Multimodal Prehabilitation Program for Women Undergoing Gynecologic Oncology Surgery

compare the 30 days postoperative morbidity of the prehabilitation and conventional group, it included (Assess the post-operative complications by using Clavien-Dindo classification; from Grade I-IV; higher grades indicate more severe complications.)

compare the 30 days postoperative mortality of the prehabilitation group and conventional group.

compare the 30 days postoperative Pain intensity; Unit of Measure: Units on a scale (0-10 cm).

Scale: 0 = no pain, 10 = worst pain imaginable; higher scores indicate worse pain of the prehabilitation group and conventional group.

compare the days of the hospital stay between the prehabilitation group and conventional group to measure the effect of the intervention program in changing the length of hospital stays (Number of days from surgery until hospital discharge).

• Eastern Cooperative Oncology Group (ECOG) is a performance method used to assess a cancer patient's level of functioning and ability to care for themselves, work, and carry out daily activities. ECOG Performance Status Scale included 5 grades from 0- 5

• Grade 0: Fully active, able to carry all activities without restriction.
• Grade 1: Restricted in physically and able to do light work
• Grade 2: Ambulatory and capable of self-care, but unable to carry out any work activities; up >50% of waking hours.
• Grade 3: Capable of only limited self-care; confined to bed or chair >50% of waking hours.
• Grade 4: Completely disabled; cannot carry on any self-care; totally confined to bed or chair.
• Grade 5: Dead.

• measure the Psychological aspect by using DASS21(Depression, Anxiety, and Stress Scale - 21 items):

. 1- Depression

• Unit of Measure: Units on a scale (0-42).
• Scale: Higher scores indicate worse depression. 2- Anxiety
• Unit of Measure: Units on a scale (0-42).
• Scale: Higher scores indicate worse anxiety. 3- Stress
• Unit of Measure: Units on a scale (0-42).
• Scale: Higher scores indicate worse stress

Nutritional Status measured through the following:

• Nutritional Status - Height/m Description: Patient height measured in meters.
• Nutritional Status - Weight/kg Description: Patient body weight measured in kilograms.

• weight and height combined to report BMI in kg/m^2

Nutritional Status measured through:

• Clinical Signs using Patient-Generated Subjective Global Assessment (PG-SGA): The PG-SGA is a subjective nutritional assessment tool used in oncology; include questions about:

• Weight change (past 1 month and 6 months (increased 0 or decreased 1
• Eating patterns changed over last weeks or months (normal, less than normal, only liquids, very little, etc.)
• Gastrointestinal Symptoms affecting intake (e.g., nausea, vomiting ,pain, diarrhea, etc.)
• Functional capacity& activity (normal activity, reduced, bed/chair bound, etc.) Scoring system of PG-SGA: A)Well-nourished (0-3) B)Moderately malnourished 4-8 C)Severely malnourished more then >9

Cardiopulmonary Fitness measured by use of:

1- 6-Minute Walk Test (6MWT) Distance

• Description: Distance walked in meters.
• Time Frame: Up to 30 days post operatively .

Cardiopulmonary Fitness measured by use of:

• VO2max (calculated): Estimated VO2max in mL/kg/min using the predictive equation from 6MWT distance and BMI.

• Time Frame: up to 30 postoperatively
• Unit of Measure: mL/kg/min.

Cardiopulmonary Fitness measured by use of:

• Fatigue - Visual Analog Scale (VAS) for Fatigue

• Time Frame: Up to 15 days preoperatively -operative.
• Unit of Measure: Units on a scale (0-10 cm).
• Scale: 0 = no fatigue, 10 = worst fatigue imaginable; higher scores indicate worse fatigue.

Cardiopulmonary Fitness measured by use of:

• Dyspnea - Visual Analog Scale (VAS) for Dyspnea

• Description: Breathlessness severity measured by VAS.
• Time Frame: Up to 15 days post-operative.
• Unit of Measure: Units on a scale (0-10 cm).
• Scale: 0 = no breathlessness, 10 = worst breathlessness imaginable; higher scores indicate worse dyspnea.