Improved functional oral intake and exercise training attenuate decline in aerobic capacity following chemoradiotherapy in patients with esophageal cancer
DOI:
https://doi.org/10.2340/jrm.v56.25906Keywords:
chemoradiotherapy, fitness, prehabilitation, swallowing, nutritionAbstract
Purpose: To investigate the impact of chemoradiotherapy on the physical fitness of patients with oesophageal cancer, and the clinical factors influencing it.
Method: A total of 67 participants successfully completed the study, with 18 of them engaging in supervised, in-hospital aerobic training at moderate intensity for a minimum of 20 sessions. Cardiopulmonary exercise testing, hand grip strength, body composition assessed via bioelectrical impedance analysis, patient-generated subjective global assessment, albumin, and the Functional Oral Intake Scale (FOIS) were evaluated before chemoradiotherapy and 6–8 weeks after its completion.
Result: Among the participants, cardiopulmonary fitness, hand grip strength, and phase angle of BC-BIA declined during chemoradiotherapy. Before and after chemoradiotherapy, V̇O2peak was 19.6 ± 4.4 and 17.4 ± 3.9 mL/min/kg respectively. The improvement in FOIS during chemoradiotherapy showed a positive correlation with changes in aerobic capacity. Additionally, exercise training was associated with attenuating the decline in aerobic capacity.
Conclusion: Physical fitness deteriorated in patients with oesophageal cancer following chemoradiotherapy. Improvement in dysphagia helps maintain aerobic capacity. Additionally, exercise training has the potential to mitigate the decline. This discovery can serve as a reference for enhancing holistic care for patients with oesophageal cancer.
Downloads
References
Dubecz A, Gall I, Solymosi N, Schweigert M, Peters JH, Feith M, et al. Temporal trends in long-term survival and cure rates in esophageal cancer: a SEER database analysis. J Thorac Oncol 2012; 7: 443-447.
https://doi.org/10.1097/JTO.0b013e3182397751 DOI: https://doi.org/10.1097/JTO.0b013e3182397751
Njei B, McCarty TR, Birk JW. Trends in esophageal cancer survival in United States adults from 1973 to 2009: A SEER database analysis. J Gastroenterol Hepatol 2016; 31: 1141-1146.
https://doi.org/10.1111/jgh.13289 DOI: https://doi.org/10.1111/jgh.13289
Ajani JA, D'Amico TA, Bentrem DJ, Chao J, Corvera C, Das P, et al. Esophageal and esophagogastric junction cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17: 855-883. DOI: https://doi.org/10.6004/jnccn.2019.0100
https://doi.org/10.6004/jnccn.2019.0033 DOI: https://doi.org/10.6004/jnccn.2019.0033
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074-2084.
https://doi.org/10.1056/NEJMoa1112088 DOI: https://doi.org/10.1056/NEJMoa1112088
Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999; 281: 1623-1627.
https://doi.org/10.1001/jama.281.17.1623 DOI: https://doi.org/10.1001/jama.281.17.1623
Awad S, Tan BH, Cui H, Bhalla A, Fearon KC, Parsons SL, et al. Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr 2012; 31: 74-77.
https://doi.org/10.1016/j.clnu.2011.08.008 DOI: https://doi.org/10.1016/j.clnu.2011.08.008
Ida S, Watanabe M, Karashima R, Imamura Y, Ishimoto T, Baba Y, et al. Changes in body composition secondary to neoadjuvant chemotherapy for advanced esophageal cancer are related to the occurrence of postoperative complications after esophagectomy. Ann Surg Oncol 2014; 21: 3675-3679.
https://doi.org/10.1245/s10434-014-3737-z DOI: https://doi.org/10.1245/s10434-014-3737-z
Minnella EM, Awasthi R, Loiselle SE, Agnihotram RV, Ferri LE, Carli F. Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery: a randomized clinical trial. JAMA Surg 2018; 153: 1081-1089.
https://doi.org/10.1001/jamasurg.2018.1645 DOI: https://doi.org/10.1001/jamasurg.2018.1645
Xu YJ, Cheng JC, Lee JM, Huang PM, Huang GH, Chen CC. A walk-and-eat intervention improves outcomes for patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy. Oncologist 2015; 20: 1216-1222.
https://doi.org/10.1634/theoncologist.2015-0178 DOI: https://doi.org/10.1634/theoncologist.2015-0178
Argudo N, Rodó-Pin A, Martínez-Llorens J, Marco E, Visa L, Messaggi-Sartor M, et al. Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: an interventional pilot study. Dis Esophagus 2021; 34: doaa086.
https://doi.org/10.1093/dote/doaa086 DOI: https://doi.org/10.1093/dote/doaa086
Jack S, West MA, Raw D, Marwood S, Ambler G, Cope TM, et al. The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. Eur J Surg Oncol 2014; 40: 1313-1320.
https://doi.org/10.1016/j.ejso.2014.03.010 DOI: https://doi.org/10.1016/j.ejso.2014.03.010
Navidi M, Phillips AW, Griffin SM, Duffield KE, Greystoke A, Sumpter K, et al. Cardiopulmonary fitness before and after neoadjuvant chemotherapy in patients with oesophagogastric cancer. Br J Surg 2018; 105: 900-906.
https://doi.org/10.1002/bjs.10802 DOI: https://doi.org/10.1002/bjs.10802
Sinclair R, Navidi M, Griffin SM, Sumpter K. The impact of neoadjuvant chemotherapy on cardiopulmonary physical fitness in gastro-oesophageal adenocarcinoma. Ann R Coll Surg Engl 2016; 98: 396-400.
https://doi.org/10.1308/rcsann.2016.0135 DOI: https://doi.org/10.1308/rcsann.2016.0135
Drummond RJ, Vass D, Wadhawan H, Craig CF, MacKay CK, Fullarton GM, et al. Routine pre- and post-neoadjuvant chemotherapy fitness testing is not indicated for oesophagogastric cancer surgery. Ann R Coll Surg Engl 2018; 100: 515-519.
https://doi.org/10.1308/rcsann.2018.0067 DOI: https://doi.org/10.1308/rcsann.2018.0067
Tatematsu N, Ezoe Y, Tanaka E, Muto M, Sakai Y, Tsuboyama T. Impact of neoadjuvant chemotherapy on physical fitness, physical activity, and health-related quality of life of patients with resectable esophageal cancer. Am J Clin Oncol 2013; 36: 53-56.
https://doi.org/10.1097/COC.0b013e3182354bf4 DOI: https://doi.org/10.1097/COC.0b013e3182354bf4
American College of Sports M, Riebe D, Ehrman JK, Liguori G, Magal M. ACSM's guidelines for exercise testing and prescription. Tenth ed. Philadelphia: Wolters Kluwer Philadelphia; 2018.
Wasserman K, Hansen J, Sue DY, Stringer W, Sietsema K, Sun X-G, et al. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. Fifth ed. Philadelphia: Lippincott, Williams & Wilkins; 2011.
Huang SC, Hsu CC, Fu TC, Chen CPC, Liao MF, Hsu CY, et al. Stepper-based training improves monocyte-platelet aggregation and thrombin generation in nonambulatory hemiplegic patients. Med Sci Sports Exerc 2022; 54: 821-829.
https://doi.org/10.1249/MSS.0000000000002846 DOI: https://doi.org/10.1249/MSS.0000000000002846
Huang SC, Yeh CH, Hsu CC, Lin YC, Lee CH, Hsiao CC, et al. Trainability for cardiopulmonary fitness is low in patients with peripheral artery disease. Eur J Cardiovasc Nurs 2024; 23: 127-136.
https://doi.org/10.1093/eurjcn/zvad044 DOI: https://doi.org/10.1093/eurjcn/zvad044
Whipp BJ, Ward SA, Wasserman K. Respiratory markers of the anaerobic threshold. Adv Cardiol 1986; 35: 47-64.
https://doi.org/10.1159/000413438 DOI: https://doi.org/10.1159/000413438
Morishita Y, Kubo K, Haga Y, Miki A, Ishibashi K, Kusano E, et al. Skeletal muscle loss is negatively associated with single-pool Kt/V and dialysis duration in hemodialysis patients. Ther Apher Dial 2014; 18: 612-617.
https://doi.org/10.1111/1744-9987.12174 DOI: https://doi.org/10.1111/1744-9987.12174
Murakami K, Hirano H, Watanabe Y, Edahiro A, Ohara Y, Yoshida H, et al. Relationship between swallowing function and the skeletal muscle mass of older adults requiring long-term care. Geriatr Gerontol Int 2015; 15: 1185-1192.
https://doi.org/10.1111/ggi.12572 DOI: https://doi.org/10.1111/ggi.12572
Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 2002; 56: 779-785.
https://doi.org/10.1038/sj.ejcn.1601412 DOI: https://doi.org/10.1038/sj.ejcn.1601412
Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 2005; 86: 1516-1520.
https://doi.org/10.1016/j.apmr.2004.11.049 DOI: https://doi.org/10.1016/j.apmr.2004.11.049
Kotz T, Federman AD, Kao J, Milman L, Packer S, Lopez-Prieto C, et al. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg 2012; 138: 376-382.
https://doi.org/10.1001/archoto.2012.187 DOI: https://doi.org/10.1001/archoto.2012.187
Sorensen JC, Cheregi BD, Timpani CA, Nurgali K, Hayes A, Rybalka E. Mitochondria: inadvertent targets in chemotherapy-induced skeletal muscle toxicity and wasting? Cancer Chemother Pharmacol 2016; 78: 673-683.
https://doi.org/10.1007/s00280-016-3045-3 DOI: https://doi.org/10.1007/s00280-016-3045-3
Tonison JJ, Fischer SG, Viehrig M, Welz S, Boeke S, Zwirner K, et al. Radiation pneumonitis after intensity-modulated radiotherapy for esophageal cancer: institutional data and a systematic review. Sci Rep 2019; 9: 2255.
https://doi.org/10.1038/s41598-018-38414-5 DOI: https://doi.org/10.1038/s41598-018-38414-5
Conde Frio C, Härter J, Santos LP, Orlandi SP, Gonzalez MC. Phase angle, physical quality of life and functionality in cancer patients undergoing chemotherapy. Clin Nutr ESPEN 2023; 57: 331-336.
https://doi.org/10.1016/j.clnesp.2023.07.017 DOI: https://doi.org/10.1016/j.clnesp.2023.07.017
Detopoulou P, Tsiouda T, Pilikidou M, Palyvou F, Tsekitsidi E, Mantzorou M, et al. Changes in body weight, body composition, phase angle, and resting metabolic rate in male patients with stage IV non-small-cell lung cancer undergoing therapy. Medicina (Kaunas) 2022; 58: 1779.
https://doi.org/10.3390/medicina58121779 DOI: https://doi.org/10.3390/medicina58121779
Ramos da Silva B, Mialich MS, Cruz LP, Rufato S, Gozzo T, Jordao AA. Performance of functionality measures and phase angle in women exposed to chemotherapy for early breast cancer. Clin Nutr ESPEN 2021; 42: 105-116.
https://doi.org/10.1016/j.clnesp.2021.02.007 DOI: https://doi.org/10.1016/j.clnesp.2021.02.007
Schmidt ME, Chong M, Klassen O, Wiskemann J, Steindorf K. Longitudinal associations of bioelectrical phase angle and fatigue in breast cancer patients. Int J Cancer 2023; 153: 1192-1200.
https://doi.org/10.1002/ijc.34630 DOI: https://doi.org/10.1002/ijc.34630
Matsuda Y, Karino M, Kanno T. Relationship between the Functional Oral Intake Scale (FOIS) and the Self-Efficacy Scale among cancer patients: a cross-sectional study. Healthcare (Basel) 2020; 8: 269.
https://doi.org/10.3390/healthcare8030269 DOI: https://doi.org/10.3390/healthcare8030269
Liu D, Pickering T, Kokot N, Crookes P, Sinha UK, Swanson MS. Outcomes of combined antegrade-retrograde dilations for radiation-induced esophageal strictures in head and neck cancer patients. Dysphagia 2021; 36: 1040-1047.
https://doi.org/10.1007/s00455-020-10236-6 DOI: https://doi.org/10.1007/s00455-020-10236-6
Sinha UK, Swanson MS, Villegas BC, Ouyoung LM, Kokot N. Outcomes of self-esophageal dilation for head and neck cancer patients. Am J Speech Lang Pathol 2019; 28: 1060-1066.
https://doi.org/10.1044/2019_AJSLP-18-0190 DOI: https://doi.org/10.1044/2019_AJSLP-18-0190
Vansant MB, Parker LA, McWhorter AJ, Bluoin D, Kunduk M. Predicting swallowing outcomes from objective videofluoroscopic timing and displacement measures in head and neck cancer patients. Dysphagia 2020; 35: 853-863.
https://doi.org/10.1007/s00455-020-10091-5 DOI: https://doi.org/10.1007/s00455-020-10091-5
Bausys A, Mazeikaite M, Bickaite K, Bausys B, Bausys R, Strupas K. The role of prehabilitation in modern esophagogastric cancer surgery: a comprehensive review. Cancers (Basel) 2022; 14: 2096.
https://doi.org/10.3390/cancers14092096 DOI: https://doi.org/10.3390/cancers14092096
Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med 2016; 9: 229-255.
https://doi.org/10.2147/IJGM.S102819 DOI: https://doi.org/10.2147/IJGM.S102819
Wang CH, Ling HH, Liu MH, Pan YP, Chang PH, Lin YC, et al. Treatment-interval changes in serum levels of albumin and histidine correlated with treatment interruption in patients with locally advanced head and neck squamous cell carcinoma completing chemoradiotherapy under recommended calorie and protein provision. Cancers (Basel) 2022; 14: 3112.
https://doi.org/10.3390/cancers14133112 DOI: https://doi.org/10.3390/cancers14133112
Published
How to Cite
License
Copyright (c) 2024 Shu-Chun Huang, Lan-Yan Yang, Yin-Kai Chao, Wei-Yang Chang, Ya-Tzu Tsao, Chuan-Yi Chou, Ching-Chung Hsiao, Chien-Hung Chiu
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
