{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:40:36Z","timestamp":1787071236951,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Prehabilitation is a proactive strategy aimed at optimizing physical, nutritional, and psychological reserves before initiating cancer treatment. While emerging evidence supports its effectiveness in improving perioperative outcomes in oncology, data specific to gynecologic cancers and low- and middle-income country (LMIC) settings remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A prospective analytical cohort study was conducted at a tertiary care center in North India from July 2023 to April 2025. A total of 183 women with newly diagnosed or suspected gynecological malignancies were assessed prior to treatment. Parameters included performance status (Eastern Cooperative Oncology Group [ECOG]), frailty (Modified Frailty Index-11), nutritional markers (body mass index [BMI], hemoglobin, and albumin), and psychological well-being (Patient Health Questionnaire-9 depression scale). Time taken from presentation to diagnosis was also recorded and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 183 women with gynecologic cancers, cervical (45.9%) and ovarian (33.3%) malignancies predominated. Baseline vulnerabilities were highly prevalent: anemia (76.0%), low BMI (40.4%), hypoalbuminemia (31.1%), high frailty (52.5%), and moderate\u2013severe depression (67.2%). The mean hemoglobin was 10.9 g\/dL, BMI 22.2 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , and albumin 3.73 g\/dL. The mean diagnostic delay was 30.2 \u00b1 7.4 days (range: 12\u201341). On multivariable regression, higher ECOG status (\u03b2 =4.44 days per point,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001), lower albumin (\u03b2 = \u22123.75 days per g\/dL,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001), and higher frailty (\u03b2 =0.38 days per unit,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001) independently predicted longer delays (\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.62). Subgroup analysis confirmed significantly prolonged delays among frail patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A high prevalence of frailty, nutritional risk, and psychological distress was identified among gynecologic oncology patients in this LMIC setting. These domains are interrelated and represent modifiable targets for structured prehabilitation. Future research and policy efforts should prioritize the implementation of cost-effective, multidisciplinary prehabilitation models tailored to resource-constrained environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmh.jmh_241_25","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T07:01:29Z","timestamp":1775199689000},"page":"141-145","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Baseline Vulnerabilities in Women with Gynecologic Cancer: A Case for Prehabilitation in Resource-limited Settings"],"prefix":"10.4103","volume":"17","author":[{"given":"Eshwarya Jessy","family":"Kaur","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Command Hospital, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhijeet","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Command Hospital, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Command Hospital, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod G.","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Army Hospital Research and Referral, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnab","family":"Bandyopadhyay","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Command Hospital, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuri","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Command Hospital, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"R1-20260414","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.soncn.2014.11.003","article-title":"Cancer prehabilitation and its role in improving health outcomes and reducing health care costs","volume":"31","author":"Silver","year":"2015","journal-title":"Semin Oncol Nurs"},{"key":"R2-20260414","first-page":"150","article-title":"Prehabilitation:Setting the stage for recovery","volume":"123","author":"Gillis","year":"2019","journal-title":"Br J Anaesth"},{"key":"R3-20260414","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jamasurg.2019.5474","article-title":"Effect of multimodal prehabilitation 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surgery:A prospective observational study","volume":"33","author":"Lafuenti","year":"2025","journal-title":"Support Care Cancer"},{"key":"R10-20260414","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1200\/JCO.2018.78.8687","article-title":"Practical assessment and management of vulnerabilities in older patients receiving chemotherapy:ASCO guideline for geriatric oncology","volume":"36","author":"Mohile","year":"2018","journal-title":"J Clin Oncol"},{"key":"R11-20260414","doi-asserted-by":"crossref","first-page":"e2181","DOI":"10.1002\/onco.13975","article-title":"The relationship between frailty and emotional health in older patients with advanced cancer","volume":"26","author":"Gilmore","year":"2021","journal-title":"Oncologist"},{"key":"R12-20260414","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1080\/13607863.2014.967174","article-title":"The relationship between depression and frailty syndrome:A systematic review","volume":"19","author":"Buigues","year":"2015","journal-title":"Aging Ment Health"},{"key":"R13-20260414","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/ijgc-2021-003170","article-title":"PROPER-prehabilitation plus enhanced recovery after surgery versus enhanced recovery after surgery in gynecologic oncology:A randomized clinical trial","volume":"32","author":"Lopes","year":"2022","journal-title":"Int J Gynecol Cancer"},{"key":"R14-20260414","doi-asserted-by":"crossref","first-page":"7440","DOI":"10.1007\/s00464-024-11198-8","article-title":"Arandomized controlled clinical trial on multimodal prehabilitation in colorectal cancer patients to improve functional capacity:Preliminary results","volume":"38","author":"Pesce","year":"2024","journal-title":"Surg Endosc"},{"key":"R15-20260414","doi-asserted-by":"crossref","first-page":"7707","DOI":"10.1245\/s10434-025-17589-y","article-title":"Prehabilitation in frail patients undergoing cancer surgery:A systematic 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