An investigation into the utility of home-based, exercise intervention in maintaining cardio-pulmonary fitness during neo-adjuvant chemotherapy for oesophago-gastric cancer

Abstract

Background Neoadjuvant chemotherapy (NAC) is a key component of treatment for locally advanced oesophago-gastric adenocarcinoma (OGA). However, it has a negative impact on patient fitness. Using prehabilitation to increase patients’ fitness may positively affect patients’ recovery from surgery, postoperative outcomes and quality of life (QoL). This study was designed to evaluate feasibility of a home-based prehabilitation programme and explore the effect of this regimen on cardiorespiratory fitness, sarcopenia and QoL. Methods This study (ChemoFit) recruited patients with OGA to a pragmatic home-based prehabilitation programme during NAC and prior to surgery. Participants completed daily aerobic sessions to a targeted step-count and daily strengthening exercises, under weekly telephone supervision. Cardiorespiratory fitness, sarcopenia and QoL were measured before and after the intervention utilising cardiopulmonary exercise testing (CPET), computed tomography measured muscle mass and hand-grip strength, and QoL questionnaires. Results A total of 42/58 (72%) patients approached were recruited and 36/39 (92%) participants completed the programme. Median compliance with wearing a pedometer and recording step count, engagement with telephone contacts, compliance with aerobic sessions and compliance with strengthening exercises were 98%, 100%, 70% and 69% respectively. Nineteen participants had a pre and post intervention CPET with no significant difference in anaerobic threshold (mean difference -0.5 ml.kg-1 .min-1 , 95% CI -1.6 to +0.6, p=0.387) or VO2peak (mean difference -0.1 ml.kg-1 .min-1 , 95% CI -1.6 to +1.4, p=0.952). Radiological sarcopenia increased from 47% to 72% of participants during the intervention (p<0.001). There was no significant difference in mean grip strength observed (p=0.386). Global quality of life significantly improved during this period (p<0.001). Conclusions This study demonstrated that recruitment to the ChemoFit programme is feasible and achieved good patient compliance and engagement. This regimen permitted a potential maintenance of the objectively measured cardiopulmonary fitness and a potential improvement to QoL during and after neoadjuvant chemotherapy, prior to surgery.