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


CONCLUSIONS
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.
School of Nursing and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan, Republic of China; Division of Radiation Oncology, Department of Oncology, and Division of Thoracic Surgery, Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan, Republic of China.
Yu-Juan
YJ
Xu
School of Nursing and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan, Republic of China; Division of Radiation Oncology, Department of Oncology, and Division of Thoracic Surgery, Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan, Republic of China.
Jason Chia-Hsien
JC
Cheng
School of Nursing and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan, Republic of China; Division of Radiation Oncology, Department of Oncology, and Division of Thoracic Surgery, Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan, Republic of China.
Jang-Ming
JM
Lee
School of Nursing and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan, Republic of China; Division of Radiation Oncology, Department of Oncology, and Division of Thoracic Surgery, Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan, Republic of China.
Pei-Ming
PM
Huang
School of Nursing and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan, Republic of China; Division of Radiation Oncology, Department of Oncology, and Division of Thoracic Surgery, Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan, Republic of China.
Guan-Hua
GH
Huang
School of Nursing and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan, Republic of China; Division of Radiation Oncology, Department of Oncology, and Division of Thoracic Surgery, Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan, Republic of China cherylchen@ntu.edu.tw.
Cheryl Chia-Hui
CC
Chen
D000368:Aged; D001835:Body Weight; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009752:Nutritional Status; D011897:Random Allocation; D016896:Treatment Outcome; D016138:Walking
Esophageal cancer; Exercise; Neoadjuvant therapy; Nutrition; Randomized controlled trial