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Randomized Controlled Trial
. 2015 Oct;20(10):1216-22.
doi: 10.1634/theoncologist.2015-0178. Epub 2015 Sep 4.

A Walk-and-Eat Intervention Improves Outcomes for Patients With Esophageal Cancer Undergoing Neoadjuvant Chemoradiotherapy

Yu-Juan Xu  1 , Jason Chia-Hsien Cheng  1 , Jang-Ming Lee  1 , Pei-Ming Huang  1 , Guan-Hua Huang  1 , Cheryl Chia-Hui Chen  2
Affiliations
Randomized Controlled Trial

A Walk-and-Eat Intervention Improves Outcomes for Patients With Esophageal Cancer Undergoing Neoadjuvant Chemoradiotherapy

Yu-Juan Xu et al. Oncologist. 2015 Oct.

Abstract
in English, Chinese

Background: Preserving functional walking capacity and nutritional status is important for patients with esophageal cancer, but no effective intervention is available, particularly during active treatment.

Methods: This pilot randomized controlled trial tested the effects of a walk-and-eat intervention for patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy. Participants with locally advanced esophageal cancer stage IIB or higher (n = 59) were randomly assigned to receive the walk-and-eat intervention (n = 30; nurse-supervised walking three times per week and weekly nutritional advice) or usual care (n = 29; control group) during 4-5 weeks of chemoradiotherapy. Primary endpoints were changes in distance on the 6-minute walk test, hand-grip strength, lean muscle mass, and body weight between initiation and completion of intervention.

Results: Participants (mean age: 59.6 years) were mostly male (92.9%) with squamous cell carcinoma (96.4%). During chemoradiotherapy, participants who received the walk-and-eat intervention had 100-m less decline than controls in walk distance (adjusted p = .012), 3-kg less decrease in hand-grip strength (adjusted p = .002), and 2.7-kg less reduction in body weight (adjusted p < .001), regardless of age. The intervention group also had significantly lower rates of need for intravenous nutritional support and wheelchair use.

Conclusion: The nurse-led walk-and-eat intervention is feasible and effective to preserve functional walking capacity and nutritional status for patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy.

摘要

背景. 保存功能性步行能力及营养状态对食道癌患者而言非常重要, 但目前尚无有效干预措施, 尤其是在积极治疗期间。

方法. 本项初步随机对照临床试验检验了步行-饮食干预对接受新辅助放化疗的食道癌患者的作用。在为期 4 ∼ 5 周的放化疗期间, 将高于或等于 IIB 期的局部晚期食道癌患者 (n = 59) 随机分配至步行-饮食干预组 (n = 30, 在护士指导下每周步行 3 次, 同时每周给予营养咨询建议) 或常规护理 (n = 29, 对照组)。主要终点为干预开始和结束时六分钟步行距离试验、手握力、肌肉量和体重的变化。

结果. 参与者 (平均年龄为 59.6 岁) 中多数为男性 (92.9%), 患有鳞状细胞癌 (96.4%)。在放化疗期间, 接受步行-饮食干预的受试者步行距离的降幅比对照组少 100 m (校正后P = 0.012), 握力降幅比对照组少 3 kg (校正后P = 0.002), 体重降幅比对照组少 2.7 kg (校正后P < 0.001), 且不受年龄影响。干预组需要静脉营养支持和使用轮椅的频率显著低于对照组。

结论. 对于接受新辅助放化疗的食道癌患者, 在护士指导下接受步行-饮食干预具有可行性, 并且能有效保存功能性步行能力和营养状态。The Oncologist 2015;20:1216–1222

对临床实践的提示: 对食道癌患者而言, 新辅助放化疗常伴有影响食欲和体重的副作用, 并且可导致体力活动明显下降, 继而削弱力量、肌肉量和功能性步行能力。本研究提示参加步行-饮食干预可能减少食道癌患者中的这些副作用。如医生和护理领导能合作促进患者遵循干预方案, 那么护士可以在肿瘤放疗科实施这些干预。

Keywords: Esophageal cancer; Exercise; Neoadjuvant therapy; Nutrition; Randomized controlled trial.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Flowchart of participants.
See this image and copyright information in PMC

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