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Cancer SurgeryPROPOSE-RCTNCT06788834

Multimodal Prehabilitation in Cancer Surgery

A study testing Multimodal prehabilitation Program in people with Cancer Surgery, run by Università Vita-Salute San Raffaele at 9 sites in Italy.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The PROPOSE RCT is a two-arm randomized controlled trial that will be conducted to test the efficacy of a personalized, multidisciplinary pre-operative prehabilitation program (preventive prehabilitation) to reduce serious complications and facilitate recovery after surgery in high-risk patients. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Cancer Surgery
What is being tested?
Multimodal prehabilitation Program
Could I receive a placebo?
No, everyone receives an active treatment
How many people
400 participants
Where
9 sitesItaly
Study dates
30 Jan 2025to Sep 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Adult patient (age > 18 years);
  • Scheduled for elective major abdominal (including urological), thoracic (including breast) or gynecological cancer surgery;
  • Signed informed consent.

Who cannot join

  • Co-morbid medical, physical, and mental conditions interfering with the ability to complete study procedures, such as:
  • Acute or unstable cardio-respiratory conditions (e.g., unstable angina or symptomatic severe aortic stenosis);
  • Severe/end-stage organ diseases (e.g., cardiac failure NYHA functional classes III-IV, COPD FEV1 <50% pred, end-stage kidney or liver disease);
  • American Society of Anesthesiologists (ASA) physical status classes 4-5;
  • Disabling orthopedic and neuromuscular disease;
  • Psychosis, dementia;
  • Symptomatic anemia with a hemoglobin value < 7 gr/dl.
  • Patients with both optimal functional capacity (a Duke activity status index [DASI] score > 45) and optimal nutritional status (NRS-nutrition screening tool-score < 2).

Trial locations and contacts

9 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Marina LG Pieri, Medical Doctor contact

+393334625052

pieri.marina@hsr.it

9 sites in 1 country

Italy9 sites, 9 recruiting
  • Policlinico Universitario AOU Renato Dulbecco di Catanzaro

    Catanzaro, Italy, 88100

    Eugenio Garofalo, Professor, +393498125841, eugenio.garofalo@gmail.com

    Recruiting
  • AOU Careggi

    Florence, Italy, 50134

    Gabriele Baldini, Professor, +393333196036, gabriele.baldini@unifi.it

    Not yet recruiting
  • Ospedale Galliera di Genova

    Genova, Italy, 16128

    Claudia Brusasco, Doctor, +393291185009, claudia.brusasco@gmail.com

    Not yet recruiting
  • ASSTN GOM Niguarda

    Milan, Italy, 20162

    Monica Gualtierotti, Doctor, +390264447918, monica.gualtierotti@ospedaleniguarda.it

    Not yet recruiting
  • IRCCS Ospedale San Raffaele

    Milan, Milan, 20132

    Marina Pieri, MD, 0226438173 ext. +39, pieri.marina@hsr.it

    Marina Pieri, MD

    Recruiting
  • IRCCS Ospedale San Gerardo dei Tintori

    Monza, Italy, 20900

    Luca C Nespoli, Professor, +393201797391, luca.nespoli@unimib.it

    Not yet recruiting
  • Ospedale Vanvitelli di Napoli

    Naples, Italy, 80129

    Pasquale Sansone, Professor, +393384969395, pasquale.sansone@unicampania.it

    Recruiting
  • AOPD Padova

    Padova, Italy, 35128

    Nicola Passuello, Doctor, +393482245159, nicola.passuello@aopd.veneto.it

    Not yet recruiting
  • Azienda sanitaria universitaria Friuli Centrale (ASU FC)

    Udine, Italy, 33100

    Tiziana Bove, Professor, +393474785763, tiziana.bove@asufc.sanita.fvg.it

    Not yet recruiting

Other trials in Italy

About this study

Official title: Multimodal Prehabilitation in Cancer Surgery PROPOSE Trial (PRehabilitation in Oncological Patients undergOing SurgEry): A Randomized Trial

The PROPOSE RCT is a two-arm randomized controlled trial that will be conducted to test the efficacy of a personalized, multidisciplinary pre-operative prehabilitation program (preventive prehabilitation) to reduce serious complications and facilitate recovery after surgery in high-risk patients.

The multimodal prehabilitation program is a preoperative intervention that includes exercise training, nutritional therapy and anxiety reduction techniques, with the aim of preventing or mitigating the functional decline brought about by surgery. 400 patients scheduled for elective major abdominal (including urological), thoracic (including breast) or gynecological cancer surgery will be enrolled. They will be randomized (1:1 ratio) and assigned either to the intervention group (Prehabilitation) or to the control group, which will only be treated according to the usual standard of care within the Enhanced Recovery After Surgery (ERAS) pathways.

Read the detailed description

The standard treatment for most solid cancer includes surgery and concurrent medical therapies, both of which have been shown to significantly improve prognosis. However, cancer treatments impose impactful physiological stress and have detrimental effects on acute and long-term health outcomes.

Physical, nutritional, and mental status can influence surgical outcomes, functional recovery and quality of life throughout the course of the disease.

The importance of postoperative rehabilitation on physical performance and recovery is well-recognized. However, the preoperative period provides a unique opportunity to address comorbidities and modifiable risk factors. In addition, the metabolic stress induced by neoadjuvant therapy has been documented to frequently result in muscle atrophy and diminished functional capacity. The recognition that selected risk factors of poor postoperative outcome can be modified has prompted clinicians to identify proactive interventions to facilitate the recovery process. In this context, prehabilitation, aimed at enhancing the patients' functional capacity to enable them to withstand the physiological stress of surgery, has emerged as a promising approach. Although the term prehabilitation is not novel, the concept of optimizing patients before acute stressor or treatment has gained attention over the last decade. Nonetheless, quantifiable evidence of its effectiveness has yet to be fully demonstrated.

This study is a multicenter randomized controlled trial to assess the efficacy of personalized procedure-specific prehabilitation programs on patient-centered surgical outcomes. A total of 400 patients will be recruited by systematic screening of patients scheduled for elective surgical procedures. All patients undergoing elective major abdominal (including urological), thoracic (including breast) or gynecological cancer surgery undergoing major cancer surgery will be screened for eligibility and those who meet the inclusion/exclusion criteria will be approached for consent. Research personnel will use a web-based randomization system to assign patients (1:1 ratio) to either the prehabilitation or control arm. Study personnel will also collect data on recruitment rates, with reasons for non-enrolment.

Eligible patients will be randomly assigned to 1 of 2 treatments:

  1. multimodal prehabilitation program for at least three weeks started as soon as possible before surgery;
  2. standard care.

The multimodal prehabilitation program will be individualized by carefully integrating and adapting various components to meet individual needs. The program will last at least three weeks (plus maintenance in case of delayed surgery), and will incorporate exercise training, nutritional therapy, and anxiety reduction techniques. After enrollment, patients will receive initial contact from trained personnel through telemedicine. To ensure personalized care, a comprehensive assessment will be conducted to identify specific physical, nutritional, or psychological challenges. Based on this assessment, a customized intervention plan will be prescribed to achieve tailored exercise training, optimized nutrition, and effective distress-coping strategies. All patients will be reassessed the day before surgery and 30 days after surgery. Based on the data obtained during the multimodal assessment, different domains and levels of care will be prescribed, focusing on exercise training, nutrition optimization, or distress-coping techniques-or a combination of these

Conditions
Cancer Surgery
Being tested
Multimodal prehabilitation Program
Keywords
Prehabilitation, Functional recovery, Relaxation, Exercise, Diet, Nutrition, Functional walking, Hospital stay, Multimodal prehabilitation program, Standard treatment, Anesthesiology
Medical subject headings
Motor Activity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Multimodal prehabilitation ProgramBehavioural

    A tailored intervention will be prescribed if specific physical, nutritional or psychological impairments will be identified during the assessment phase.

    Based on the data obtained during the multimodal assessment, different domains and levels of care will be prescribed, focusing on exercise training, and/or nutrition optimization, and/or distress-coping techniques. Different combinations of three domains will be utilized to maximize their synergistic anabolic effects. The duration of the program will be set at a minimum of three weeks.

Study groups in NCT06788834
Study groupRoleWhat they receive
PrehabilitationExperimentalThe prehabilitation arm group will receive preoperative intervention which includes exercise training, nutritional therapy and anxiety reducing techniques, aimed at preventing or attenuating surgery-driven functional decline. This will be on top of Standard care treatment with application of ERAS pathways (Enhanced Recovery After Surgery).
Receives: Behavioral: Multimodal prehabilitation Program
Control groupNo interventionStandard care treatment with application of ERAS pathways (Enhanced Recovery After Surgery)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Assess the impact of prehabilitation on severe postoperative complications among high-risk patients undergoing oncological surgery

    The proportion of patients experiencing severe postoperative complications within 30 days after surgery defined as grade 3a or greater according to the Clavien-Dindo classification

    Measured: 30 days after surgery

Secondary outcomes (6)
  1. Time to Functional Recovery (TFR)

    Faster return to basal functional preoperative capacity in treatment group

    Measured: 30 days after surgery

  2. Lenght of hospital stay (LOS)

    Reduction of lenght of hospital stay in treatment group

    Measured: 30 days after surgery

  3. Days at home up to 30 days after surgery (DAH-30)

    The mean number of days at home in the first 30 days after surgery will be compared between groups

    Measured: 30 days after surgery

  4. Complication severity

    Assess complication severity as measured by the Comprehensive Complication Index (CCI)

    Measured: 30 days after surgery

  5. Proportion of patients returning to preoperative functional walking capacity

    Improvement in the return to basal functional preoperative capacity

    Measured: 30 days after surgery

  6. Self-reported activity status and generic health related quality of life

    Assess quality of life in the first 30 days at home after surgery using the EuroQol-5 Dimension (EQ-5D-5L) questionnaire, a validated tool for evaluating health-related quality of life. The outcome will be reported as the mean EQ-5D-5L index score and the mean EQ-VAS score measured at 30 days postoperatively.

    Measured: 30 days after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jan 2025
  2. Study start30 Jan 2025
  3. Primary completionAug 2026 (estimated)
  4. Study completionSep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
400 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06788834
Sponsor's protocol ID
PNRR-MCNT2-2023-12378183
Acronym
PROPOSE-RCT
Status last verified
Aug 2025
First submitted
17 Jan 2025
Last updated
7 Aug 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Colado JC, Pedrosa FM, Juesas A, Gargallo P, Carrasco JJ, Flandez J, Chupel MU, Teixeira AM, Naclerio F. Concurrent validation of the OMNI-Resistance Exercise Scale of perceived exertion with elastic bands in the elderly. Exp Gerontol. 2018 Mar;103:11-16. doi: 10.1016/j.exger.2017.12.009. Epub 2017 Dec 17.

    PubMed 29262307
  • Levett DZH, Jack S, Swart M, Carlisle J, Wilson J, Snowden C, Riley M, Danjoux G, Ward SA, Older P, Grocott MPW; Perioperative Exercise Testing and Training Society (POETTS). Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth. 2018 Mar;120(3):484-500. doi: 10.1016/j.bja.2017.10.020. Epub 2017 Nov 24.

    PubMed 29452805
  • Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev. 2022 May 19;5(5):CD013259. doi: 10.1002/14651858.CD013259.pub2.

    PubMed 35588252
  • Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil. 2013 Aug;92(8):715-27. doi: 10.1097/PHM.0b013e31829b4afe.

    PubMed 23756434
  • Lemanne D, Cassileth B, Gubili J. The role of physical activity in cancer prevention, treatment, recovery, and survivorship. Oncology (Williston Park). 2013 Jun;27(6):580-5.

    PubMed 23909073
  • Carli F. Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response. Can J Anaesth. 2015 Feb;62(2):110-9. doi: 10.1007/s12630-014-0264-0. Epub 2014 Dec 12.

    PubMed 25501695

Questions about this trial

What is this clinical trial studying?

A study testing Multimodal prehabilitation Program in people with Cancer Surgery, run by Università Vita-Salute San Raffaele at 9 sites in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 7 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Marina LG Pieri, Medical Doctor (+393334625052, pieri.marina@hsr.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Assess the impact of prehabilitation on severe postoperative complications among high-risk patients undergoing oncological surgery (time frame: 30 days after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06788834, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Aug 2025.

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