P185 MULTI-MODAL PREHABILITATION DURING NEOADJUVANT THERAPY PRIOR TO RESECTION FOR OESOPHAGOGASTRIC CANCER: A PILOT RANDOMISED CONTROLLED TRIAL

Aim We aimed to assess the effect of prehabilitation on cardiopulmonary exercise test (CPET) performance in patients undergoing neoadjuvant chemotherapy (NAC) for oesophagogastric (OG) cancer. Background & Methods NAC reduces fitness as assessed by CPET1 and induces skeletal muscle loss (sarcopenia)2,3. Both are associated with poorer post-operative outcomes. A parallel-arm RCT was conducted (December 2016 to November 2018), with randomisation to receive a 15-week multi-modal prehabilitation programme (Prehab) or standard-care (Control). Prehab comprised twice-weekly supervised and thrice-weekly home exercise sessions, Medical Coaching, and tailored dietetic input. CPET was performed before and after NAC, and 1 week pre-operatively. On staging and re-staging CT, skeletal muscle cross-sectional area at L3 was analysed by a blinded investigator. Becks’ Depression Inventory questionnaires were completed pre- and post-surgery. Results Groups (Prehab n=25, Control n=28) were matched at baseline. Supervised and home exercise programme compliance was 76%, and 65% respectively, with no adverse events. Prehab resulted in an improvement in peak VO2 following NAC (Prehab +31.50ml/min/m2 vs Control -89.57 ml/min/m2; p=0.004) with a trend towards lesser reduction in anaerobic threshold (Prehab -0.87ml/kg/min vs Control -1.44ml/kg/min; p=0.342). A higher proportion of controls required NAC deferral or dose reduction (Prehab 16% (4/25) vs Control 43% (12/28); p=0.041), with 72% (Prehab) and 46% (Control) completing all cycles at full dose (p=0.076). There was no difference in chemotherapy-related toxicity. The Prehab group demonstrated less skeletal muscle loss following NAC (Prehab -11.62 vs Control -15.61; p=0.049). Controls showed a trend towards more sarcopenia development after NAC (Prehab: Pre-NAC 37% (9/24) and post-NAC 54% (13/24) vs Control: Pre-NAC 32% (9/28) and post-NAC 64% 18/28) (p=0.404). Prehab subjects had a significant improvement in depression scores following NAC (Prehab -2.71 vs Control +0.57; p=0.003). There was a trend towards shorter median length of stay in the Prehab group (Prehab 11 vs Control 16 days; p=0.155) and lower complication rates (Prehab 50% (11/22) vs Control 74% (17/23); p=0.89). Conclusion Multi-modal prehabilitation is safe and feasible in OG patients receiving NAC. Despite the effects of NAC, prehabilitation produced a significant improvement in peak VO2, depression scores and less skeletal muscle loss, with a trend towards improved clinical outcomes. This warrants further investigation.