Prehabilitation is feasible in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy and may minimize physical deterioration: results from the REx trial

Abstract

Aim Rectal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT) experience physical deterioration and reductions in their quality of life. This feasibility study assessed prehabilitation (a walking intervention) before, during and after NACRT to inform a definitive multi-centred randomized clinical trial (REx trial).Methods Patients planned for NACRT followed by potentially curative surgery were approached (August 2014-March 2016) (www.isrctn.com; 62859294). Prior to NACRT, baseline physical and psycho-social data were recorded using validated tools. Participants were randomized to either the intervention group (exercise counselling session followed by a 13-17 week telephone-guided walking programme) or a control group (standard care). Follow-up testing was undertaken 1-2 weeks before surgery. ResultsOf the 296 screened patients, 78 (26%) were eligible and 48 (61%) were recruited. N = 31 (65%) were men with a mean age of 65.9 years (range 33.7-82.6). Mean intervention duration was 14 weeks with 75% adherence. n = 40 (83%) completed follow-up testing.Both groups recorded reductions in daily walking but the reduction was less in the intervention group although not statistically significant. Participants reported high satisfaction and fidelity to trial procedures.Conclusion This study demonstrates that prehabilitation is feasible in rectal cancer patients undergoing NACRT. Good recruitment, adherence, retention and patient satisfaction rates support the development of a fully powered trial. The effects of the intervention on physical outcomes were promising.What does this paper add to the literature? This is the first study to show that performing prehabilitation in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy is feasible, safe and well tolerated by patients. With no reported interruption to each participant's planned clinical management, these findings support progression to a large powered multicentred trial.

Does prehabilitation modify muscle mass in patients with rectal cancer undergoing neoadjuvant therapy? A subanalysis from the REx randomised controlled trial

“…From August 2014 to March 2016 (20 months), any adult over 18 years with a new diagnosis of rectal cancer where NACRT was planned was considered for inclusion in the REx trial [ 23 ]. The trial was approved by the West of Scotland Research Ethics Service (14/WS/0079) and registered with ISRCTN ( www.isrctn.com ; 62859294; 17th March 2014).…”

“…This was a two-arm randomised controlled feasibility study (RCT) with the full protocol, physical intervention and results published [ 23 ]. Briefly, each participant’s demographics were recorded and they completed baseline-testing including daily step count, physical parameters and psychological.…”

Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients

“…To date, few studies have examined using pre-operative exercise whilst patients are receiving NAC. 12,[15][16][17] The aims of this study are:…”

Prehabilitation for the Anesthesiologist

“…38 Prehabilitation in patients undergoing neoadjuvant treatment for rectal cancer was also shown to be feasible and impactful on patient's functional outcome. 39 The prehabilitation program should then continue if possible after surgery if the patient needs adjuvant therapy. The multidisciplinary team and the tumor board should evaluate each patient and promote timely prehabilitation for high-risk patients such as those who are malnourished, sarcopenic, older, or frail, are experiencing social marginalization, and are experiencing several comorbidities.…”