The RESTORE Randomized Controlled Trial: Impact of a Multidisciplinary Rehabilitative Program on Cardiorespiratory Fitness in Esophagogastric cancer Survivorship.

O’Neill LM; Guinan E; Doyle SL; Bennett AE; Murphy C; Elliott JA;
O’Sullivan J; Reynolds JV; Hussey J.

Annals of Surgery. 268(5):747-755, 2018 11.

OBJECTIVE: The Rehabilitation Strategies in Esophagogastric cancer
(RESTORE) randomized controlled trial evaluated the efficacy of a 12-week
multidisciplinary program to increase the cardiorespiratory fitness and
health-related quality of life (HRQOL) of esophagogastric cancer

BACKGROUND: Patients following treatment for esophagogastric cancer are
at risk of physical deconditioning, nutritional compromise, and
sarcopenia. Accordingly, compelling rationale exists to target these
impairments in recovery.

METHODS: Disease-free patients treated for esophagogastric cancer were
randomized to either usual care or the 12-week RESTORE program (exercise
training, dietary counseling, and multidisciplinary education). The
primary outcome was cardiopulmonary exercise testing (VO2peak). Secondary
outcomes included body composition (bioimpedance analysis), and HRQOL
(EORTC-QLQ-C30). Outcomes were assessed at baseline (T0), postintervention
(T1), and at 3-month follow-up (T2).

RESULTS: Twenty-two participants were randomized to the control group
[mean (standard deviation) age 64.14 (10.46) yr, body mass index 25.67
(4.83) kg/m, time postsurgery 33.68 (19.56) mo], and 21 to the
intervention group [age 67.19(7.49) yr, body mass index 25.69(4.02) kg/m,
time postsurgery 23.52(15.23) mo]. Mean adherence to prescribed exercise
sessions were 94(12)% (supervised) and 78(27)% (unsupervised). Correcting
for baseline VO2peak, the intervention arm had significantly higher
VO2peak at both T1, 22.20 (4.35) versus 21.41 (4.49) mL . min . kg, P <
0.001, and T2, 21.75 (4.27) versus 20.74 (4.65) mL . min . kg, P = 0.001,
compared with the control group. Correcting for baseline values, no
changes in body composition or HRQOL were observed.

CONCLUSIONS: The RESTORE program significantly improved cardiorespiratory
fitness of disease-free patients after esophagogastric cancer surgery,
without compromise to body composition. This randomized controlled trial
provides proof of principle for rehabilitation programs in esophagogastric