Prehabilitation is feasible during neoadjuvant chemoradiotherapy and may minimize physical deterioration: Results from The REx randomised controlled trial.


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Susan Moug1,Nanette Mutrie2,Sarah Barry3,Graham Mackay1,Robert Steele4,Charles Boachie3,Annie Anderson4
1NHS Greater Glasgow and Clyde,2University of Edinburgh,3University of Glasgow,4University of Dundee

Abstract

Background

Rectal cancer patients undergoing NACRT (neo-adjuvant chemoradiotherapy) experience physical deterioration and reductions in their quality of life. This feasibility study assessed pre-habilitation (a walking intervention) before, during and after NACRT to inform a definitive multi-centred RCT.

Method

Patients planned for NACRT then potentially curative surgery were approached (August 2014 - March 2016) (www.isrctn.com; 62859294). Baseline physical and psycho-social measures were performed before NACRT. Participants were randomised to either the intervention (exercise counselling session followed by 13-17 weeks telephone-guided walking programme) or control group (standard care). Follow-up testing was undertaken 1-2 weeks before surgery.

Results

Of 296 screened patients, 78 were eligible (26%) and 48 were recruited (62%): 65% male; mean age 65.9 years (range 33.7-82.6). Mean intervention duration was 14 weeks with 75% adherence. 83% of participants completed follow-up testing and both groups recorded reductions in daily walking, however, the reduction was less in the Intervention group. 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.