Neoadjuvant therapy (NAT) with chemoimmunotherapy is currently indicated for patients with locoregional advanced non-small cell lung cancer (NSCLC) prior to resection surgery, but literature has suggested that this is associated with decreased pulmonary function and potentially cardiorespiratory fitness, leading to increased risk of postoperative complications. In this study, we aimed to: 1) compare the effects of NAT on cardiorespiratory fitness (VO2peak) and lung function (DLCO, FEV1 and FVC) in patients with locoregional lung cancer undergoing prehabilitation before lung resection surgery. Secondary objectives included: 1. To determine feasibility of the intervention (recruitment rate, competition rate and adherence) as well as safety (incidence of adverse events), particularly regarding the exercise component; 2. To quantify the effects of the intervention in terms of functional capacity (1min Sit-to-Stand Test), mood (Hospital Anxiety and Depression Scale) and self-reported physical activity (Yale Physical Activity Survey). 3. To assess the effects of multimodal prehabilitation on treatment completion (dose reductions/delays in planning/treatment withdrawal) as well as tolerability/toxicity (Coming Terminology Criteria for Adverse Events version 4.03) to chemo/immunotherapy 4. To assess the effects of multimodal prehabilitation on surgical outcomes (postoperative complications based on the Comprehensive Complication Index (CCI) of the Clavien-Dindo Classification System and length of hospital stay). 5. To determine the effect of the intervention on post-operative functional recovery by means of the 1-min Sit-To-Stand test conducted at hospital discharge. In order to achieve this, we will conduct a prospective study including all patients with NSCLC scheduled for NAT (chemoimmunotherapy or chemotherapy alone) across four different hospitals in Spain and France. Patients will be identified from the multidisciplinary tumour board and will be subsequently referred to the oncologist consultation. After this, one of the members of the researchers will contact the patient and explain the purpose of the study. Those who are willing to participate, will be scheduled to undergo a CardioPulmonary Exercise Test (CPET) in addition to standard lung function tests (spirometry, diffusion capacity of carbon monoxide). After that, patients will be invited to participate in a multimodal prehabilitation program including supervised exercise training, home-based inspiratory muscle training, nutritional optimization and psychological support. Patients who refuse participation in the program due to logistic reasons, will be asked to serve as controls. In addition, we will also use data from a historical cohort including patients treated with chemoimmunotherapy prior to the implementation of the study as controls. Patients will be assessed at baseline, after NAT and post-surgery (at hospital discharge).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
The multimodal prehabilitation programme will consist of 1) twice weekly, supervised exercise training at the hospital gym for approximately 12-16 weeks; 2) nutritional consultation and diet optimization and supplementation if needed; 3) individual or group-based psychological support.
Hospital Clinic de Barcelona
Barcelona, Barcelona, Spain
RECRUITINGChanges in cardiorespiratory fitness assessed with a cardiopulmonary exercise test
Differences in maximum oxygen consumption (VO2pic) pre to post neoadjvuant therapy during an incremental, symptom-limited test
Time frame: 2 weeks post-neoadjuvant therapy
Changes in diffusion capacity of carbon monoxide (DLCO)
Differences in diffusion capacity of carbon monoxide pre to post-neoadjuvant therapy
Time frame: 2 weeks post-neoadjuvant therapy
Changes in submaximal cardiorespiratory fitness assessed with a cardiopulmonary exercise test
Differences in oxygen consumption at the anaerobic threshold (VO2AT) pre to post-neoadjuvant therapy during an incremental, symptom-limited test
Time frame: 2 weeks post-neoadjuvant therapy
Changes in ventilatory efficiency (VE/VCO2 slope) assessed during a cardiopulmonary exercise test
Changes in ventilatory efficiency (VE/VCO2 slope) pre to post-neoadjuvant therapy
Time frame: 2 weeks post-neoadjuvant therapy
Changes in pulmonary function (FEV1)
Differences observed in the maximum volume achieved during the first second (FEV1) of a forced spirometry test, pre to post-neoadjuvant therapy
Time frame: 2 weeks post-neoadjuvant therapy
Changes in pulmonary function (FVC)
Differences observed in the forced ventilatory capacity (FVC) of a forced spirometry test, pre to post-neoadjuvant therapy
Time frame: 2 weeks post-neoadjuvant therapy
Feasibility (recruitment rate ) of multimodal prehabilitation
Feasibility of the multimodal prehabilitation programme assessed by the recruitment rate (number of patients attending prehabilitation versus number of eligible patients)
Time frame: 1 week before surgery
Feasibility (completion rate) of multimodal prehabilitation
Feasibility of the multimodal prehabilitation programme assessed by the completion rate (number of completers among those who accepted to participate in the programme)
Time frame: 1 week before surgery
Adherence
Number of completed exercise sessions in the prehabilitation cohort versus number of scheduled sessions
Time frame: 1 week before surgery
Adverse events
Number of adverse events registered during the exercise training sessions
Time frame: 1 week before surgery
Postoperative Complications
Number and severity of postoperative complications will be assessed by reviewing medical records and calculating the Comprehensive Complication Index (CCI) according to the Clavien-Dindo Classification.
Time frame: within 30 days of hospital discharge
30-Day readmissions, re-interventions and emergency room visits
Readmissions, surgical re-interventions and emergency room visits post-discharge and during the first 30 days will be recorded by reviewing medical records
Time frame: 30 days after surgery
Chemoimmunotherapy completion rates
Chemoimmunotherapy complete dosage, treatment delays and treatment withdrawal rates will be calculated and compared in both groups
Time frame: 1 week post-neoadjuvant therapy
Post-surgery functional capacity
Functional capacity assessed with the 1 min Sit-to-Stand Test which consist of counting the number of times the patient can stand up and sit back onto a chair without arm support during one minute.
Time frame: Same day as dicharge from hospital
Post-NAT functional capacity
Functional capacity assessed with the 1 min Sit-to-Stand Test which consist of counting the number of times the patient can stand up and sit back onto a chair without arm support during one minute.
Time frame: 2 weeks post-neoadjuvant therapy
Post-NAT mood
Anxiety and depression symptoms will be assessed with a self-administer questionnaire, the Hospital Anxiety and Depression Scale
Time frame: 2 weeks post-neoadjuvant therapy
Post-NAT self-reported physical activity
Self-reported physical activity levels will be measured using a validated questionnaire, the Yale Physical Activity Survey
Time frame: 2 weeks post-neoadjuvant therapy
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