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

Abstract

Background: Neoadjuvant chemotherapy (NAC) reduces fitness as assessed by cardiopulmonary exercise testing (CPET), induces skeletal muscle loss (sarcopenia), and is associated with an increase in depression and anxiety symptoms. Each of these are associated with poorer post‐operative outcomes. The primary aim was to assess the effect of prehabilitation on CPET performance in patients undergoing NAC for oesophagogastric (OG) cancer. Secondary aims included compliance, NAC completion rates and toxicity, sarcopenia, clinical outcomes, quality of life, depression and anxiety scores, insulin resistance and hand grip strength. Methods: A parallel‐arm randomised controlled trial was conducted between December 2016 and November 2018, with randomisation to receive a 15‐week multi‐modal prehabilitation programme (Prehab n=25) or standard‐care (Control n=28). Prehab comprised twice‐weekly supervised exercise sessions (compliance of 76%), thrice‐weekly home exercise (compliance of 65%), Medical Coaching, and tailored dietetic input. CPET was performed to measure peak VO2 and anaerobic threshold (AT) 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. EORTC QLQ‐C30, Becks' Depression Inventory and Anxiety questionnaires were completed pre‐ and post‐NAC and surgery. Results: Prehab resulted in improved peak VO2 following NAC (Prehab +31.50 vs Control ‐89.57ml/min/m2;p=0.004) with a trend towards lesser reduction in AT (Prehab ‐0.87 vs Control ‐1.44ml/kg/min;p=0.342). More controls required NAC deferral/dose reduction (Prehab 16% vs Control 43%;p=0.041), with 72% (Prehab) and 46% (Control) completing NAC at full dose (p=0.076). Prehab generated less skeletal muscle loss following NAC (Prehab ‐11.62 vs Control ‐15.61;p=0.049). With Prehab, depression and anxiety scores improved significantly following NAC, with a trend towards shorter hospital stay (Prehab 11 vs Control 16 days;p=0.155), lower complications (Prehab 50% vs Control 74%;p=0.89), and significant improvements in global health status post‐operatively. Conclusions: Multi‐modal prehabilitation is safe, feasible, and achievable with good compliance in OG patients receiving NAC. Despite the effects of NAC, prehabilitation produced a significant improvement in peakVO2, depression and anxiety scores, and less skeletal muscle loss. Patients undergoing prehabilitation were significantly less likely to have their NAC deferred or have a reduction in dose. Additionally, they showed a trend towards improved clinical outcomes. This warrants further investigation.