Multimodal prehabilitation and adherence to perioperative chemotherapy in localized gastroesophageal adenocarcinoma.

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Background: Perioperative chemotherapy improves survival in resectable gastroesophageal adenocarcinoma (GEA), yet many patients do not complete the intended postoperative component. Multimodal prehabilitation targets modifiable physical, nutritional, and psychosocial factors before surgery. We assessed whether prehabilitation is associated with improved adherence to perioperative chemotherapy. Methods: We conducted a single-center retrospective cohort study of patients with localized gastroesophageal adenocarcinoma treated with perioperative chemotherapy and curative-intent surgery at the McGill University Health Centre from 2007 to 2025. Patients were identified from an institutional registry, the prehabilitation clinic dataset, and the electronic medical record (OACIS). Eligibility required complete treatment and outcome data and neoadjuvant chemotherapy given with intent to deliver a full perioperative course. Multivariable logistic regression evaluated predictors of receipt of adjuvant chemotherapy. We performed a subgroup analysis of patients treated with perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT). The institutional prehabilitation program began in 2022 and included supervised exercise, nutritional optimization, and psychosocial support. Results: We included 258 patients. Twenty-four patients underwent multimodal prehabilitation. In the adjusted analyses, younger age, neutrophil-to-lymphocyte ratio less than 3, and receipt of a regimen that included immunotherapy were independently associated with receipt of adjuvant chemotherapy. In the FLOT subgroup, prehabilitation was not associated with a higher likelihood of receiving adjuvant chemotherapy, but it was associated with higher completion of the preoperative FLOT course (24 of 24, 100%) versus patients without prehabilitation (54 of 64, 84.4%). Conclusions: In this real-world cohort, multimodal prehabilitation was associated with improved completion of preoperative FLOT, but not with receipt of adjuvant therapy. Prospective studies should test whether prehabilitation can increase completion of the full perioperative course and improve outcomes in GEA patients receiving FLOT or other perioperative regimens.