ECSS Paris 2023: OP-MH07
INTRODUCTION: Testicular cancer (TC) is the most common type of malignancy in young adult males of European ancestry and the incidence is still increasing steadily (1). Multi-disciplinary care, including orchiectomy and cisplatin combination chemotherapy (CHT), have resulted in dramatic improvement in the cure rate for TC and nowadays is considered as one of the most curable malignancies (2, 3). However, platinum-based CHT is associated with toxic actions and dysfunctions in non-targeted tissues (4). Exercise seems to be promising as adjuvant therapy in reducing some of the toxic actions and dysfunctions in patients undergoing platinum-based CHT (2, 4, 5). This case report explored the effects of exercise intervention on body composition, muscle strength, power, muscle endurance and cardiorespiratory fitness (CRF) in TC patient during the treatment. METHODS: Patient (age 50 y., height 172 cm, body weight 85,2 kg, BMI 28,8 kg/m2) diagnosed with seminoma underwent orchiectomy and 4 cycles of etoposide, cisplatin CHT treatment. Supervised and home-based exercise intervention was implemented during the 11-week treatment period where strength and aerobic training was performed. Electrical bioimpedance (BF511, OMRON, Japan) was used to assess fat mass, visceral fat and lean mass. Maximum muscle strength was assessed using the hand grip dynamometer (CAMRY EH101, China). Linear position transducer (FitroDyne Premium, FiTRONiC s.r.o., Slovakia) was used to assess muscle power during the counter-movement jump. Compound exercises were used to assess muscle endurance of upper and lower body. CRF was assessed by modified 3-minutes Step test (“YMCA version”). RESULTS: After implementing exercise intervention during 12-week platinum-based CHT treatment period, we observed reduction in fat mass (-2,2%), visceral fat (-2,0) and increase in lean mass (+1,1%). Despite observing slight reduction in maximum muscle strength, there were slight increase in muscle power production (+0,3%) and large increases in muscle endurance of lower and upper body (+20%, +5,7%, respectively). There was also an improvement observed in CRF (+14,3%). CONCLUSION: Exercise intervention during anti-cancer treatment may have the potential to ameliorate and/or reverse some acute toxic effects in TC patients. Rationale exists for the promotion of exercise oncology research in this setting, in order to provide exercise recommendations for patients during the treatment. The contribution was created with the support of APVV-19-0411. REFERENCES: 1) Znaor A. et al. (2020). Int J Cancer. PMID: 31773729. 2) Bloomquist K. et al. (2023). Acta Oncol. PMID: 37450654. 3) Chovanec M. et al. (2017). Ann Oncol. PMID: 29045502. 4) Christensen J. F. et al. (2014). Br J Cancer. PMID: 24867693. 5) van der Schoot G. G. F. et al. (2023). J Cancer Res Clin Oncol. PMID: 37889308.
Read CV Viktor OlivaECSS Paris 2023: OP-MH07
INTRODUCTION: Exercise prehabilitation has shown to improve clinical outcomes after lung cancer surgery. However, its efficacy in preventing deterioration in postoperative quality of life (QoL) has not been determined. Moreover, although patients awaiting major cancer surgery express a preference to exercise in their home-based environment, most prehabilitation trials in lung cancer surgery have focused on hospital-based interventions. The main purpose of this study was to investigate whether a preoperative home-based exercise program (PHEP) prevents the deterioration in QoL after lung cancer surgery. Secondarily, it aimed to determine the effects of the PHEP on physical performance. METHODS: A parallel, assessor-blinded, randomized controlled trial was conducted at 4 hospitals in Portugal. Patients awaiting lung cancer resection (clinical stage I-IIIA), were randomly allocated to either a non-exercise control group (n=21) or to a PHEP group (n=20). The PHEP consisted of moderate-intensity aerobic plus resistance training, with weekly telephone supervision. Primary endpoint was QoL measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. Secondary endpoints were exercise capacity (incremental shuttle-walk test) and muscle strength (maximal handgrip strength and 5 times sit-to-stand). Outcomes were measured at baseline (i.e., before randomization), 1-5 days pre-surgery, and 1-month post-surgery. A repeated measures analysis of variance (ANOVA) was employed to compare groups over time based on the intention-to-treat principle. The proportion of patients who had clinically relevant deterioration on QoL was analyzed based on the minimal importance difference. RESULTS: A significant group X time interaction was found for global QoL (p=0.004). Significantly and clinically relevant differences between groups were found on global QoL at pre-surgery (mean difference [MD], 13.5 points; 95% confidence interval [CI], 2.4–24.6; p=0.019) and post-surgery (MD, 12.4 points; 95% CI, 1.3–23.4; p= 0.029), favoring the PHEP group. After surgery, the proportion of patients who had a clinically relevant deterioration on QoL was significantly lower in the PHEP group compared with the CG in the following domains: physical function (PHEP: 20% vs CG: 66.7%; p=0.004), role function (PHEP: 10% vs CG: 52.4%; p=0.006), social function (PHEP: 15% vs CG: 47.3%; p=0.043), pain (PHEP: 25% vs CG: 61.9%; p=0.028) and appetite loss (PHEP: 5% vs CG: 38.1%; p=0.020). In addition, between-group differences were found in preoperative five-times sit-to-stand (median difference, −1.8 s; 95% CI, −0.1 to −3.7 s; p=0.041) and postoperative exercise capacity (MD, 147.4 m; 95% CI, 17.3–264.2 m; p=0.027), favoring the PHEP group. No between-group differences were found on handgrip strength. CONCLUSION: This study found that a PHEP prevents deterioration in QoL and exercise capacity after lung cancer surgery. Further research is needed to determine its efficacy on surgical outcomes.
Read CV Pedro MachadoECSS Paris 2023: OP-MH07
INTRODUCTION: Multimodal prehabilitation is the systematic process of improving patients physical, emotional, and nutritional status between diagnosis and surgery [1]. Patients with better health status before bowel surgery, show improved response to treatment, experience less complications, have shorter hospital stays and improved quality of life [2]. Given the short surgery wait times for colorectal cancer patients, current prehabilitation guidelines are insufficient. This pilot service evaluated the tolerability and feasibility of multimodal high intensity interval training (HITT) with higher frequency (>5 days/week) to optimise patients within reduced surgery wait times (< 4 weeks). METHODS: Ten patients received personalised home-based exercise, breathing and pelvic floor exercise, nutritional advice and emotional support using motivational interviewing. Primary outcome: functional walking capacity (six-minute walk test [6MWT]). Secondary outcomes: muscular strength/endurance (sit to stand test [STS]), self-efficacy for exercise, anxiety/depression (Hospital Anxiety and Depression Scale [HADS]), nutritional status (Malnutrition Universal Screening Tool ([MUST]), quality of life (EQ-5D-5L), adherence, sedentary behaviour change, affect regulation and patient satisfaction. Distribution dependant, appropriate descriptive (mean±standard deviation; median/range) and inferential (paired T-tests; Wilcoxon) statistics were used and statistical significance set at p < .05. RESULTS: Prehabilitation (median:20, range:6-35 days), improved all functional outcomes. Affect regulation improved significantly. 6MWT distance increased by 16.9m±96m (p=.6), STS increased by 31.1% (Mean Difference (MD) 3.5±6.2, p=.1). EQ-5D-5L Index score improved by 5.6% (MD=.04±.09, p=.1) and self-reported health status by 26.5% (MD=16±24.6, p=.07), HADS Fear by 13.6% (MD=.9±4.7, p= .5) and HADS Depression by 10.5% (MD=.4±3.9, p=.7). Patients reported 16.9% more confidence to partake in exercise (MD=10.9±20.9, p=.1). Body mass index (BMI) improved significantly (MD=.6±.6, p=.03). Resting blood pressure improved by 8.7% systolic/3.7% diastolic pressure. Patients managed mean physical exercise of 79±66 mins/session, and cumulatively 119.9±39.3 activity mins/day. Significant affective improvements in activation (arousal) (MD=.5±0.9, p<.00) and affective valence (feeling) (MD=.6±1, p<.00) were observed before/after exercise when intensity was self-selected. Adherence was excellent, patient satisfaction increased, and no adverse events occurred. CONCLUSION: Multimodal home-based HITT prehabilitation with high frequency is feasible and tolerable within reduced surgery wait times. Optimal results may require >3 weeks of physical exercise and early referral is vital. These findings have important implications for informing current clinical practice. REFERENCES: 1. Bolshinsky, V., et al., Multimodal prehabilitation. Dis. Colon Rectum, 2018. 61(1): p. 124-138. 2. Chmelo, J., et al., Prehabilitation. Rozhl Chir, 2021. 100(9): p. 421
Read CV Talitha de KlerkECSS Paris 2023: OP-MH07