391. PREHABILITATION DURING NACT IN ESOPHAGEAL CANCER CARE—A FEASIBILITY STUDYJade St-Pierre, Miquel Coca-Martinez, Kenneth Drummond, Enrico Minnella, Lorenzo Ferri, Celena Scheede-Bergdahl, Franco Carli
- General Medicine
Esophageal cancer bears a high disease burden with elevated morbidity and mortality. Treatment of esophageal adenocarcinoma (EAC) includes Neoadjuvant Chemotherapy (NACT) followed by surgical resection and subsequent adjuvant chemotherapy (ACT). This treatment triad effectively weakens already ill patients. Prehabilitation, a preoperative intervention designed to optimize patients through exercise, nutrition, and psychology, is understudied in this malignancy. Given limited prehabilitation resources at many hospitals, efficacy of home-based programs vs traditional supervised programs was investigated.
Patients diagnosed with EAC underwent a multimodal prehabilitation intervention and were blindly randomized to either supervised exercise or home-based exercise. The study was considered feasible if patients complied to 70% of the program. Compliance was measured by number of completed exercise sessions and adherence to nutritional advice and supplementation. Safety was measured by occurrence of adverse events. Cardiorespiratory fitness was measured by cardiopulmonary exercise testing (CPET). Functional capacity was measured by 6-minute walking test (6MWT), Sit-to-Stand and Hand Grip Strength. Quality of Life was measured by ESAS and FACT-E. All patients underwent assessment at baseline, preoperatively and 8 weeks postoperatively.
44 patients were enrolled, supervised (n = 23) and home-based (n = 21). Average age was 64, BMI 27.9 kg/m2 and 68% underwent an Ivor Lewis esophagectomy. There were no significant differences between groups at baseline. Overall adherence to the program by the supervised group was 72% and 77% by the home-based group. Exercise allocation was not linked to adherence (p = 0.45). There were 2 non-serious adverse events recorded during this trial: one bout of syncope and one of light headedness during exercise. There is a relative maintenance or even improvement of cardiorespiratory fitness, functional capacity and QoL during NACT throughout the preoperative period.
Prehabilitation is an effective and safe intervention in esophageal cancer patients undergoing NACT. Home-based programs seem to provide similar benefits to supervised programs. This allows for wider implementation of prehabilitation in hospitals which do not have dedicated outpatient clinics for this purpose. Buffering functional decline during treatment is a triumph in a population that usually suffers. However, larger trials investigating prehab’s effect on post operative complications and QoL are needed.