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Rehabilitation Strategies following Oesophagogastric and Hepatopancreaticobiliary Cancer

Curative treatment for cancers of the upper gastrointestinal tract is associated with numerous side-effects including sarcopenia and nutritional compromise, which are known to increase morbidity, compromise functional capacity and decrease health-related quality of life (HR-QOL) in survivorship. As cancer survival improves in upper gastrointestinal cancer, there is increasing focus on optimising survivorship however research examining rehabilitation programmes in this newly-emergent and complex cohort of cancer survivors is lacking.
We recently designed, implemented and evaluated the Rehabilitation Strategies following Oesophagogastric Cancer (ReStOre) trial, a novel multidisciplinary rehabilitation programme tailored for oesophagogastric cancer survivorship. We have established the feasibility and preliminary efficacy of the ReStOre programme and recognise the need to further examine programme efficacy in a definitive trial.
This programme of work will examine if multidisciplinary rehabilitation can improve functional capacity and HR-QOL in upper gastrointestinal cancer survivors, and complete a cost-analysis of the intervention. Using a convergent parallel mixed methods study design, the rehabilitation programme will be implemented as a 2-armed randomised controlled trial, and HR-QOL will be evaluated using quantitative and qualitative methods.
Following the established model, ReStOre II will prescribe a 12-week programme of supervised aerobic and resistance training, self-directed unsupervised exercise, individualised dietetic counselling and multidisciplinary education for patients who are >3 months following oesophagectomy, gastrectomy, pancreaticoduodenectomy, or major liver resection. A sample of 48 participants per arm will be recruited to establish a mean increase in functional capacity (cardiorespiratory fitness) of 3.5 ml/kg/min with 80% power, 5% significant and 20% drop-out.
Quantitative assessments including cardiopulmonary fitness, functional exercise capacity, muscle strength inflammatory status and HR-QOL, will be completed at baseline, post-intervention and 3 months post intervention (Objective 1). The impact of the intervention on physical, mental and social wellbeing, will be examined during focus groups with intervention participants, immediately post-intervention and at 3-months follow up (Objective 2). The implementation costs of the programme will be analysed in consideration of clinician salaries, overheads and equipment costs (Objective 3).
Following this evaluation, the ReStOre II programme will provide a unique model of multidisciplinary rehabilitation in nutritionally complex upper gastrointestinal cancer survivors.