The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery

Jack, Sandy and West, Malcolm and Raw, David and Marwood, Simon and Ambler, Gareth and Cope, Tristan and Shotri, Milind and Sturgess, Richard and Calverley, Peter and Ottensmeier, Christian and Grocott, Michael (2014) The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. European Journal of Surgical Oncology (EJSO), 40. pp. 1313-1320. ISSN 0748-7983

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Abstract

"Background: Neoadjuvant chemotherapy (NAC) followed by surgery for resectable oesophageal or gastric cancer improves outcome when compared with surgery alone. However NAC has adverse effects and will reduce physical fitness. We assess here whether this might translate into impaired survival following surgery.
Methods: We prospectively studied 116 patients with oesophageal or gastric cancer to assess the effect of NAC on physical fitness, of whom 89 underwent cardiopulmonary exercise testing (CPET) before NAC and proceeded to surgery. 39 patients were tested after all cycles of NAC but prior to surgery. Physical fitness was assessed by measuring oxygen uptake ( o2 in ml.kg-1.min-1) at the estimated lactate threshold ( L) and at peak exercise ( o2 peak in ml.kg-1.min-1).
Results: o2 at L and at peak were significantly lower after NAC compared to pre-NAC values: o2 at L 14.5±3.8 (baseline) vs. 12•3±3.0 (post-NAC) ml.kg-1.min1; p≤0.001; o2 peak 20•8±6.0 vs. 18•3±5.1 ml.kg-.min-1; p≤0.001; absolute o2 (ml.min-1) at L and peak were also lower post-NAC; p≤0•001. Decreased baseline o2 at L and peak were associated with increased one year mortality in patients who completed a full course of NAC and had surgery; p=0.014.
Conclusion: NAC before cancer surgery significantly reduced physical fitness in the overall cohort. Lower baseline fitness was associated with reduced one-year-survival in patients completing NAC and surgery, but not in patients who did not complete NAC. It is possible that in some patients the harms of NAC may outweigh the benefits. "

Item Type:	Article
Additional Information and Comments:	“NOTICE: this is the author’s version of a work that was accepted for publication in EJSO – European Journal of Surgical Oncology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in EJSO, [VOL 40, ISSUE 10, (October 2014)] DOI#doi:10.1016/j.ejso.2014.03.010
Keywords:	Neoadjuvant chemotherapy, Cardiopulmonary exercise testing, Cancer surgery, Survival, Oesphagogastric, Physical fitness
Faculty / Department:	Faculty of Human and Digital Sciences > School of Health and Sport Sciences
Depositing User:	Karen Foxton
Date Deposited:	22 Mar 2016 09:40
Last Modified:	18 Apr 2020 10:02
URI:	https://hira.hope.ac.uk/id/eprint/785

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