P185 MULTI-MODAL PREHABILITATION DURING NEOADJUVANT THERAPY PRIOR TO RESECTION FOR OESOPHAGOGASTRIC CANCER: A PILOT RANDOMISED CONTROLLED TRIAL. (23rd November 2019)

• Record Type: Journal Article
• Authors: Allen, S K; Brown, V; White, D; King, D; Hunt, J; Prabhu, P; Rockall, T A; Preston, S R; Sultan, J
• Is Part Of: Diseases of the esophagus. Volume 32(2019)Supplement 2
• Publication Date: 2019-11-23
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doz092.185
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Aim: We aimed to assess the effect of prehabilitation on cardiopulmonary exercise test (CPET) performance in patients undergoing neoadjuvant chemotherapy (NAC) for oesophagogastric (OG) cancer. Background & Methods: NAC reduces fitness as assessed by CPET 1 and induces skeletal muscle loss (sarcopenia) 2, 3 . Both are associated with poorer post-operative outcomes. A parallel-arm RCT was conducted (December 2016 to November 2018), with randomisation to receive a 15-week multi-modal prehabilitation programme (Prehab) or standard-care (Control). Prehab comprised twice-weekly supervised and thrice-weekly home exercise sessions, Medical Coaching, and tailored dietetic input. CPET was performed before and after NAC, and 1 week pre-operatively. On staging and re-staging CT, skeletal muscle cross-sectional area at L3 was analysed by a blinded investigator. Becks' Depression Inventory questionnaires were completed pre- and post-surgery. Results: Groups (Prehab n=25, Control n=28) were matched at baseline. Supervised and home exercise programme compliance was 76%, and 65% respectively, with no adverse events. Prehab resulted in an improvement in peak VO2 following NAC (Prehab +31.50ml/min/m 2 vs Control -89.57 ml/min/m 2 ; p =0.004) with a trend towards lesser reduction in anaerobic threshold (Prehab -0.87ml/kg/min vs Control -1.44ml/kg/min; p =0.342). A higher proportion of controls required NAC deferral or dose reduction (Prehab 16% (4/25) vs Control 43% (12/28); p =0.041), with 72% (Prehab) and 46% (Control) completing all cycles at full dose ( p =0.076). There was no difference in chemotherapy-related toxicity. The Prehab group demonstrated less skeletal muscle loss following NAC (Prehab -11.62 vs Control -15.61; p =0.049). Controls showed a trend towards more sarcopenia development after NAC (Prehab: Pre-NAC 37% (9/24) and post-NAC 54% (13/24) vs Control: Pre-NAC 32% (9/28) and post-NAC 64% 18/28) ( p =0.404). Prehab subjects had a significant improvement in depression scores following NAC (Prehab -2.71 vs Control +0.57; p =0.003). There was a trend towards shorter median length of stay in the Prehab group (Prehab 11 vs Control 16 days; p =0.155) and lower complication rates (Prehab 50% (11/22) vs Control 74% (17/23); p =0.89). Conclusion: Multi-modal prehabilitation is safe and feasible in OG patients receiving NAC. Despite the effects of NAC, prehabilitation produced a significant improvement in peak VO2, depression scores and less skeletal muscle loss, with a trend towards improved clinical outcomes. This warrants further investigation.