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Cancer symptom burden negatively affects health-related quality of life in patients undergoing prehabilitation prior to liver resection: results from a 12-week randomized controlled trial [with consumer summary]
Kasvis P, Vigano A, Bui T, Carli F, Kilgour RD
Physiologie Appliquee Nutrition et Metabolisme [Applied Physiology, Nutrition, & Metabolism] 2024 Jan;49(1):64-76
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: No; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

This study aimed to (1) explore determinants of health-related quality of life (HRQoL) in patients with cancer awaiting liver resection and entering a prehabilitation program, and (2) examine the effect of prehabilitation on HRQoL in both the pre- and postoperative period. We randomized patients to prehabilitation or rehabilitation. Prehabilitation began an exercise, nutrition, and relaxation intervention four weeks preoperatively; rehabilitation began the same intervention postoperatively. We measured the following at baseline, preoperatively, 4 weeks and 8 weeks postoperatively; HRQoL (Functional Assessment of Cancer Therapy-General (FACT-G)), nutritional status (abridged Patient-Generated Subjective Global Assessment (aPG-SGA)), cancer symptom burden (revised Edmonton Symptom Assessment System (ESAS-r)), fatigue (Brief Fatigue Inventory (BFI)) and anxiety/depression (Hospital Anxiety and Depression Scale (HADS)), six-minute walk distance, handgrip strength and body composition. At baseline (n = 35, prehabilitation = 17), there were significant negative associations between FACT-G and ESAS-r total score (r = -0.675, p < 0.001), HADS depression (r = -0.618, p < 0.001), BFI (r = -0.612, p < 0.001), aPG-SGA (r = -0.432, p < 0.05) and HADS anxiety (r = -0.397, p < 0.05). There were no associations between FACT-G and strength/function tests or body composition. Robust multivariate regression analysis revealed ESAS-r was the only variable to consistently remain significant and predictive of baseline FACT-G (beta = -0.67 to -0.83, p < 0.05, R2 = 36 to 41%). There were no differences in FACT-G within or between groups at any timepoint. Cancer symptom burden was predictive of poor HRQoL in patients entering a prehabilitation program prior to liver resection. Future prehabilitation studies in this patient population should test whether the addition of supportive care measures to relieve cancer-related symptoms will lead to significant improvements in HRQoL. ClinicalTrials.gov registration NCT03475966.

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