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

S.J. Moug, S J E Barry, S. Maguire, N. Johns, Ross D Dolan, R. J. C. Steele, Caitlin C Buchan, G. Mackay, A. S. Anderson, Nanette Mutrie

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Patients with rectal cancer who present with sarcopenia (low muscle mass) are at significantly greater risk of postoperative complications and reduction in disease-free survival. We performed a subanalysis of a randomised controlled study [the REx trial; www.isrct n.com; 62859294] to assess the potential of prehabilitation to modify muscle mass in patient shaving neoadjuvant chemoradiotherapy (NACRT).Methods: Patients scheduled for NACRT, then potentially curative surgery (August 2014–March 2016) had baseline physical assessment and psoas muscle mass measurement (total psoas index using computed tomography-based measurements).Participants were randomised to either the intervention (13–17-week telephone-guided graduated walking programme) or control group (standard care). Follow-up testing was performed 1–2 weeks before surgery.Results: The 44 patients had a mean age of 66.8 years (SD 9.6) and were male (64%); white (98%); American Society of Anesthesiologists class 2 (66%); co-morbid (58%); overweight (72%) (body mass index ≥ 25 kg/m2). At baseline, 14%were sarcopenic. At follow-up, 13 (65%) of patients in the prehabilitation group had increased muscle mass versus 7 (35%)that experienced a decrease. Conversely, 16 (67%) controls experienced a decrease in muscle mass and 8 (33%) showed an increase. An adjusted linear regression model estimated a mean treatment difference in Total Psoas Index of 40.2mm2/m2(95% CI − 3.4 to 83.7) between groups in change from baseline (p = 0.07).Conclusions Prehabilitation improved muscle mass in patients with rectal cancer who had NACRT. These results need to be explored in a larger trial to determine if the poorer short- and long-term patient outcomes associated with low muscle masscan be minimised by prehabilitation.
Original languageEnglish
Number of pages8
JournalTechniques in Coloproctology
Early online date20 Jun 2020
DOIs
Publication statusE-pub ahead of print - 20 Jun 2020

Keywords

  • prehabilitation
  • muscle wasting
  • rectal cancer
  • sarcopenia
  • neoadjuvant chemotherapy
  • neoadjuvant therapy
  • Preoperative Care
  • walking

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