The effects of prehabilitation on body composition in patients undergoing multimodal therapy for esophageal cancer

Abstract

Summary Prehabilitation aims to optimize a patient’s functional capacity in preparation for surgery. Esophageal cancer patients have a high incidence of sarcopenia and commonly undergo neoadjuvant therapy, which is associated with loss of muscle mass. This study examines the effects of prehabilitation on body composition during neoadjuvant therapy in esophageal cancer patients. In this cohort study, changes in body composition were compared between esophageal cancer patients who participated in prehabilitation during neoadjuvant therapy and controls who did not receive prehabilitation. Assessment of body composition was performed from CT images acquired at the time of diagnosis and after neoadjuvant therapy. Fifty-one prehabilitation patients and 28 control patients were identified. There was a significantly greater fall in skeletal muscle index (SMI) in the control group compared with the prehabilitation patients (Δ SMI mean difference = −2.2 cm2/m2, 95% CI –4.3 to −0.1, p=0.038). Within the prehabilitation cohort, there was a smaller decline in SMI in patients with ≥75% adherence to exercise in comparison to those with lower adherence (Δ SMI mean difference = −3.2, 95% CI –6.0 to −0.5, P = 0.023). A greater decrease in visceral adipose tissue (VAT) was seen with increasing volumes of exercise completed during prehabilitation (P = 0.046). Loss of VAT during neoadjuvant therapy was associated with a lower risk of post-operative complications (P = 0.017). By limiting the fall in SMI and promoting VAT loss, prehabilitation may have multiple beneficial effects in patients with esophageal cancer. Multi-center, randomized studies are needed to further explore these findings.

Evaluation of nutrition components within prehabilitation programs in gastrointestinal cancers: Is prehab worth the hype?

“…Of the 13 studies that included a nutrition component, 5 (38%) were randomized controlled trials, 7 (54%) were retrospective cohort studies, [25][26][27][28][29][30][31] and 1 (8%) was an uncontrolled before-and-after study. 32 All 13 studies included patients undergoing surgical intervention for gastrointestinal cancer, including six (46%) for colorectal cancer 25,26,[32][33][34] ; six (46%) for cancers of the esophagus, stomach, or pancreas [27][28][29][30]35,36 ; and one (8%) included a mix of upper and lower gastrointestinal cancers. 31 The mean age ranged from 62 to 79 years in all 13 studies.…”

“…31 The mean age ranged from 62 to 79 years in all 13 studies. The most frequently reported outcomes were postoperative complications [25][26][27][28][29][30][31][32][33][34][35][36][37] (n = 13, 100%) and length of stay (n = 11, 85%). 25,26,[28][29][30][31][32][33][34]36,37 Other outcomes reported included functional capacity, 28,[33][34][35]37 readmission rates, 28,29,32,34,35,37 and mortality.…”

“…25,26,29,32,35 Four (31%) studies examined the impact of bimodal prehabilitation, 26,30,31,35 four (31%) studies examined trimodal prehabilitation, 29,33,34,37 and five (38%) studies examined multimodal (more than three components) prehabilitation programs. 25,27,28,32,36 Most of the prehabilitation programs were roughly 4 weeks in duration, 25,[30][31][32][33][34][35]37 whereas three (23%) studies were ≤2 weeks 26,29,36 and two (15%) studies were 16 weeks. 27,28 Exercise interventions varied among authors; however, a greater number of exercise interventions were more standardized compared with the described nutrition interventions and typically included aerobic, resistance, and mobility activities among study participants.…”

“…25,27,28,32,36 Most of the prehabilitation programs were roughly 4 weeks in duration, 25,[30][31][32][33][34][35]37 whereas three (23%) studies were ≤2 weeks 26,29,36 and two (15%) studies were 16 weeks. 27,28 Exercise interventions varied among authors; however, a greater number of exercise interventions were more standardized compared with the described nutrition interventions and typically included aerobic, resistance, and mobility activities among study participants. Other components such as psychological, smoking cessation, and respiratory care may have been included in the prehabilitation programs.…”

“…A registered dietitian was mentioned in nine (69%) studies, but their roles and level of involvement varied or were minimally defined. 25,27,28,[32][33][34][35][36][37] Screening Only 5 (38%) of the 13 studies reviewed described screening for nutrition risk among study participants. 29,32,[34][35][36] Four studies specifically reported on the screening tool used, 29,32,34,35 but only one research group utilized a tool validated for oncology populations.…”