PREoperativ Study of Exercise Training
- Conditions
- GastroEsophageal Cancer
- Interventions
- Behavioral: Exercise training
- Registration Number
- NCT03490565
- Lead Sponsor
- Jesper Frank Christensen, PhD
- Brief Summary
Background Patients undergoing resection for gastro-esophageal (GE)-cancer are subjected to high burden of disease and treatment-specific morbidities with potential detrimental impact on survival and quality of life. Exercise training is a promising strategy to improve physical functional before and after tumor resection, but it is not established if this translates into lower risk of peri- and post-operative complications, improved treatment tolerance.
Objectives:
* To explore the effect a preoperative exercise-training intervention on the risk of treatment failure, defined as the risk of not reaching surgery, in patients diagnosed with operable GE cancer.
* To explore the effect of preoperative exercise training on median time to tumor progression (disease free survival), and overall survival
* To explore the effect of preoperative exercise training on the risk of treatment complications
* To explore the effect of preoperative exercise training on health related quality of life, anxiety and depression,cardiopulmonary fitness, muscle strength, and body composition
Subjects and Methods In total, 310 GE-cancer patients will be included in the study and randomly allocated to pre-operative exercise training (n=155) or usual care control (n=155). All participants will undergo 2 study visits; assessed for cardiopulmonary fitness; muscle strength, body composition; blood sample (50 ml); quality of life by questionnaires; physical function; and blood volume profile.
Quality of life will be assessed by questionnaires by self-report three times (at 12, 24, and 36 months after diagnosis), and we will collect data from medical records regarding mortality and disease recurrence up to 36 months after diagnosis.
Treatment arms:
The intervention-group will be prescribed 2-3 weekly supervised exercise training for a total of 12 weeks before surgery during neo-adjuvant chemotherapy. The control group will follow current usual care guidelines. After surgery during adjuvant chemotherapy, both groups will be referred to municipality-based rehabilitation.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 310
- patients with histologically verified, resectable adenocarcinoma of the esophagus, stomach or gastro-esophageal junction
- Deemed inoperable at the point of diagnoses
- Pregnancy
- Any other known malignancy requiring active treatment
- Not eligible for preoperative chemo- or chemoradiotherapy
- Performance status > 1
- Physical disabilities precluding physical testing and/or exercise
- Inability to read and understand Danish
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description EX group Exercise training Exercise training
- Primary Outcome Measures
Name Time Method Risk of treatment failure From date of randomization, until the date of treatment failure is clinically determined before scheduled surgery assessed for up to 20 weeks The frequency of patients scheduled to receive neo-adjuvant treatment and tumor resection with curative intend, but fail to reach surgery due to death, disease progression or physical deterioration
- Secondary Outcome Measures
Name Time Method 3 year disease free survival Baseline to 3 year follow-up Frequency of patients alive without clinical disease relapse 3 years after diagnosis
IL-10 From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in plasma IL-10 concentration
Risk of neoadjuvant treatment complications From date of randomization to the date of surgery, up to 20 weeks Incidence of registered toxicities (graded 1-4)
Risk of post-operative complications From surgery to 30 days post surgery Incidence of registered post-operative complications (Clavien-Dindo grade 2-4)
Time to disease progression Baseline to 3 year follow-up Time from point of diagnosis to clinical disease relapse
Health Related Quality of Life Baseline, scheduled surgery, 1-year follow-up, 2-year follow-up, 3-year follow-up Changes from baseline in the Functional Assessment of Cancer Therapy (FACT) questionaire
Lean Body Mass From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in whole-body lean mass assessed by
dual energy x-ray absorptiometry (DXA) scanAppendicular lean mass Baseline to scheduled surgery Changes in appendicular lean mass assessed by DXA scan
Interleukin (IL)-6 From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in plasma IL-6 concentration
CRP From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in plasma CRP concentration
3 year overall survival Baseline to 3 year follow-up Frequency of patients alive 3 years after diagnosis
Anxiety and Depression Baseline, scheduled surgery, 1-year follow-up, 2-year follow-up, 3-year follow-up Changes from baseline in the HADs questionaire
Total length of hospital stays From date of randomization up to 30 days after surgery Total number of days hospitalized
Cardiopulmonary fitness From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in VO2peak
Fat percentage From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in whole-body fat percentage assessed by DXA scan
Leg-extensor power From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in maximum leg power assessed by Nottingham Power Rig
TNFa From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in plasma TNFa concentration
Risk of neoadjuvant treatment dose-reduction From date of randomization to the date of surgery, up to 20 weeks Incidence of dose-reduction
Maximum muscle strength From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in 1 repetition maximum strength leg-press
Blood Volume From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in blood volume assessed by CO2 rebreathing
HbA1c From visit 1 (date of randomization, before neoajuvant treatment) until to visit 2 (the week before surgery, after neoadjuvant treatment) up to 20 weeks Changes in plasma HbA1c concentration
Pre-operative risk of hospitalization From date of randomization, until the date of hospitilization before scheduled surgery assessed for up to 20 weeks Frequency of non-scheduled hospitalization during neoadjuvant treatment
Tumor regression grade From date of randomization (baseline tumor biopsy) to tumor resection (surgery), up to 20 weeks Pathology assessment of tumor response to neoadjuvant treatment
Trial Locations
- Locations (1)
Rigshospitalet
🇩🇰Copenhagen, Denmark