Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer
Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer
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DOI：
10.1002/jcsm.12351
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发表时间：
2019-02-01
影响因子：
8.9
通讯作者：
Takayama, Koichi
中科院分区：
文献类型：
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作者：
Naito, Tateaki;Mitsunaga, Shuichi;Takayama, Koichi
背景：运动与营养干预相结合可能会改善恶病质癌患者的功能预后。然而，高损耗率和对干预措施的依从性差限制了其疗效。我们的目的是测试早期诱导新的多模式干预的可行性，特别是针对老年晚期癌症患者的晚期癌症营养和运动治疗（NEXTAC）计划。方法本研究为多中心前瞻性单臂研究。我们招募了46名筛选的70岁患者中的30名，这些患者计划接受新诊断的晚期胰腺癌或非小细胞肺癌的一线化疗。使用计步器/加速度计测量身体活动（LifecorderA (R)，铃木株式会社，日本）。为期8周的教育干预包括三次锻炼和三次营养课程。运动干预结合了以家庭为基础的低强度阻力训练和咨询，以促进身体活动。营养干预措施包括标准营养咨询和指导如何处理干扰患者食欲和口服摄入的症状。提供富含支链氨基酸的补品（Inner PowerA (R)，大冢制药株式会社，日本）。研究的主要终点是可行性，其定义为6个疗程中参加(3)4的患者比例。次要终点包括依从性和安全性。结果患者年龄中位数为75岁（范围70-84岁）。12例患者（40%）在基线时为恶病质。29名患者参加了6次计划疗程中的4次（96.7%，95%可信区间，83.3 ~ 99.4）。1名患者因健康状况恶化而退出。补充剂摄入和运动表现的中位天数比例分别为99%和91%。在5例患者中观察到可能与NEXTAC计划相关的不良事件，包括肌肉疼痛（2例为1级）、关节痛（1例为1级）、用力时呼吸困难（1例为1级）和足底腱膜炎（1例为1级）。结论早期诱导多模式干预对老年新诊断的胰腺癌和非小细胞肺癌同步化疗患者具有良好的依从性和安全性。我们目前正在进行一项随机II期研究，以衡量这些干预措施对功能预后的影响。
Background Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. Methods This was a multicentre prospective single-arm study. We recruited 30 of 46 screened patients aged (3)70 years scheduled to receive first-line chemotherapy for newly diagnosed, advanced pancreatic, or non-small-cell lung cancer. Physical activity was measured using pedometers/accelerometer (LifecorderA (R), Suzuken Co., Ltd., Japan). An 8 week educational intervention comprised three exercise and three nutritional sessions. The exercise interventions combined home-based low-intensity resistance training and counselling to promote physical activity. Nutritional interventions included standard nutritional counselling and instruction on how to manage symptoms that interfere with patient's appetite and oral intake. Supplements rich in branched-chain amino acids (Inner PowerA (R), Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending (3)4 of six sessions. Secondary endpoints included compliance and safety. Results The median patient age was 75 years (range, 70-84). Twelve patients (40%) were cachectic at baseline. Twenty-nine patients attended (3)4 of the six planned sessions (96.7%, 95% confidence interval, 83.3 to 99.4). One patient dropped out due to deteriorating health status. The median proportion of days of compliance with supplement consumption and exercise performance were 99% and 91%, respectively. Adverse events possibly related to the NEXTAC programme were observed in five patients and included muscle pain (Grade 1 in two patients), arthralgia (Grade 1 in one patient), dyspnoea on exertion (Grade 1 in one patient), and plantar aponeurositis (Grade 1 in one patient). Conclusions The early induction of multimodal interventions showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. We are now conducting a randomized phase II study to measure the impact of these interventions on functional prognosis.