Effect of Exercise and Nutrition Prehabilitation in Esophagogastric Cancer Surgery

Selena Horner — Mon, 05 Nov 2018 11:00:00 +0000

Have you thought about people who have been recently diagnosed with cancer? Often times these individuals do choose to undergo medical treatment.

Rehabilitation providers will see more and more research highlighting prospective surveillance models of care for individuals who have been diagnosed with cancer.

This model of care is not reactive in nature. Services revolve around not only monitoring, but also include a proactive approach to reduce the side effects of surgery and even chemotherapy treatments. The effects of various treatment options are known. Research is beginning to focus on how some of the effects can be mitigated with rehabilitation services. Services not only during and after treatment, but also prior to any treatment intervention.

The medical world and even people who have cancer and now looking for more than just survival. People want to live and want to live with a particular level of function or ability. The pendulum has swung to considering a person’s quality of life and functional ability – along with reducing decline as much as possible.

This particular study focused on esophagogastric cancer and addressed nutrition and physical activity prior to surgery. Physical activity was individualized and based on a baseline fitness test according to the American College of Sports Medicine standard. The exercise component comprised of 35 minutes of general exercise 3 days per week. Aerobic and strengthening exercises were alternated between days.

Something to consider for this population of patients to fit their needs as they are diagnosed and go through treatments.

You’ll find the abstract to the recent study below.

Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial.

Minnella EM¹, Awasthi R¹, Loiselle SE¹, Agnihotram RV², Ferri LE³, Carli F¹.

Abstract

IMPORTANCE:

Preserving functional capacity is a key element in the care continuum for patients with esophagogastric cancer. Prehabilitation, a preoperative conditioning intervention aiming to optimize physical status, has not been tested in upper gastrointestinal surgery to date.

OBJECTIVE:

To investigate whether prehabilitation is effective in improving functional status in patients undergoing esophagogastric cancer resection.

DESIGN, SETTING, AND PARTICIPANTS:

A randomized clinical trial (available-case analysis based on completed assessments) was conducted at McGill University Health Centre (Montreal, Quebec, Canada) comparing prehabilitation with a control group. Intervention consisted of preoperative exercise and nutrition optimization. Participants were adults awaiting elective esophagogastric resection for cancer. The study dates were February 13, 2013, to February 10, 2017.

MAIN OUTCOMES AND MEASURES:

The primary outcome was change in functional capacity, measured with absolute change in 6-minute walk distance (6MWD). Preoperative (end of the prehabilitation period) and postoperative (from 4 to 8 weeks after surgery) data were compared between groups.

RESULTS:

Sixty-eight patients were randomized, and 51 were included in the primary analysis. The control group were a mean (SD) age, 68.0 (11.6) years and 20 (80%) men. Patients in the prehabilitation group were a mean (SD) age, 67.3 (7.4) years and 18 (69%) men. Compared with the control group, the prehabilitation group had improved functional capacity both before surgery (mean [SD] 6MWD change, 36.9 [51.4] vs -22.8 [52.5] m; P < .001) and after surgery (mean [SD] 6MWD change, 15.4 [65.6] vs -81.8 [87.0] m; P < .001).

CONCLUSIONS AND RELEVANCE:

Prehabilitation improves perioperative functional capacity in esophagogastric surgery. Keeping patients from physical and nutritional status decline could have a significant effect on the cancer care continuum.

JAMA Surg. 2018 Sep 5. doi: 10.1001/jamasurg.2018.1645. [Epub ahead of print]

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