Supplementary table i: Study characteristics

Study ID / Participamts / Intervention(s) / Usual care / Outcomes assessed / Quality score
Prostate cancer
Burgio 2006 [21] / Prostate cancer (awaiting radical prostatectomy) / N=63
(N=51 at final follow-up; reasons for loss to follow-up not reported)
Definition:
Pelvic floor muscle training (PFMT) and biofeedback
Initiation:
Pre-surgery
Content:
  • One session of biofeedback with PFMT
  • Daily pelvic floor exercises (45 exercises, 3 sessions to build up gradually to 10 sessions)
/ N=62
(N=51at final follow-up; reasons for loss to follow-up not reported)
Brief verbal instructions at postoperative visit / Post-intervention
  • Seven-day bladder diary
  • Use of incontinence pads
  • Time to continence
Six-week, three- and six-month follow-up
  • Bladder control
  • Lifestyle issues
  • Health status
  • Distress
  • Incontinence impact
/ High risk of bias
Centemero 2010 [28] / Prostate cancer (awaiting radical prostatectomy) / N=59
(no losses to follow-up)
Definition:
PFMT
Initiation:
30-days pre-surgery
Content:
  • PFMT exercises, visual biofeedback and verbal instruction and reinforcement.
  • Twice supervised per week (30minutes) and daily at home (30minutes) for 48-hours after catheter removal until continence was achieved.
/ N=59
(no losses to follow-up)
PFMT to be undertaken post-operatively as part of standard care / One- and three-months post-surgery
  • Self-reported continence.
  • Degree of urinary incontinence
  • Satisfaction with preoperative PFMT
/ Low risk of bias
Parekh 2003 [16] / Prostate cancer (awaiting radical prostatectomy) / N=19
(n=1 loss to follow-up, no reason reported)
Definition:
PFMT
Initiation:
Pre-surgery
Content:
  • Physical therapy and pelvic floor muscle training.
  • Education in pelvic floor muscle awareness.
  • Two sessions prior to surgery
  • Every three-weeks post-surgery up to three-months
  • Up to six-months or more at home post-surgery
/ N=19 enrolled
(N=1 loss to follow-up, no reason reported)
Usual care / Six-, 12-, 16-, 20-, 28- and 52-weeks post-operation
  • Urinary continence
  • Frequency of daily pad use.
  • Median time to continence
/ High risk of bias
Parker 2009 [13] / Prostate cancer patients (awaiting radical prostatectomy) / Group 1: Stress Management
N=53 enrolled
(n=38 at final follow-up; reasons for loss to follow-up reported)
Initiation:
One to two weeks prior to surgery
Content:
  • Guided manual
  • Two 60-90minute individual sessions with a clinical psychologist.
  • Training in relaxationand problem-focused coping skills.
  • Information about prostate cancer, surgery and management of effects.
  • Two booster sessions
Group 2: Supportive attention
N=54 enrolled
(N=45 available at follow-up; reasons for loss to follow-up reported)
Initiation:
One to two weeks prior to surgery
Content:
  • Two 60-90minute sessions with a clinical psychologist who undertook a detailed psychosocial and medical history with participants.
  • Two booster sessions
/ N=52 enrolled
(N=44 available at follow-up; reasons for loss to follow-up reported)
Usual care / One-week pre-surgery, morning of surgery. six-weeks, six- and 12-months post-surgery
  • Mood disturbance
One-week pre-surgery, six-weeks, six- and 12-months post-surgery
  • Impact of events
Six-weeks, six- and 12-months post-surgery
  • Quality of life
/ High risk of bias
Tienforti 2011 [19] / Patients with localised prostate cancer awaiting radical prostatectomy / N=17 enrolled
(n=16 available at follow-up, reasons for follow-up reported)
Definition:
PFMT
Initiation:
One-day pre-surgery
Content:
  • One supervised PFMT and biofeedback session with a dedicated caregiver
  • Written and oral instructions on PF muscle contractions
  • Structured programme of exercises
/ N=17 enrolled
(N=16 available at follow-up, reasons for drop-out reported)
Standard care- verbal and written instruction on PFMT after catheter removal / IV group assessed at each monthly visit post-catheter removal and controls at one-, three- and six-months post-catheter removal
  • Urinary function/symptoms
  • Impact of continence
Six-months post-catheter removal
  • Frequency of incontinence episodes per week
  • Weekly pad use
/ Moderate risk of bias
Cohen 2011 [14] / Prostate cancer patients (awaiting radical prostatectomy) / Same as Parker 2009 [13] / Same as Parker 2009 [13] / 48hours post-surgery
  • Immunological markers
/ High risk of bias
Lung cancer
Benzo 2011a [12] / Lung cancer (resectable) and moderate/severe COPD / N=5
(No losses to follow-up)
Definition:
Pulmonary rehabilitation
Initiation:
Pre-surgery
Content:
  • Exercise guidelines according to American Thoracic Society
  • Four weeks, three times per week (two supervised; one unsupervised)
/ N=4
(no losses to follow-up)
Usual care /
  • Hospital length of stay
  • Post-operative pulmonary complications
  • Severe atelectasis
  • Prolonged chest intubation
  • Prolonged mechanical ventilation
/ High risk of bias
Benzo 2011b [12] / Lung cancer (resectable) and moderate/severe COPD / N=10
(1 loss to follow-up, person found to be non-resectable during surgery)
Definition:
Pulmonary rehabilitation
Initiation:
Pre-surgery
Content:
  • Lower extremity endurance exercises, strength exercises
  • IMT, slow breathing and walking
  • Five days
  • Ten face to face sessions, two daily
/ N=9
(1 loss to follow-up, person found to be non-resectable during surgery)
Usual care /
  • Hospital length of stay
  • Post-operative pulmonary complications Severe atelectasis
  • Prolonged chest tubes
/ High risk of bias
Lai 2016 [17] / Non-small cell lung cancer (awaiting surgery) / N= 30
(4 lost to follow-up, reasonsinclude not able to undertake endurance training)
Definition:
Exercise-based prehabilitation
Initiation:
Pre-surgery
Content:
  • Twodaily 15-20 minute sessions of abdominal breathing
  • Threedaily 15-20 minute sessions of expiration exercise
  • One daily 30-minute session of aerobic endurance training.
/ N=30
(no losses to follow-up)
Usual care /
  • 30-day post-operative pulmonary complications
  • Quality of life and patient symptoms
  • Functional ability
  • Pulmonary function
/ High risk of bias
Licker (2016) [18] / Lung cancer stage I-IIIa (awaiting surgery) / N=83 enrolled
(losses to follow-up withdrawal n=3 and operation cancelled n=3)
Definition: Exercise- High Intensity Interval Training
Initiation: time pre-surgery not specified
Content: Supervised cycling ergometer sessions. Five-minute warm-up at 50% peak work rate. Two 10 minute sets alternate 15-seconds intervals of sprint at 80-100% peak work rate and pause. Four-minute rest period between sets. Five-minute cool-down at 30% peak work rate. Individualised additional exercises added. Risk management and active mobilisation (30-minute daily walking) advised.
Duration: Supervised cycling ergometer sessions 2-3 times per week pre-surgery only. / N=81
(losses to follow-up withdrawal n=5 and operation cancelled n=2)
Risk management and active mobilisation (30-minute daily walking) advised. /
  • Composite morbidity score
  • Cardiopulmonary function
  • Post-operative pulmonary complications
  • Functional ability
  • Length of stay in post-anaesthetic care unit
  • Admission to intensive care unit
/ High risk of bias
Pehlivan 2011 [22] / Operable lung cancer (stages Ia-IIIb) without major cardiac morbidity / N=30
(no losses to follow-up)
Definition:
Intensive physical therapy
Initiation:
One-week prior to surgery
Content:
  • Breathing exercises
  • Walking on a treadmill three-times a day and encouraged to walk other times of the day.
/ N=30
(no losses to follow-up)
Usual care /
  • Length of hospital stay (days)
  • Perfusion distribution
  • Pulmonary function
  • Heart rate
  • Recovery rate
  • Distance walked
  • Dyspnea
  • Post-operative complications
/ High risk of bias
Stefanelli 2013 (25) / Non-small cell lung cancer (stages I-IIa) with COPD less than 75-years old / N in each arm not reported
Definition:
Pulmonary Rehabilitation Program
Initiation:
Three-weeks pre-operation
Content:
  • Respiratory exercises
  • Upper limb exercises
  • Lower limb exercises
  • Fifteen, one-hour sessions (three times a day)
/ N in each arm not reported
Standard care / End of PRP (before surgery) and 60-days post-surgery
  • Respiratory function
  • Dyspnea
  • Physical performance
/ High risk of bias
Wall 2000 (26) / Non-small cell lung cancer (stages I-IIIa) / N=49 completed the study
(reasons for loss to follow-up reported)
Definition:
Exercise
Initiation:
Pre-surgery
Content:
  • Written and practical instruction of exercises.
  • Sniff and blow breathing exercises, arm-, leg-, walking- and stairclimbing- exercises
  • Between one and 20 days
/ N=48 completed the study
(reasons for loss to follow-up reported)
Usual care / Seven to ten days pre-surgery at time of diagnosis (T1), day before surgery and completion of IV (T2), four to six days post-surgery:
  • Hope
  • Empowerment
/ High risk of bias
Breast cancer
Burton 1995 [23] / Breast cancer (awaiting full or partial mastectomy) / Group 1: Interview and psychotherapeutic intervention
N=51
(n=45 at one-year follow-up; reasons for loss to follow-up not fully known)
Initiation:
Day pre-surgery
Content:
  • Pre-operation interview (45 mins)
  • Psychotherapeutic intervention (30mins: situate current illness and surgery within current life to explore feelings)
Group 2: Interview and ‘chat’ (to control for attention)
N=57
(n=46 at one-year follow-up; reasons for loss to follow-up not fully known)
Initiation:
Day pre-surgery
Content:
  • Pre-operation interview (same as above).
  • Chat (hobbies and holidays).
Group 3: Interview
N=46
(n=46 at one-year follow-up)
Initiation:
Day pre-surgery
Content:
  • Pre-operation interview (same as above).
/ N=53
(n=46 at one-year follow-up; reasons for loss to follow-up not fully known)
Usual care / Four-days post-surgery
  • Anxiety
  • Depression
Three-months post-surgery
  • Anxiety
  • Depression
  • Body image distress
One-year follow-up
  • Cancer-related distress
  • Morbidity
  • Coping styles
  • Worry
  • Quality of life
  • Body image distress
  • Stressful life events.
/ High risk of bias
Cho 2013 [20] / Breast cancer (stage II-III) awaiting complete or partial mastectomy / Group 1: Papilla gown and education
N=45
(N=15 at six-months follow-up; reasons for loss to follow-up reported)
Initiation:
Pre-surgery
Content:
  • Papilla Gown given, along with instructions on how to wear it.
  • Education- teaching standard arm exercises (40-minutes personal education sessions)
Group 2: Education
N=46 (N=12 at six-month follow-up; reasons for loss to follow-up reported)
Initiation:
One-week pre-surgery
Content:
  • Education (as above)
Group 3: Papilla gown
N=46
(N=13 at six-month follow-up; reasons for loss to follow-up reported)
Initiation:
Post-surgery
Content:
  • As above
All participants in the treatment groups received a pictorial handbook, Care after Surgery for Breast Cancer. / N=46
(N=13 at six-months follow-up; reasons for loss to follow-up reported)
Standard hospital gown / One-week and six-months post-surgery
  • Post-mastectomy activity
  • Body image
  • Post-mastectomy gown comfort
  • Breast cancer knowledge
Six-months post-surgery
  • Lymphedema
/ High risk of bias
Garssen 2013 [29] / Breast cancer patients (awaiting surgery) / N=42 enrolled
(N=34 included in analysis; reasons for losses to follow-up reported)
Definition: Stress Management Training
Initiation:
Five-day prior to surgery
Content:
  • Four sessions (Two sessions pre-surgery; Two post-surgery- 45-60minutes each) of relaxation and guided imagery techniques and counseling
  • Delivered by a clinical psychologist.
/ N=43
(N=36 included in analysis; reasons for loss to follow-up reported)
Usual care / Days six and one pre-surgery, days two, five, 30 and 90 post-surgery
  • Anxiety
  • Depression
  • Quality of life
  • Wellbeing
  • Perception of control
  • Fatigue
  • Sleep disturbances
  • Satisfaction with intervention
/ High risk of bias
Larson 2000 [27] / Breast cancer patients (awaiting surgery) / N=23 enrolled
(no losses to follow-up)
Definition:
Psychosocial intervention
Initiation:
Pre-surgery
Content:
  • Two 90-min intervention sessions conducted individually or in small groups led by clinical psychologists.
  • Discussion of the emotional impact of their diagnosis and impending surgery and educated about stress.
  • Progressive muscle relaxation and led through an exercise.
  • Each patient was given a cassette recording of this exercise to practice the exercise twice daily.
/ N=18 enrolled
(no losses to follow-up)
Standard care / Post-IV (one to three days prior to surgery) and one-week post-surgery
  • Depression
  • Impact of events
  • Global optimism
  • Quality of life
  • Immunological markers
/ High risk of bias
Bladder cancer
Jensen 2014 [24] / Invasive muscle or high risk non-invasive muscle bladder cancer patients scheduled for radical cystectomy / N=65 enrolled
(n=47 completed, reasons for loss to follow-up were documented)
Definition:
Exercise-based prehabilitation programme
Initiation:
14-days pre-surgery
Content:
  • Standardised fast track surgery principles.
  • Programme included endurance and strength exercises. A step-trainer was provided.
/ N=64 enrolled
(N=53 available at follow-up; reason for losses to follow-up documented)
Standardised fast track surgery principles /
  • Physical activity
  • Personal ADLs
  • Habitual bowel function
  • Time to restored bowel function
  • Pain and nausea
  • Early complications -less than 90 days post-operation
  • Death (cause)
  • Readmission (Within 30 days)
/ Moderate risk of bias
Multiple cancer sites
Purcell 2011 [15] / Cancer patients set to receive at least 20 days of radiotherapy aged over 18-years old / Group 1: Pre- and Post-Radiotherapy Cancer-related Fatigue Intervention Trial (CAN-FIT)
N=27 enrolled in study
(N=21 available at final follow-up, reasons for losses to follow-up reported)
Initiation:
One-week prior to radiotherapy
Content:
  • Based on Health Belief Model.
  • Participant handbook, goal setting and progress diary.
  • Session content: what is radiotherapy and its processes, side effects of treatment including fatigue
  • Behavioural strategies to combat fatigue
Group 2: Pre-radiotherapy only CAN-FIT
N=28 enrolled in study
(N=24 available at final follow-up, reasons for losses to follow-up reported)
Initiation:
One to two-weeks pre-radiotherapy
Content:
  • see above
Group 3: Post-radiotherapy only CAN-FIT
N=27 enrolled in study
(N=22 available at final follow-up, reasons for losses to follow-up reported)
Initiation:
Post-radiotherapy
Content:
  • see above
/ N=28 enrolled at beginning of study
(N=24 available at final follow-up, reasons for follow-up reported)
Face-to-face education delivered by a nurse about the radiotherapy process and patient-specific diagnosis and generic one-page flyer regarding fatigue / Post-radiotherapy and six-weeks post-radiotherapy
  • Fatigue
  • Quality of life
  • Physical activity
  • Anxiety
  • Depression
  • Sleep disturbances
  • Employment
/ Low risk of bias

ADLs= Activities of Daily Living, CAN-FIT= Cancer Fatigue Intervention Trial, COPD= Chronic Obstructive Pulmonary Disease, IMT= Inspiratory Muscle Training, IV= Intervention, N= number, PFMT= Pelvic Floor Muscle Training, PRP=pulmonary rehabilitation programme, T= Time-point