Lanterna Rally

Author: Kenneth Drummond

Publisher:

Published: 2021

Total Pages:

ISBN-13:

"Background: The prognosis among patients with esophageal adenocarcinoma (EAC) is poor, moreover the aggressive nature of the disease and treatments often leads to a pervasive decline in functional status throughout the perioperative period. Importantly, prehabilitation has been demonstrated to improve functional trajectories in patients with esophagogastric cancers. Despite the logical rationale, few studies have investigated its clinical potential during neoadjuvant chemotherapy (NACT). The thesis aimed to (1) assess the safety and feasibility of prehabilitation (2) investigate the impact of a multimodal prehabilitation program on preoperative functional status and QoL, and (3) to document the short-term clinical outcomes of EAC patients receiving prehabilitation concurrently with NACT. It was hypothesized that prehabilitation would be feasible even with the challenges of the disease and treatments. Additionally, researchers anticipated an improvement in cardiorespiratory fitness following prehabilitation.Methods: The current thesis describes a single cohort pilot study operated out of a single high-volume centre. Patients diagnosed with non-metastatic EAC referred to receive NACT prior to an esophagectomy were approached for recruitment. All patients received a personalized multimodal prehabilitation program until surgery, varying with respect to modality of exercise delivery (home-based, in-hospital supervised, teleprehabilitation supervised. Program feasibility was dependent on patients’ weekly self-reported adherence to exercise and nutritional interventions. All patients performed a complete battery of functional tests at baseline and before surgery, which included: 6-MWT, CPET, TUG, HGS, STS and 1-arm curl test. Patient reported outcomes included: FACT-E, ESAS, DASI, CHAMPS and HADS. Results: Between August 1st, 2019 and November 1st, 2020, a total of 23 patients met the inclusion criteria, 56.5% (n=13) were recruited. All received either home-based (n=6), in-hospital supervised (n=5) or teleprehabilitation (n=2). All patients completed the program, performed both evaluations and received their respective surgeries. The cohort reported a satisfactory overall adherence rate to the program (68.9% vs 70%, p=0.7). Cardiorespiratory fitness as determined by the 6-MWD did not significantly change (p=0.6). Conversely, muscle strength improved, as determined by timed-repetitions performed in both sit-to-stand (p=0.004) and 1-arm curl tests (p=0.005). The median compliance to NACT was 100%, with only three patients ceasing treatments prematurely. The five patients did not experience postoperative complications, the median length of stay was seven days, and the incidence of in-hospital mortality was two.Conclusion: The thesis confirmed that personalized multimodal prehabilitation programs could be safe and feasibly delivered to EAC patients during NACT. Notwithstanding the lacking functional improvements, the results suggest that prehabilitation may have played a role in preserving cardiorespiratory fitness, functional status and QoL throughout the preoperative period"--