Gastric cancer patients may exhibit malnutrition and sarcopenia with attendant significant risk of physical decline. A reduction in exercise capacity during neoadjuvant therapy for esophago-gastric cancer may occur. Conversely, a preoperative conditioning intervention aimed at optimizing physical status, was shown to improve perioperative functional capacity in esophagogastric cancer. This is a pilot study aimed at evaluating the feasibility of recruitment, randomization, retention, and implementation of an exercise counselling program in gastric cancer during perioperative treatment. Forty patients with operable stage >T1 NO esophagogastric junction and gastric adenocarcinoma, candidates for FLOT (with 5-fluorouracil/leucovorin, oxaliplatin and docetaxel) perioperative chemotherapy will be randomized into a control group, receiving standard care and an intervention group treated with standard care plus an exercise counselling program. This consists in an initial phase of N. 3 theoretical and practical sessions within 1-month period, starting from the first functional evaluation visit after diagnosis (T0). A second visit (T1) will take place immediately before the surgery after the completion of 4 cycles of FLOT. After the surgery, patients will undergo to another exercise counselling session and follow the same exercise protocol adapted during the third functional evaluation visit (T2). T3 andT4 evaluations will take place at 4 and 6 months after surgery respectively. The efficacy of the intervention will be evaluated by means of: CT scan (planned for the staging of the disease), the EORTC QLQ-C30 questionnaire and the CGA classification of frailty. Volume of physical activity, fitness, body composition anthropometric and biochemical parameters will also be evaluated. We expect to assess that this counselling approach is a feasible intervention enabling to improve QoL and mitigate therapy-related toxicity in the perioperative setting of gastric cancer.
Physical activity is increasingly considered a basic strategy to prevent and control cancer.
Physical exercise added to standard care can improve quality of life, especially physical functioning, depression and fatigue in patients with cancer. Aerobic exercise training has been shown to significantly improve outcomes and objective physical functioning without interfering with medical treatments or response. Moreover, PA is considered a promising method to support cancer patients during therapy.
A final consideration is that cancer survivors have a higher probability of hospitalization associated with relapses and therapy-related adverse events, accelerating functional or health decline.
The project is aimed at implementing a counselling-based method to promote and maintain a physically active lifestyle in patients with gastro-esophageal junction and gastric cancer, who are considered for perioperative chemotherapy.
We seek to develop and share good practices by promoting health-enhancing physical activity in the field of cancer care. The present research takes place in the wider outlook of the exercise oncology to define and share good practices, counselling protocols and procedures to foster PA in cancer care and overcome cultural barriers that impede the dissemination of exercise oncology among physicians, sports professionals and patients.
We expect to demonstrate that PA with a counselling approach is a feasible intervention in patients affected with both gastric and gastroesophageal cancer enabling improvement of QoL and mitigate therapy-related toxicity in the perioperative setting.