Stakeholder views on integrating prehabilitation in neoadjuvant therapy for breast cancer.

BACKGROUND

Neoadjuvant systemic therapy (NAST) for breast cancer can cause fatigue, neuropathy, and sleep disturbance, affecting treatment adherence and recovery. Early supportive care-including exercise, psychological support, and integrative therapies-may reduce side effects and improve outcomes. However, it remains unclear how best to deliver such care to optimise patient participation and effectiveness. This study explored the perspectives of women with breast cancer and healthcare professionals (HCPs) on the design and delivery of a multimodal supportive care program during NAST.

METHODS

This descriptive qualitative study with conventional content analysis involved 24 participants: 12 women receiving neoadjuvant therapy, one receiving adjuvant therapy, and 11 HCPs across disciplines. Data were analysed thematically to identify key themes related to stakeholder knowledge, experiences, and perceived barriers and facilitators.

RESULTS

Supportive care was viewed by both patients and healthcare professionals as critical to managing treatment-related side effects and maintaining quality of life. Stakeholders emphasised the need for early introduction, tailored delivery within a structured "program" format, and multidisciplinary coordination to support adherence and sustainability. Patients emphasised simplicity and the ability to 'just sign up' early in their treatment journey, ideally at diagnosis, with flexibility to adjust based on readiness.

CONCLUSIONS

Stakeholders viewed early, multimodal supportive care as a valuable strategy to manage treatment-related side effects and enhance recovery. Success depends on programs being flexible but structured ('just sign up'), person-centered, and integrated into the oncology care pathway. Given emerging evidence that exercise during treatment may influence tumour biology and response, these insights can inform the design of interventions that can support both clinical and quality-of-life outcomes of cancer treatment.