a nutrition & exercise prehabilitation intervention on inflammatory biomarkers in ai cancer patients

Conditions: Cancer; Obesity

Summary: the purpose of this study is to assess the feasibility of a prehab intervention among american indian (ai) patients diagnosed with obesity-related cancer and measure inflammatory biomarkers to evaluate the preliminary impact of the trial intervention. the central hypothesis is that this community-informed prehab intervention will demonstrate feasibility, patient acceptability, and modulation of host and tumor-microenvironment inflammatory biomarkers. aim 1: implement the prehab translational clinical trial for ai patients with obesity-related solid tumor cancer scheduled for surgery. aim 2 measure host and tumor-microenvironment (tme) biomarkers using paired serum and tissue samples to compare baseline and post-intervention levels of expression. serum markers include crp, il-6, il-10, tnfa, igf-1, vegf, complete blood count (cbc) with differential, comprehensive metabolic panel (cmp), and prealbumin. tissue markers include ki67, insulin receptor, tnfa, nfkb, nos2, and cleaved caspase 3. aim 3: (optional exploratory aim): assess differential expression of inflammatory genes in the tme using tumor tissue samples to compare baseline and post-intervention levels of expression. this will be done with a panel that analyzes inflammatory genes only.

the research entails a single-arm, pre-post, window-of-opportunity prehab intervention trial. the tailored prehab program will be implemented for cancer patients receiving care at san carlos apache healthcare corporation (scahc) who are preparing for cancer surgery for a 3-week duration in the preoperative window of opportunity. the prehab intervention is designed to modify inﬂammatory biomarkers in paired pre/post-intervention blood and tissue samples. for the pilot intervention, 30 individuals who are 18-80 years old with a diagnosis of obesity-related solid tumor cancer, scheduled at least 3 weeks out from cancer surgery who receive care at scahc will be recruited over the duration of the study. participants meeting criteria will be screened for eligibility. those meeting eligibility criteria who are interested will be consented and enrolled. they will undergo baseline measurements that include medical/ family/cancer history and demographics, baseline anthropometric measures (blood pressure, weight, height, and waist circumference), completion of diet/exercise and health behavior questionnaires, 6-minute walk test, sit-to- stand test and blood samples which will be run for inﬂammatory biomarkers. the consent will include permission to obtain the diagnostic biopsy tissue for the purposes of this research study to measure tissue biomarkers. after baseline evaluation, patients will receive diet and exercise counseling prior to commencing the prehab program. they will receive general nutritional guidance on healthy eating, walking, and instructed on the methods of self-monitoring their activity levels (pedometer, daily log, checklists). they will participate in twice weekly 60-minute training sessions supervised by certiﬁed fitness trainers and perform 30 minutes of walking daily on their own. they will consume 60g of walnuts (1/2cup) which can be consumed raw or incorporated into meals and recipes of their choosing. participants will return to the clinic after 3 weeks of the prehab program to repeat all baseline metrics and participate in an exit interview. residual tissue from the surgical specimen after clinical assessments are completed will be used to measure post-intervention biomarker expression. paired pre/post-intervention blood and tissue samples will be stored and analyzed for biomarker expression at the university of arizona shared resources. analysis of the qualitative data from the exit interviews and the biospecimens will be conducted at the university of arizona.

Eligibility criteria:
inclusion criteria: * age 18-80 years * clinical diagnosis of obesity-related solid tumor cancer: obesity-related solid tumor cancers include thyroid, breast, liver, gallbladder, gastric, pancreatic, colorectal, ovarian, uterine, kidney, esophageal cancers. * preoperative status with plan to undergo an operation to remove the tumor * scheduled at least 3 weeks out from the operation * receiving care at san carlos apache healthcare corporation (scahc) * must be having cancer surgery at san carlos apache healthcare corporation or banner university medical center-tucson exclusion criteria: * current or planned receipt of chemotherapy during the preoperative study period * digestive tract disease that would restrict diet modifications * allergy to the foods intended for the nutrition intervention * uncontrolled cardiac disease or other contraindications to moderate-intensity exercise

Keywords: obesity-related cancer nutrition and exercise prehabilitation intervention inflammatory biomarkers