Objectives: The management of oesophago-gastric cancer can cause significant physical decline, impacting on completion rates and outcomes. This systematic review aimed to examine the impact of oesophago-gastric cancer and its treatments on objectively measured physical function, in particular this review aimed to; i) determine the impact of chemotherapy, chemoradiotherapy and surgery on physical function; ii) identify associations between physical function and postoperative 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: 25 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 three months post-resection. Lower pre-operative exercise capacity is associated with an increased risk of postoperative pulmonary complications (PPCs). Evidence to support exercise prehabilitation and rehabilitation in these treatment pathways is currently lacking. 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.
Discussion: Previously physical function in oesophago-gastric cancer has largely been reported in the literature using QOL questionnaires such as the EORTC-QLQ-C30, and the SF-36. A weakness of this literature is that is self-reported, and subjective, and such measures are limited in their ability to reflect true physical function, as it is well described that there is poor correlation between self-reported physical function and objectively measured exercise capacity [1, 2]. This systematic review demonstrates that there is is a gap in the literature linking the clear attrition on physical function through the curative treatment of oesophago-gastric cancer, and in survivorship, and its relevance to decision making, management, and recovery, and potential for modulation to therapeutic benefit. High quality longitudinal studies are required, as well as rigorous assessment of multidisciplinary programmes in the settings of prehabilitation, rehabilitation, and survivorship for patients with oesophago-gastric cancer.
Ethical Approval: Ethical approval was not required for this study.
References:
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2. Boyle T, Lynch BM, CourneyaKS, Vallance JK. Agreement between accelerometer-assessed and self-reportedphysical activity and sedentary time in colon cancer survivors. Supportive carein cancer : official journal of the Multinational Association of SupportiveCare in Cancer. 2015;23(4):1121-6. doi:10.1007/s00520-014-2453-3.
