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]
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]
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: 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: 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-1.min-1 (-1.80 to - 0.69) and -3.02ml.kg-1.min-1 (-3.85 to -2.20); p<0.0001). Baseline chemo/chemoradiotherapy anaerobic threshold and peak were associated with one-year mortality (HR=0.72, 95%CI 0.59 to 0.88; p=0.001 and HR=0.85, 0.76 to 0.95; p=0.005). The change in physical fitness was not associated with one-year mortality.
Conclusion: 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.
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Anastasiou, Zachos
8def9bfb-5748-401d-b8ad-f80a7e3d3fce
Ambler, Gareth
3b9b18c5-1f7b-4608-b86f-30491d1c2418
Loughney, Lisa
9c3e7db1-468b-405c-b32f-cedd9cc251fe
Mythen, Michael G.
940f5be7-e5bc-4a90-94aa-09fdc658caad
Owen, Thomas
4f432dc6-034a-46a0-a1b3-3daa1e36ffbf
Danjoux, Gerard
dfa15839-bde2-472f-9763-1489d34b1cee
Levett, Denny Z.H.
1743763a-2853-4baf-affe-6152fde8d05f
Calverley, Peter M.A.
f35ac542-a95e-4625-b1c2-620e7aca2233
Kelly, Jamie J.
f75cc5d5-1d31-41b1-91e8-000c2a562b51
Jack, Sandy
a175e649-83e1-4a76-8f11-ab37ffd954ea
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Anastasiou, Zachos
8def9bfb-5748-401d-b8ad-f80a7e3d3fce
Ambler, Gareth
3b9b18c5-1f7b-4608-b86f-30491d1c2418
Loughney, Lisa
9c3e7db1-468b-405c-b32f-cedd9cc251fe
Mythen, Michael G.
940f5be7-e5bc-4a90-94aa-09fdc658caad
Owen, Thomas
4f432dc6-034a-46a0-a1b3-3daa1e36ffbf
Danjoux, Gerard
dfa15839-bde2-472f-9763-1489d34b1cee
Levett, Denny Z.H.
1743763a-2853-4baf-affe-6152fde8d05f
Calverley, Peter M.A.
f35ac542-a95e-4625-b1c2-620e7aca2233
Kelly, Jamie J.
f75cc5d5-1d31-41b1-91e8-000c2a562b51
Jack, Sandy
a175e649-83e1-4a76-8f11-ab37ffd954ea
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
West, Malcolm A., Anastasiou, Zachos, Ambler, Gareth, Loughney, Lisa, Mythen, Michael G., Owen, Thomas, Danjoux, Gerard, Levett, Denny Z.H., Kelly, Jamie J., Jack, Sandy and Grocott, Michael P.W.
,
Fit4Surgery Consortium
(2021)
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].
NIHR open research, 1 (1).
(doi:10.3310/nihropenres.13217.1).
Abstract
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: 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: 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-1.min-1 (-1.80 to - 0.69) and -3.02ml.kg-1.min-1 (-3.85 to -2.20); p<0.0001). Baseline chemo/chemoradiotherapy anaerobic threshold and peak were associated with one-year mortality (HR=0.72, 95%CI 0.59 to 0.88; p=0.001 and HR=0.85, 0.76 to 0.95; p=0.005). The change in physical fitness was not associated with one-year mortality.
Conclusion: 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.
Text
ad648f8e-d2f0-4352-b70b-fe5cbe3adbe2_13217_-_lisa_loughney
- Version of Record
More information
e-pub ahead of print date: 16 June 2021
Additional Information:
Grant information: this project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0609-18262). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Identifiers
Local EPrints ID: 454999
URI: http://eprints.soton.ac.uk/id/eprint/454999
ISSN: 2633-4402
PURE UUID: bf5f7fd6-0293-4f35-b013-42c13844651e
Catalogue record
Date deposited: 03 Mar 2022 17:40
Last modified: 17 Mar 2024 03:46
Export record
Altmetrics
Contributors
Author:
Zachos Anastasiou
Author:
Gareth Ambler
Author:
Lisa Loughney
Author:
Michael G. Mythen
Author:
Thomas Owen
Author:
Gerard Danjoux
Author:
Denny Z.H. Levett
Author:
Peter M.A. Calverley
Author:
Jamie J. Kelly
Author:
Sandy Jack
Corporate Author: Fit4Surgery Consortium
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
