A lifestyle intervention before surgery improves outcomes for women with ovarian, uterine, or vulvar cancer. This is the key finding of the PhD research conducted by Joëlle Dhanis at Radboud university medical center. Women who worked on their physical fitness, nutrition, and mental well-being prior to surgery experienced fewer complications and recovered more quickly after their procedures.
Approximately 4,500 women in the Netherlands are diagnosed with ovarian, uterine, or vulvar cancer each year. The incidence of these forms of gynecological cancer is rising, with unhealthy lifestyle habits being one of the contributing factors. Overweight and obesity, physical inactivity, poor dietary habits, smoking, and alcohol consumption all increase the risk of developing these and other types of cancer.
An unhealthy lifestyle not only increases the risk of developing cancer, but can also affect how well patients recover from surgery. For most women with a gynecological tumor, surgery is an essential part of treatment. Poor physical fitness, inadequate nutrition, and smoking are associated with a higher risk of complications, including infections and delayed wound healing.
Preparing for surgery
To investigate whether recovery after surgery could be improved, PhD candidate Joëlle Dhanis examined the effects of a lifestyle intervention before surgery, known as prehabilitation. The program provided approximately three weeks of support prior to surgery. In total, 180 women participated in supervised strength and endurance training sessions three times a week under the guidance of a physiotherapist. They also received nutritional counselling from a dietitian, with particular attention to adequate protein intake. Participants who required additional support were offered psychological counselling, while women who smoked were enrolled in a smoking cessation program.
Fewer complications
Dhanis' research demonstrates that prehabilitation leads to better surgical outcomes. Among women who participated in the program, 27% experienced a postoperative complication, compared with 37% in the group that received standard care without prehabilitation. The largest improvement was seen in wound-related complications. Women who had worked on their fitness, nutrition, and mental well-being before surgery were less likely to experience wound problems following their procedure. ‘For patients, this makes a tremendous difference,’ says Dhanis. ‘A wound infection can result in additional hospital visits, prolonged recovery, and considerable discomfort.’
PhD-candidate Joëlle Dhanis.
Extending the benefits beyond the patient
As part of her research, Dhanis interviewed participants about their experiences with the lifestyle program. Many expressed a desire to continue receiving support after surgery. ‘That is important, because the benefits of a healthy lifestyle do not end after the operation,’ says Hanny Pijnenborg, Professor of Gynecological Oncology at Radboudumc. ‘By adopting healthier habits, participants invest not only in their own health but can also positively influence their partners, family members, and friends. Healthy behaviors are often adopted by those around them, helping to reduce the risk of cancer and chronic disease more broadly.’
Towards personalized prehabilitation
In the study, all participants received the same combination of interventions. The next step is to determine which forms of support are most effective for different patient groups. ’Not every woman has the same needs or risk profile,’ says Dhanis. ‘With better screening before treatment, we hope to offer personalized prehabilitation programs in the future. This will help ensure that women are as fit as possible when they undergo surgery, reducing the risk of complications and enabling a faster recovery.’
At Radboudumc, the prehabilitation program has already been incorporated into standard care for women with gynecological cancer. ‘Ultimately, we aim to expand this approach to other treatments, including radiotherapy and chemotherapy, and to incorporate it into national clinical guidelines,’ says Pijnenborg. ‘By doing so, we can reduce treatment-related complications for women with gynecological cancer on a broader scale.’
About the PhD defense
Defense on 27 August 2026, at 10:30 by Joëlle Dhanis. Dissertation title: Ready – Fit – Go. Prehabilitation for Women undergoing Surgical Treatment of Gynaecological Cancer (online available after 27 August). Supervisors: Prof. dr. C.J.H.M. van Laarhoven en prof. dr. J.M.A. Pijnenborg. C-supervisors: dr. B. van den Heuvel en dr. A. Smits. The defense can be followed via this livestream.
Dhanis' research forms part of the broader F4S PREHAB Trial, a Radboudumc initiative that is implementing prehabilitation across multiple clinical care pathways.
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