P185 MULTI-MODAL PREHABILITATION DURING NEOADJUVANT THERAPY PRIOR TO RESECTION FOR OESOPHAGOGASTRIC CANCER: A PILOT RANDOMISED CONTROLLED TRIAL

Abstract

Abstract Aim We aimed to assess the effect of prehabilitation on cardiopulmonary exercise test (CPET) performance in patients undergoing neoadjuvant chemotherapy (NAC) for oesophagogastric (OG) cancer. Background & Methods NAC reduces fitness as assessed by CPET1 and induces skeletal muscle loss (sarcopenia)2,3. Both are associated with poorer post-operative outcomes. A parallel-arm RCT was conducted (December 2016 to November 2018), with randomisation to receive a 15-week multi-modal prehabilitation programme (Prehab) or standard-care (Control). Prehab comprised twice-weekly supervised and thrice-weekly home exercise sessions, Medical Coaching, and tailored dietetic input. CPET was performed before and after NAC, and 1 week pre-operatively. On staging and re-staging CT, skeletal muscle cross-sectional area at L3 was analysed by a blinded investigator. Becks’ Depression Inventory questionnaires were completed pre- and post-surgery. Results Groups (Prehab n=25, Control n=28) were matched at baseline. Supervised and home exercise programme compliance was 76%, and 65% respectively, with no adverse events. Prehab resulted in an improvement in peak VO2 following NAC (Prehab +31.50ml/min/m2 vs Control -89.57 ml/min/m2; p=0.004) with a trend towards lesser reduction in anaerobic threshold (Prehab -0.87ml/kg/min vs Control -1.44ml/kg/min; p=0.342). A higher proportion of controls required NAC deferral or dose reduction (Prehab 16% (4/25) vs Control 43% (12/28); p=0.041), with 72% (Prehab) and 46% (Control) completing all cycles at full dose (p=0.076). There was no difference in chemotherapy-related toxicity. The Prehab group demonstrated less skeletal muscle loss following NAC (Prehab -11.62 vs Control -15.61; p=0.049). Controls showed a trend towards more sarcopenia development after NAC (Prehab: Pre-NAC 37% (9/24) and post-NAC 54% (13/24) vs Control: Pre-NAC 32% (9/28) and post-NAC 64% 18/28) (p=0.404). Prehab subjects had a significant improvement in depression scores following NAC (Prehab -2.71 vs Control +0.57; p=0.003). There was a trend towards shorter median length of stay in the Prehab group (Prehab 11 vs Control 16 days; p=0.155) and lower complication rates (Prehab 50% (11/22) vs Control 74% (17/23); p=0.89). Conclusion Multi-modal prehabilitation is safe and feasible in OG patients receiving NAC. Despite the effects of NAC, prehabilitation produced a significant improvement in peak VO2, depression scores and less skeletal muscle loss, with a trend towards improved clinical outcomes. This warrants further investigation.