Prehabilitation Before Colorectal Cancer Surgery Might Prolong Disease-Free Survival

By Will Boggs MD

August 10, 2019

NEW YORK (Reuters Health) - A month of prehabilitation before colorectal cancer is associated with higher disease-free survival (DFS) rates, according to a pooled analysis of three studies.

Trimodal prehabilitation before surgery (including exercise, nutritional and psychological interventions) aims to attenuate the risk of postoperative functional decline and the poor surgical outcomes associated with it.

Dr. Lawrence Lee from McGill University Health Center, in Montreal, Canada, and colleagues used data from cohort study and two randomized controlled trials of prehabilitation, including a total of 202 patients, to investigate the effect of trimodal prehabilitation on long-term oncologic outcomes after elective surgery for colorectal cancer.

The prehabilitation program consisted of an individualized home exercise program, nutritional counseling, whey protein isolate supplements, and anxiety-reduction techniques. Its median duration was 29 days, and the median compliance with the program was 80%.

Patients who underwent prehabilitation did not differ significantly from controls in five-year cumulative overall survival (96.4% vs. 91.7%, respectively) or DFS (85.3% vs. 79.3%), the team reports in the Annals of Surgery, online July 15.

Prehabilitation was associated with higher five-year DFS in the subgroup analysis of stage III disease (73.4% vs. 50.9%; log-rank P=0.045), whereas five-year DFS and overall survival were similar between groups in the subgroup analysis of rectal cancer patients.

However, after adjustment for possible confounders, trimodal prehabilitation was associated with a significant 55% reduction in the hazard of DFS for all stages and a significant 74% reduction in the hazard of DFS for stage III disease.

Similarly, in the subgroup of rectal cancer patients, prehabilitation was independently associated with a 78% reduction in the hazard of DFS.

"This study may thus provide very preliminary evidence supporting the use of routine prehabilitation as an important adjunct in the treatment of primary nonmetastatic colorectal cancer, but should be confirmed in larger prospective trials," the researchers conclude. "Future studies examining the cost implications of this intervention should be conducted to better assess prospects for scale-up, and optimize cancer care."

Dr. Carla Agasi-Idenburg from The Netherlands Cancer Institute Amsterdam and the University of Applied Sciences Utrecht, who recently interviewed older adults scheduled for colorectal cancer surgery to get their views about physical exercise, urged caution when interpreting the findings due to the small sample size.

In her study, limited time, not receiving or misunderstanding information, physical ailments, and emotional impact of the diagnosis were barriers to preoperative exercise, whereas not having physical complaints, understandable information provided by a physician, and low-cost programs facilitated exercise.

"In frail elderly that do not seem to want to join prehabilitation trials, a reduction in self-care capacity can last up to 22 month," she told Reuters Health by email. "Prehabilitation trials should be adjusted more to their preferences and needs (and the effect of these adjusted prehabilitation programs should be researched)."

Dr. Lee did not respond to a request for comments.

SOURCE: https://bit.ly/336l7GP

Ann Surg 2019.

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