Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Prehabilitation improves nutritional and muscle parameters prior to oesophago-gastric cancer surgery  (#180)

Jaimee Cacic 1 , Ashley Bigaran 2 , David Liu 2 , Kate Crombie 2 , Darren Wong 2 , Kat Hall 2 , Linda Watson 2 , Ronald Ma 2 , Carlene Wilson 2 , Amanda Dalyell 2 , Ahmad Aly 2 , Steven Kunz 2 , Marissa Ferguson 2 , Laurence Weinberg 2 , Danny Brazzale 2 , Claire O'Donnell 2 , Grace Williams 2 , Karalyn McDonald 2 , Celia Lanteri 2 , Brooke Chapman 1
  1. Nutrition & Dietetics, Austin Health, Heidelberg, Victoria, Australia
  2. Austin Health, Heidelberg, Victoria, Australia

Aims 

Malnutrition is highly prevalent in patients with oesophago-gastric cancer and contributes to adverse peri and post operative outcomes. Prehabilitation including early, tailored nutrition interventions may improve clinical outcomes. We aim to describe changes in nutritional and muscle parameters in patients undergoing a multidisciplinary prehabilitation program prior to oesophago-gastric surgery.  

Methods 

Patients were provided with a comprehensive program encompassing nutrition, physical and psychological optimization and followed prospectively until surgery. Nutrition and muscle parameters were assessed via Patient Generated Subjective Global Assessment (PG-SGA), handgrip strength (HGS), triceps skinfold (TSF) and calf circumference (CC). Targeted nutrition interventions aimed to meet patient’s measured resting metabolic rate as measured by indirect calorimetry.  

Results  

Ten patients have completed prehabilitation (90% male, mean age 63.8 ±6.7 years). Nutritional status improved significantly from 40% malnourished at baseline to 10% malnourished at surgery (p=0.03), with a non-significant trend (p=0.08) towards improved nutrition impact scoring on PG-SGA during the period of prehabilitation (mean 8.2±5.7 at baseline versus 3.3±2.5 at surgery), with a large effect found (d=1.1 95% CI [1.67-3.52]). Dietary energy and protein intake improved significantly following dietetic intervention, from 6.5± 2.2 MJ and 63.1± 24 g protein to 9.2±1.4 and 93.1±19 g protein (both p<0.005); equivalent to 94% of individual’s measured metabolic rate and 100% of estimated protein requirements.  Anthropometric improvements were seen in TSF (9.9±6.1 to 11.4±6.4 mm p=0.04) and CC (36.2±2.5 to 38.0±3.1 cm p=0.001). Non-significant improvements in HGS were seen (31.5±6.12 to 34.3±8.6 p=0.27) with a small to medium effect size found (d=0.37 95% CI [3.8 -5.6]).  

 

Conclusions  

Preliminary data shows that prehabilitation improves dietary intake, nutritional status and anthropometric parameters in patients undergoing oesophago-gastric cancer surgery. Future research will focus on replicating these results in a larger sample and observing the impact on post operative patient and clinical outcomes.