Prehabilitation is feasible in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy and may minimize physical deterioration: results from the REx trial

• Published in: Colorectal disease Vol. 21; no. 5; pp. 548 - 562
• Main Authors: Moug, S. J., Mutrie, N., Barry, S. J. E., Mackay, G., Steele, R. J. C., Boachie, C., Buchan, C., Anderson, A. S.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2019
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Colorectal cancer; Deterioration; Feasibility Studies; feasibility study; Female; Humans; Male; Middle Aged; neoadjuvant therapy; Neoadjuvant Therapy - adverse effects; Patient satisfaction; Patients; Physical Functional Performance; Postoperative Complications - etiology; Postoperative Complications - prevention & control; prehabilitation; Preoperative Care - methods; Proctectomy - adverse effects; Proctectomy - rehabilitation; Quality of life; rectal cancer; Rectal Neoplasms - physiopathology; Rectal Neoplasms - rehabilitation; Rectal Neoplasms - therapy; Rectum; Statistical analysis; Surgery; Treatment Outcome; Walking; feasibility study; prehabilitation; neoadjuvant therapy; rectal cancer; surgery
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.14560

Aim Rectal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT) experience physical deterioration and reductions in their quality of life. This feasibility study assessed prehabilitation (a walking intervention) before, during and after NACRT to inform a definitive multi‐centred randomized clinical trial (REx trial). Methods Patients planned for NACRT followed by potentially curative surgery were approached (August 2014–March 2016) (www.isrctn.com; 62859294). Prior to NACRT, baseline physical and psycho‐social data were recorded using validated tools. Participants were randomized to either the intervention group (exercise counselling session followed by a 13–17 week telephone‐guided walking programme) or a control group (standard care). Follow‐up testing was undertaken 1–2 weeks before surgery. Results Of the 296 screened patients, 78 (26%) were eligible and 48 (61%) were recruited. N = 31 (65%) were men with a mean age of 65.9 years (range 33.7–82.6). Mean intervention duration was 14 weeks with 75% adherence. n = 40 (83%) completed follow‐up testing. Both groups recorded reductions in daily walking but the reduction was less in the intervention group although not statistically significant. Participants reported high satisfaction and fidelity to trial procedures. Conclusion This study demonstrates that prehabilitation is feasible in rectal cancer patients undergoing NACRT. Good recruitment, adherence, retention and patient satisfaction rates support the development of a fully powered trial. The effects of the intervention on physical outcomes were promising.