File
E. Reijneveld1,2, J. Dronkers1,2, M. Velthuis3, S. Beijer3, J. Ruurda4, E. van Adrichem5, C. Veenhof1,2
1HU University of Applied Sciences, Innovation of Human Movement Care Research Group, Utrecht, Netherlands, 2University Medical Center Utrecht, Utrecht University, Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, Utrecht, Netherlands, 3Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands, 4University Medical Center Utrecht, Department of Surgery, Utrecht, Netherlands, 5University Medical Center Groningen, University Groningen, Department of Rehabilitation Medicine, Groningen, Netherlands
Background: The standard curative treatment for patients with esophageal cancer consists of chemoradiotherapy followed by esophagectomy. Previous research has shown physical fitness to be decreased during chemoradiotherapy. Therefore, preoperative exercise programs are increasingly implemented in usual care pathways after the completion of chemoradiotherapy, with varying effectiveness. It may be questioned whether physical fitness before the start of chemoradiotherapy or the decrease of physical fitness during chemoradiotherapy is more associated with the effect of the exercise program. Insight in the clinical characteristics associated with the effect of a preoperative exercise program is important to optimize the preoperative care.
Purpose: To determine whether clinical characteristics or the change of clinical characteristics during chemoradiotherapy are associated with the change in exercise capacity after a preoperative exercise program in patients with esophageal cancer.
Methods: This multicenter prospective cohort study included patients with esophageal cancer planned for esophagectomy who participated in a six-week supervised exercise program in the period after chemoradiotherapy and before surgery. Effect of the exercise program was measured by the change of exercise capacity, estimated by the Steep Ramp Test, before the start and after finishing the exercise program. Clinical characteristics included body mass index (BMI), exercise capacity (Steep Ramp Test), fatigue (Short Fatigue Questionnaire) and physical activity (LASA Physical Activity Questionnaire) and were measured before the start of the chemoradiotherapy and after chemoradiotherapy (before the start of the exercise program). We included both the scores before chemoradiotherapy as the change scores during chemoradiotherapy in the analysis. Associations between clinical characteristics and the change of exercise capacity during the exercise program were determined using univariate and multivariate linear regression analyses.
Results: One hundred twenty-three patients participated in the study (mean age 65.0 ± 8.8 years; 80% male). Exercise capacity changed from 22.9 ± 5.9 to 25.6 ± 5.8 ml/kg/min (p<0.001) during the exercise program. Less physical activity (β=-0.231, p=0.011) and a higher degree of fatigue (β=0.271, p=0.003) measured before the start of chemoradiotherapy and a greater reduction of exercise capacity during chemoradiotherapy (β=-0.474, p<0.001) were univariate associated with more improvement during the exercise program. In the multivariable model, a greater reduction of exercise capacity during chemoradiotherapy (β=-0.581, p<0.001) and a higher degree of fatigue before chemoradiotherapy (β=0.169, p=0.001) were independently associated with more improvement during the exercise program (R2=0.30). BMI and exercise capacity before chemoradiotherapy and the change of BMI, fatigue and physical activity during chemoradiotherapy were not significantly associated with the effect of the exercise program.
Conclusion(s): A greater reduction of exercise capacity during chemoradiotherapy and a higher degree of fatigue before chemoradiotherapy are associated with more improvement in exercise capacity during preoperative training. Given the low explained variation in this study, future studies should investigate whether other factors including psychosocial characteristics, nutritional status or the presence of comorbidity are associated with the effect of a preoperative exercise program.
Implications: A decrease in exercise capacity during chemoradiotherapy in patients with esophageal cancer restores during a preoperative exercise program. Furthermore this study shows that fatigue is not a limiting factor for patients to improve their exercise capacity.
Funding, acknowledgements: The study was funded by the foundation ‘Vrienden Integrale Oncologische Zorg’.
Keywords: Esophageal cancer, Exercise, Preoperative care
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? No
Institution: University Medical Center Utrecht
Committee: Medical Research Ethics Committee Utrecht
Reason: Data were collected from standard healthcare data.
All authors, affiliations and abstracts have been published as submitted.
