Abstract
BACKGROUND: To optimize prehabilitation for patients with oesophageal cancer, insight is required into the response to prehabilitation, and factors affecting this response. This study investigated (1) the response to prehabilitation in patients with oesophageal cancer following neoadjuvant treatment, (2) the association between baseline physical fitness and preoperative changes in fitness, (3) differences in physical fitness, nutritional status, and fatigue between responders and non-responders to prehabilitation. METHODS: This multicenter cohort study included patients with oesophageal cancer, following a 6-10 week personalized prehabilitation program as part of standard care. Prehabilitation, consisting of supervised exercise and nutritional counseling, started after neoadjuvant treatment. Preoperative physical fitness and nutritional status were monitored before and after neoadjuvant treatment, and after prehabilitation. Changes over time were analyzed using linear mixed models. Impact of baseline fitness on preoperative changes in exercise capacity was investigated using a linear mixed regression model. Differences between responders to prehabilitation (> 0 Watt improvement during exercise training) and non-responders were analyzed using Independent T-Tests and multivariable logistic regression. RESULTS: Two hundred forty patients were included (mean age 66.0 (9.3) years; 77.1% male). On average, physical fitness and nutritional status declined during neoadjuvant treatment, and significantly improved during prehabilitation. Exercise capacity increased by + 32.7 Watts (95% CI: 25.2-40.2) during prehabilitation, with similar improvements across patients with low, moderate, and high baseline capacity. Substantial heterogeneity in preoperative changes was observed, with only 49.6% of patients following a pattern of decline-improvement (corresponding to average values for exercise capacity). Sixty-five percent of patients were classified as responders. Greater decline in fitness during neoadjuvant treatment (p < .001), lower fitness after neoadjuvant treatment (p = .001), and higher fatigue (p = .01) were associated with a positive response to prehabilitation. CONCLUSIONS: On average, patients with oesophageal cancer improved in physical fitness and nutritional status during prehabilitation, recovering from the impact of neoadjuvant treatment. Response to prehabilitation was independent of baseline fitness. A greater decline in fitness during neoadjuvant treatment, lower fitness before prehabilitation and higher fatigue were associated with a positive response. The heterogeneity in preoperative trajectories among patients underscores the importance of regular monitoring to tailor interventions to individual needs.