The effects of cancer therapies on physical fitness before oesophagogastric cancer surgery: a prospective, blinded, multi-centre, observational, cohort study [version 1; peer review: 2 approved].

O2 diffusion during exercise Pre-operative evaluation: American College of Cardiology Guidelines

Journal

NIHR open research
ISSN: 2633-4402
Titre abrégé: NIHR Open Res
Pays: England
ID NLM: 9918333281906676

Informations de publication

Date de publication:
16 Jun 2021
Historique:
entrez: 2 2 2022
pubmed: 3 2 2022
medline: 3 2 2022
Statut: epublish

Résumé

Neoadjuvant cancer treatment is associated with improved survival following major oesophagogastric cancer surgery. The impact of neoadjuvant chemo/chemoradiotherapy on physical fitness and operative outcomes is however unclear. This study aims to investigate the impact of neoadjuvant chemo/chemoradiotherapy on fitness and post-operative mortality. Patients with oesophagogastric cancer scheduled for chemo/chemoradiotherapy and surgery were recruited to a prospective, blinded, multi-centre, observational cohort study. Primary outcomes were changes in fitness with chemo/chemoradiotherapy, measured using cardiopulmonary exercise testing and its association with mortality one-year after surgery. Patients were followed up for re-admission at 30-days, in-hospital morbidity and quality of life (exploratory outcomes). In total, 384 patients were screened, 217 met the inclusion criteria, 160 consented and 159 were included (72% male, mean age 65 years). A total of 132 patients (83%) underwent chemo/chemoradiotherapy, 109 (71%) underwent chemo/chemoradiotherapy and two exercise tests, 100 (63%) completed surgery and follow-up. A significant decline in oxygen uptake at anaerobic threshold and oxygen uptake peak was observed following chemo/chemoradiotherapy: -1.25ml.kg Chemo/chemoradiotherapy prior to oesophagogastric cancer surgery reduced physical fitness. Lower baseline fitness was associated with reduced overall survival at one-year. Careful consideration of fitness prior to chemo/chemoradiotherapy and surgery is urgently needed.

Sections du résumé

BACKGROUND BACKGROUND
Neoadjuvant cancer treatment is associated with improved survival following major oesophagogastric cancer surgery. The impact of neoadjuvant chemo/chemoradiotherapy on physical fitness and operative outcomes is however unclear. This study aims to investigate the impact of neoadjuvant chemo/chemoradiotherapy on fitness and post-operative mortality.
METHODS METHODS
Patients with oesophagogastric cancer scheduled for chemo/chemoradiotherapy and surgery were recruited to a prospective, blinded, multi-centre, observational cohort study. Primary outcomes were changes in fitness with chemo/chemoradiotherapy, measured using cardiopulmonary exercise testing and its association with mortality one-year after surgery. Patients were followed up for re-admission at 30-days, in-hospital morbidity and quality of life (exploratory outcomes).
RESULTS RESULTS
In total, 384 patients were screened, 217 met the inclusion criteria, 160 consented and 159 were included (72% male, mean age 65 years). A total of 132 patients (83%) underwent chemo/chemoradiotherapy, 109 (71%) underwent chemo/chemoradiotherapy and two exercise tests, 100 (63%) completed surgery and follow-up. A significant decline in oxygen uptake at anaerobic threshold and oxygen uptake peak was observed following chemo/chemoradiotherapy: -1.25ml.kg
CONCLUSION CONCLUSIONS
Chemo/chemoradiotherapy prior to oesophagogastric cancer surgery reduced physical fitness. Lower baseline fitness was associated with reduced overall survival at one-year. Careful consideration of fitness prior to chemo/chemoradiotherapy and surgery is urgently needed.

Identifiants

DOI: 10.3310/nihropenres.13217.1 PMID: 35106479 PMC: PMC7612293
pubmed: 35106479
doi: 10.3310/nihropenres.13217.1
pmc: PMC7612293
mid: EMS140788
doi:

Types de publication

Journal Article

Langues

eng

Pagination

1

Subventions

Organisme : Department of Health
ID : PB-PG-0609-18262
Pays : United Kingdom

Déclaration de conflit d'intérêts

Competing interests: MAW – National Institute for Health Research funded Academic Clinical Lecturer in surgery at the University of Southampton. ZA, GA, LL, JJK – No external funding and no competing interests declared MGM - Chair at UCL sponsored by Smiths Medical; Consultant for Edwards Lifesciences; Director Medinspire Ltd, UK; Editorial Board Member British Journal of Anaesthesia; Director, Evidence Based Perioperative Medicine Ltd (EBPOM), UK.; Director and Editor -in-Chief TopMedTalk; Board member Perioperative Quality Initiative (POQI). TO, GD, DZHL, PMAC, SJ - No external funding and no competing interests declared MG – Joint Editor-in-Chief Perioperative Medicine journal; Director Medinspire Ltd, UK; Director Evidence Based Perioperative Medicine Ltd, UK; Board member, Perioperative Quality Initiative (POQI); Vice President, Royal College of Anaesthetists, UK; Chair National Institute of Academic Anaesthesia, UK; Vice-chair, UK Centre for Perioperative Care.

Références

Eur J Cancer. 2009 Jan;45(2):228-47
pubmed: 19097774
Int J Surg. 2018 May;53:86-92
pubmed: 29555526
Nutr Rev. 2010 Jul;68(7):375-88
pubmed: 20591106
Br J Surg. 2018 Jun;105(7):900-906
pubmed: 29601082
Chem Biol. 2013 Nov 21;20(11):1323-8
pubmed: 24183971
Clin Nutr. 2016 Jun;35(3):724-30
pubmed: 26065721
NIHR Open Res. 2021 Jun 16;1:1
pubmed: 35106479
BMC Cancer. 2018 Jan 31;18(1):118
pubmed: 29385994
Br J Anaesth. 2018 Mar;120(3):484-500
pubmed: 29452805
Br J Anaesth. 2014 Apr;112(4):665-71
pubmed: 24322573
Toxicol Appl Pharmacol. 2011 Feb 1;250(3):312-21
pubmed: 21074548
N Engl J Med. 2012 May 31;366(22):2074-84
pubmed: 22646630
Ann R Coll Surg Engl. 2013 Mar;95(2):125-30
pubmed: 23484995
Cancer Chemother Pharmacol. 2016 Oct;78(4):673-83
pubmed: 27167634
Eur J Cancer Care (Engl). 2019 Jul;28(4):e13023
pubmed: 30859650
Eur J Transl Myol. 2018 Jun 06;28(2):7590
pubmed: 29991992
Clin Nutr. 2012 Feb;31(1):74-7
pubmed: 21875767
Stat Med. 2012 May 20;31(11-12):1150-61
pubmed: 21997569
Lancet Oncol. 2017 Mar;18(3):357-370
pubmed: 28163000
J Cachexia Sarcopenia Muscle. 2020 Apr;11(2):366-380
pubmed: 31916411
Trials. 2014 Apr 27;15:144
pubmed: 24767575
Circulation. 1999 Sep 7;100(10):1043-9
pubmed: 10477528
Br J Surg. 2004 Mar;91(3):288-95
pubmed: 14991628
Br J Surg. 2017 Dec;104(13):1816-1828
pubmed: 28944954
Qual Life Res. 2013 Sep;22(7):1717-27
pubmed: 23184421
BMC Cancer. 2016 Sep 02;16(1):710
pubmed: 27589870
Int J Cancer. 2018 Jul 15;143(2):430-437
pubmed: 29441562
N Engl J Med. 2012 Aug 30;367(9):872-3; author reply 873-4
pubmed: 22931331
N Engl J Med. 2008 Jan 3;358(1):36-46
pubmed: 18172173
Lancet. 2018 Jun 30;391(10140):2631-2640
pubmed: 30070222
Eur J Surg Oncol. 2014 Oct;40(10):1313-20
pubmed: 24731268
Br J Anaesth. 2016 Feb;116(2):177-91
pubmed: 26787788
J Gastric Cancer. 2017 Mar;17(1):74-87
pubmed: 28337365
Cochrane Database Syst Rev. 2015 May 19;(5):CD001556
pubmed: 25988291
Cochrane Database Syst Rev. 2015 Oct 05;(10):CD010356
pubmed: 26436600
Lancet Oncol. 2016 Dec;17(12):1697-1708
pubmed: 27776843
N Engl J Med. 2006 Jul 6;355(1):11-20
pubmed: 16822992
Best Pract Res Clin Anaesthesiol. 2016 Jun;30(2):145-57
pubmed: 27396803
Lancet Oncol. 2015 Sep;16(9):1090-1098
pubmed: 26254683
JAMA Surg. 2018 Dec 1;153(12):1081-1089
pubmed: 30193337
BMC Cancer. 2015 Feb 12;15:48
pubmed: 25880814
Semin Radiat Oncol. 2003 Jul;13(3):176-81
pubmed: 12903007
J Clin Epidemiol. 2007 Sep;60(9):919-28
pubmed: 17689808
Ann Surg. 2017 Nov;266(5):822-830
pubmed: 28796017

Auteurs

Malcolm A West (MA)

Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
Acute Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.

Zachos Anastasiou (Z)

Department of Statistical Science, University College London, London, W1T 7PJ, UK.

Gareth Ambler (G)

Department of Statistical Science, University College London, London, W1T 7PJ, UK.

Lisa Loughney (L)

Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
Acute Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
ORCID: 0000-0003-0842-672X

Michael G Mythen (MG)

Centre for Anaesthesia, Institute of Sport Exercise and Health, University College London Hospitals NIHR Biomedical Research Centre, London, W1T 7HA, UK.

Thomas Owen (T)

Department of Critical Care and Anaesthesia, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, PR7 1PP, UK.

Gerard Danjoux (G)

Department of Critical Care and Anaesthesia, The James Cook University Hospital, Middlesborough, TS4 3BW, UK.

Denny Z H Levett (DZH)

Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
Acute Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.

Peter M A Calverley (PMA)

Department of Respiratory Research, University of Liverpool, University Hospitals Aintree, Liverpool, L9 7AL, UK.

Jamie J Kelly (JJ)

Department of Upper Gastro-intestinal Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.

Sandy Jack (S)

Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
Acute Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.

Michael P W Grocott (MPW)

Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
Acute Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.

Classifications MeSH