TY - JOUR
T1 - Multimodal Prehabilitation During Neoadjuvant Therapy Prior to Esophagogastric Cancer Resection
T2 - Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass and Quality of Life—A Pilot Randomized Clinical Trial
AU - Allen, Sophie K.
AU - Brown, Vanessa
AU - White, Daniel
AU - King, David
AU - Hunt, Julie
AU - Wainwright, Joe
AU - Emery, Annabelle
AU - Hodge, Emily
AU - Kehinde, Aga
AU - Prabhu, Pradeep
AU - Rockall, Timothy A.
AU - Preston, Shaun R.
AU - Sultan, Javed
N1 - Funding Information:
The authors thank Anna McGuire, Sarah Oakes, and Rishabh Singh for their help with recruitment and data collection, and Fountain Centre staff, particularly Anne Pike and Natalie Silverdale, for their support and use of their facility. This work was supported by Macmillan Cancer Support (5227431 [25/6/15] and 5635161 [25/10/16]), who funded exercise sessions, medical coaching, activity monitors, and CPET. They had no role in the study design, results analysis, data interpretation, or decision to submit the results.
Publisher Copyright:
© 2021, Society of Surgical Oncology.
PY - 2022/3
Y1 - 2022/3
N2 - Background: Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO2), skeletal muscle mass, QOL, and neoadjuvant therapy completion.Methods: This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months.Results: Fifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO2 decline {−0.4 [95% confidence interval (CI) −0.8 to 0.1] vs. −2.5 [95% CI −2.8 to −2.2] mL/kg/min; p = 0.022}, less muscle loss [−11.6 (95% CI −14.2 to −9.0) vs. −15.6 (95% CI −18.7 to −15.4) cm2/m2; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported.Conclusions: This study has demonstrated some retention of cardiopulmonary fitness (peak VO2), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration ClinicalTrials.gov NCT02950324.
AB - Background: Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO2), skeletal muscle mass, QOL, and neoadjuvant therapy completion.Methods: This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months.Results: Fifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO2 decline {−0.4 [95% confidence interval (CI) −0.8 to 0.1] vs. −2.5 [95% CI −2.8 to −2.2] mL/kg/min; p = 0.022}, less muscle loss [−11.6 (95% CI −14.2 to −9.0) vs. −15.6 (95% CI −18.7 to −15.4) cm2/m2; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported.Conclusions: This study has demonstrated some retention of cardiopulmonary fitness (peak VO2), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration ClinicalTrials.gov NCT02950324.
UR - http://www.scopus.com/inward/record.url?scp=85118364859&partnerID=8YFLogxK
U2 - 10.1245/s10434-021-11002-0
DO - 10.1245/s10434-021-11002-0
M3 - Article
C2 - 34725764
AN - SCOPUS:85118364859
SN - 1068-9265
VL - 29
SP - 1839
EP - 1850
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 3
ER -
