Linda O'Neill1, Jonathan Moran2, Emer M Guinan3, John V Reynolds4, Juliette Hussey2. 1. Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland. oneilll8@tcd.ie. 2. Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland. 3. School of Medicine, Trinity College Dublin, Dublin, Ireland. 4. Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland.
Abstract
PURPOSE: The management of oesophageal and gastric cancer can cause significant physical decline, impacting on completion rates and outcomes. This systematic review aimed to (i) determine the impact of chemotherapy, chemoradiotherapy and surgery on physical function; (ii) identify associations between physical function and post-operative outcomes; and (iii) examine the effects of rehabilitation on physical function. METHODS: We included randomised controlled trials (RCT), non-RCTs of interventions and cohort studies that measured physical function by objective means in patients with oesophageal or gastric cancer. EMBASE, PubMed, CINAHL, Cochrane Library, SCOPUS, PEDro and the WHO Trial Registry were searched up to June 2016. Risk of bias assessment was performed using a suite of validated tools. RESULTS: Twenty-five studies involving 1897 participants were included. A meta-analysis was not indicated due to the heterogeneity of the literature. Significant reductions in physical function occur in patients undergoing neoadjuvant treatment and in the first 3 months post-resection. Lower pre-operative exercise capacity is associated with an increased risk of post-operative pulmonary complications (PPCs). Evidence to support exercise prehabilitation and rehabilitation in these treatment pathways is currently lacking. CONCLUSIONS: Chemotherapy, chemoradiation and surgery lead to reduced physical function in patients with oesophageal and gastric cancer. High quality evidence is lacking to prove the benefit of interventions that improve physical function through the treatment pathway and in recovery, and well-designed studies are required. This review was limited due to the heterogeneity of the literature, high risk of bias in some articles and the lack of high quality research encompassing sufficient time points in the patient journey. IMPLICATIONS FOR CANCER SURVIVORS: Curative treatment for oesophago-gastric cancer can negatively impact on physical function. Rehabilitation programmes have considerable potential to enhance physical function across the oesophago-gastric cancer journey.
PURPOSE: The management of oesophageal and gastric cancer can cause significant physical decline, impacting on completion rates and outcomes. This systematic review aimed to (i) determine the impact of chemotherapy, chemoradiotherapy and surgery on physical function; (ii) identify associations between physical function and post-operative outcomes; and (iii) examine the effects of rehabilitation on physical function. METHODS: We included randomised controlled trials (RCT), non-RCTs of interventions and cohort studies that measured physical function by objective means in patients with oesophageal or gastric cancer. EMBASE, PubMed, CINAHL, Cochrane Library, SCOPUS, PEDro and the WHO Trial Registry were searched up to June 2016. Risk of bias assessment was performed using a suite of validated tools. RESULTS: Twenty-five studies involving 1897 participants were included. A meta-analysis was not indicated due to the heterogeneity of the literature. Significant reductions in physical function occur in patients undergoing neoadjuvant treatment and in the first 3 months post-resection. Lower pre-operative exercise capacity is associated with an increased risk of post-operative pulmonary complications (PPCs). Evidence to support exercise prehabilitation and rehabilitation in these treatment pathways is currently lacking. CONCLUSIONS: Chemotherapy, chemoradiation and surgery lead to reduced physical function in patients with oesophageal and gastric cancer. High quality evidence is lacking to prove the benefit of interventions that improve physical function through the treatment pathway and in recovery, and well-designed studies are required. This review was limited due to the heterogeneity of the literature, high risk of bias in some articles and the lack of high quality research encompassing sufficient time points in the patient journey. IMPLICATIONS FOR CANCER SURVIVORS: Curative treatment for oesophago-gastric cancer can negatively impact on physical function. Rehabilitation programmes have considerable potential to enhance physical function across the oesophago-gastric cancer journey.
Authors: L Thorsen; W Nystad; H Stigum; M Hjermstad; L Oldervoll; E W Martinsen; K Hornslien; S B Strømme; A A Dahl; S D Fosså Journal: J Sports Med Phys Fitness Date: 2006-03 Impact factor: 1.637
Authors: Connie Yip; Vicky Goh; Andrew Davies; James Gossage; Rosalind Mitchell-Hay; Orla Hynes; Nick Maisey; Paul Ross; Andrew Gaya; David B Landau; Gary J Cook; Nyree Griffin; Robert Mason Journal: Eur Radiol Date: 2014-02-18 Impact factor: 5.315
Authors: Chelsia Gillis; Chao Li; Lawrence Lee; Rashami Awasthi; Berson Augustin; Ann Gamsa; A Sender Liberman; Barry Stein; Patrick Charlebois; Liane S Feldman; Francesco Carli Journal: Anesthesiology Date: 2014-11 Impact factor: 7.892
Authors: Mikael Lund; Gabriella Alexandersson von Döbeln; Magnus Nilsson; Reidar Winter; Lars Lundell; Jon A Tsai; Sigridur Kalman Journal: Radiat Oncol Date: 2015-01-13 Impact factor: 3.481
Authors: Maarten A van Egmond; Raoul H H Engelbert; Jean H G Klinkenbijl; Mark I van Berge Henegouwen; Marike van der Schaaf Journal: J Med Internet Res Date: 2020-06-09 Impact factor: 5.428
Authors: C Simonsen; S Thorsen-Streit; A Sundberg; S S Djurhuus; C E Mortensen; C Qvortrup; B K Pedersen; L B Svendsen; P de Heer; J F Christensen Journal: BJS Open Date: 2020-08-28