Feasibility and effectiveness of a multimodal rehabilitation program (Fit4Chemo) in patients with stage 3 colon carcinoma prior to and during adjuvant chemotherapy

Abstract

Background: In the Netherlands, 5,000 patients are diagnosed with colon carcinoma (CC) with lymph node metastases every year. These stage 3 CC patients require adjuvant chemotherapy after surgical resection to prevent recurrence or metastasis and thus to improve survivability. If the additional chemotherapy cannot be started in time or cannot be fully completed, 5-year survival rates drop from 75% to 39%. Due to high risk of complications (up to 60%) after colorectal surgery, postoperative recovery in patients is often delayed. As a result, only 50% of patients can start adjuvant chemotherapy in time, but another 50% of these patients need a dose reduction or discontinuation of adjuvant chemotherapy due to side effects. Research shows that functional recovery can be accelerated by optimizing a patient’s condition preoperatively through multimodal prehabilitation. By analogy, it can be hypothesized that a comparable multimodal rehabilitation program might lead into enhanced recovery after surgery, resulting in timely started adjuvant chemotherapy and higher compliance in patients with stage 3 CC.