methods: Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis. Results: Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95% CI: 0.59-2.07; seven trials), and improvements in pain (MD = 6.12; 95% CI: 3.40-8.84; four trials), depression (MD = 2.82; 95% CI: 0.65-4.99; five trials), fatigue (MD = 10.10; 95% CI: 6.97-13.23; three trials) and distress (MD = 1.23; 95% CI: 0.30-2.16; single trial) compared with controls. Conclusions: Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies.

U2 - 10.3390/cancers18020296

DO - 10.3390/cancers18020296

M3 - Review article

C2 - 41595215

SN - 2072-6694

VL - 18

SP - 1

EP - 33

JO - Cancers

JF - Cancers

IS - 2

M1 - 296

ER -

Technology-enabled (p)rehabilitation for patients undergoing cancer surgery: A systematic review and meta-analysis

Abstract

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