Multimodal Prehabilitation for Cystectomy Using the Comprehensive Geriatric Assessment: Design and Implementation

Purpose: This study describes the design and implementation of a multimodal prehabilitation program for patients undergoing radical cystectomy, utilizing the comprehensive geriatric assessment (CGA) to identify and address preoperative impairments. It also characterizes baseline patient findings obtained through the CGA.Materials and Methods: We describe a multimodal prehabilitation program within the Department of Supportive Oncology at Atrium Health Levine Cancer, a large academic hybrid cancer center in United States. Patients with bladder cancer scheduled for radical cystectomy were referred by the genitourinary oncology team at least 2 weeks before surgery and underwent baseline evaluation using the CGA. Tailored interventions were subsequently implemented to address vulnerabilities identified during the assessment.Results: Between February 2022 and January 2024, 142 patients undergoing cystectomy were offered prehabilitation; 54 (38%) enrolled, and an additional 4 completed the program before its formal launch. Assessments were performed either in person or virtually. At baseline, 64% of participants were classified as intermediate frail or frail; 40% screened positive for cognitive impairment, and 57% were either malnourished or at risk of malnutrition. All patients received individualized exercise prescriptions based on their frailty phenotype (fit, intermediate frail, or frail). Referrals were made to an exercise specialist, registered dietitian, or counselor, depending on identified needs.Conclusion: The use of the CGA facilitated the implementation of a multimodal prehabilitation program for patients undergoing radical cystectomy. High rates of preoperative frailty, cognitive impairment, and nutritional risk were observed, allowing targeted interventions before surgery. While the program demonstrated successful integration and participation, future efforts should focus on standardizing intervention delivery and adherence monitoring to assess the objective impact of prehabilitation on postoperative outcomes.