Development of Prehabilitation program during neoadjuvant chemotherapy to prevent skeletal muscle mass loss in older patients with esophageal cancer

Abstract

In recent years, patients with cancer have been aging internationally, and these older patients with cancer are known to be at high risk of postoperative complications and of dependency of care. Esophagectomy following neoadjuvant chemotherapy for locally advanced esophageal cancer is one of the most intense cancer treatments, which is very burdensome for especially older patients with cancer. Considering these backgrounds, cancer rehabilitation during cancer treatments is especially important for older patients with locally advanced esophageal cancer to prevent complications and the dependency of care.

The rehabilitation is generally performed after surgery to promote functional recovery. Recently, preoperative rehabilitation (Prehabilitation) has also been implemented at an earlier phase to prevent complications and the dependency of care after surgery. However, Prehabilitation to date has mostly been performed in a short period of time (2 to 4 weeks) prior to surgery. Prehabilitation during neoadjuvant chemotherapy has not generally been performed earlier after diagnosis.

We have reported that muscle mass loss during neoadjuvant chemotherapy in older patients with locally advanced esophageal cancer was associated with postoperative complications, long-term delay in muscle mass recovery, and prognosis. Therefore, we believe that if we can develop a Prehabilitation program during neoadjuvant chemotherapy to prevent muscle mass loss, we can improve the quality of life and postoperative clinical outcomes of older patients with locally advanced esophageal cancer.

We will conduct the following two studies to develop a multidisciplinary Prehabilitation program during neoadjuvant chemotherapy to prevent loss of skeletal muscle mass in older patients with locally advanced esophageal cancer.

(i) Prospective observational study to elucidate the clinical mechanism of muscle mass loss during neoadjuvant chemotherapy.

(ii) A single-center, single-arm intervention study to examine the feasibility of Prehabilitation.

Perspectives

• We can expect to develop a novel Prehabilitation program during neoadjuvant chemotherapy specifically for older patients.
• We may establish a novel supportive care that can reduce the risk of postoperative complications and the dependency of care in older patients with cancer.
• We can have the potential to apply the Prerehabilitation program to a broad population, including unresectable older patients with cancer during chemotherapy and older patients with other resectable cancer during neoadjuvant chemotherapy.

Comments from principal researcher

Tsuyoshi HARADA (Department of Rehabilitation Medicine, National Cancer Center Hospital East)

I am a physical therapist engaged in cancer rehabilitation medicine. I have seen many older patients with esophageal cancer who suffered from pneumonia and physical deterioration after esophagectomy, and were restricted comfortable activities of daily living after discharge from the hospital. We believe that the establishment of Prehabilitation that can prevent pneumonia and physical deterioration after esophagectomy, which will enable older patients with cancer to receive safe and satisfactory cancer treatment.

Shared Researchers

Kakeru HASHIMOTO（Department of Rehabilitation, National Center for Geriatrics and Gerontology）