Prehabilitation in Head and Neck Cancer: A Narrative Review

Background: Head and neck cancer (HNC) affects approximately 650,000 individuals annually worldwide. Its treatment frequently leads to significant functional impairments, nutritional deficits, and reduced quality of life. Prehabilitation, defined as a set of interventions delivered between diagnosis and the initiation of treatment, aims to optimize patients' physical, nutritional, and psychological condition to improve treatment tolerance and postoperative outcomes. Aim: This review aims to synthesize current evidence on prehabilitation in patients with HNC, with particular emphasis on multimodal programs and physiotherapy-led interventions. It also identifies research gaps and outlines directions for future clinical implementation. Methods: Narrative review with systematic search according to PRISMA principles was conducted using PubMed, Scopus, and Web of Science, covering the period from 2002 to 2024. Twenty nine studies were included, comprising randomized controlled trials, observational studies, and systematic reviews. Interventions were categorized into physical (including physiotherapy and swallowing exercises), nutritional, and psychosocial components. Outcomes assessed included postoperative complications, length of hospital stay, functional status, and quality of life. Results: Multimodal prehabilitation was associated with reduced complication rates, shorter hospital stays (on average by four days), and improved treatment tolerance. Nutritional interventions helped mitigate the risk of malnutrition, while physical therapy contributed to the preservation of swallowing function. Despite the limited number of studies, consistent positive trends were observed across intervention types. The evidence also suggests potential cost savings, estimated at approximately $18,754 per patient [1] . Conclusions: Prehabilitation is a promising strategy to support functional outcomes in patients undergoing treatment for head and neck cancer. Multimodal approaches show the most benefit and should be further developed and integrated into standard care. Further studies are needed to establish standardized protocols, define optimal timing, and identify patient subgroups most likely to benefit.