Prehabilitation to Improve Cancer Surgery Outcomes in AYA Patients With Extremity Sarcomas
Condition: Sarcoma,Soft Tissue; Osteosarcoma
MeSH terms: Sarcoma; Osteosarcoma
Study type: Interventional

Summary: 
      The purpose of this study was to evaluate the feasibility of a multimodal prehabilitation
      intervention intended to optimize postoperative recovery in adolescents and young adults
      (AYAs) diagnosed with soft tissue and bone-based sarcomas of the upper and lower extremities
      (extremity sarcomas; ES).
    

Detailed description: 
      Objectives:

      This objective of this study was to investigate the feasibility of multimodal prehabilitation
      for adolescents and young adults (AYAs) diagnosed with soft tissue and bone-based sarcomas of
      the upper and lower extremities (extremity sarcomas; ES) and explore its effects on
      measurements of health-related quality of life, physical function, length of hospital stays,
      and post-operative complications. Specific aims of the study included:

        -  To determine the feasibility of conducting a larger phase II investigation of HIIT-based
           multimodal prehabilitation according to three primary criteria, including (i) recruiting
           >=50% of otherwise eligible patients (OEP; i.e., patients meeting all eligibility
           criteria), (ii) no patient experiences a testing-related or an intervention-related
           serious adverse event (SAE), and (iii) patients achieve an exercise intervention
           adherence rate of >=70%.

        -  To further determine the feasibility of conducting a larger phase II investigation of
           HIIT-based multimodal prehabilitation according to the secondary feasibility criteria.

        -  To explore the preliminary effects of prehabilitation on measures of short-term
           perioperative outcomes including health-related quality of life, physical function,
           length of hospital stays, and post-operative complications.

      Methods:

      A single-arm, proof-of-concept trial design was informed by the ORBIT model of behavioural
      treatment development. Mixed methods were employed to obtain relevant context for
      investigating the feasibility of multimodal prehabilitation in newly diagnosed AYAs with ES
      within the circumstances of the COVID-19 pandemic.

      Participants underwent virtual multimodal prehabilitation before undergoing major extremity
      sarcoma surgery. This program encompassed personalized exercise, nutrition, and stress
      management support delivered by a registered kinesiologist, registered dietitian, and
      clinical psychologist, respectively. The interventions were designed to enhance physical and
      psychological resilience to stress, with the objective of improving recovery outcomes and
      mitigating the risk of adverse events.

      Feasibility (e.g., recruitment, safety, tolerability), physical function, and
      patient-reported outcomes were measured at baseline (T0), immediately preoperatively (T1),
      and one month postoperatively (T2).

      Feasibility data and field notes were collected by the research coordinators (during
      recruitment and postoperative follow-up) and by the study lead / research assistants during
      the intervention period. A postoperative interview explored experiences with prehabilitation
      into explore the feasibility and practical considerations of virtual prehabilitation for
      adolescents and young adults with extremity sarcomas.
    

Intervention name(s): Multimodal prehabilitation
Intervention type(s): Behavioral
Intervention description(s): Multimodal Prehabilitation
Aerobic exercise
Home-based, high-intensity interval training (HIIT), 2 days/week
Home-based, moderate-intensity continuous training (MICT), 2-3 days/week
Resistance exercise
Home-based, moderate-intensity resistance training, 2-3 d/wk, all major muscle groups (working around tumour-related deficits), 8-10 exercises, 12-15 repetitions, resistance bands and body weight based
Nutrition
Protein intake 1.2-1.5 g/kg body weight/day in compliance with European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines
Stress management
Daily mindfulness practice, 20 min/session, guided by audio file created at Mount Sinai Hospital
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Preoperative Care; Exercise Therapy; Prehabilitation; Extremity Sarcoma; Adolescents and Young Adults