Fitness before cancer surgery shown to be important predictor of survival

New research with cancer patients has shown being fit before surgery influences outcomes more than muscle-wastage associated with cancer treatments.

The study assessed patients with cancer of the upper gastrointestinal tract, which runs from the mouth to the top of the small intestine. It found that physical fitness before surgery is a key factor in survival.

This adds support for the existing Fit-4-Surgery programme running in Southampton, where cancer patients are enrolled in research studies investigating the utility of tailored exercise programmes before surgery.

Is the patient fit enough?

Overall, 160 patients with upper gastrointestinal cancer took part. They were all undergoing chemotherapy or chemoradiotherapy and surgery as part of their treatment.

The research team analysed the results of cardiopulmonary exercise tests – a measure of fitness – for 100 of these patients.

They found fitness before starting any treatment was an indicator of how well the patient recovered from surgery. There was an association between poor fitness and survival a year after the operation.

By comparing CT scans before and after chemotherapy, the researchers also found a reduction in chest wall muscle structure and function was associated with a lower chance of survival. Their results are published in NIHR Open Research and more the Journal of Surgical Oncology.

Southampton’s Mr Malcolm West, who was part of the research team, says this shows doctors should consider whether patients are fit enough to withstand the known drop in fitness caused by cancer treatments before recommending these treatments or surgery.

What is Fit-4-Surgery?

The Fit-4-Surgery programme, led by our critical care research team, offers ‘prehabilitation’ for cancer patients. Prehabilitation is like rehabilitation, in that it helps patients recover from surgery - but instead of happening after their operation, prehabilitation happens before.

They are trialling specific multimodality programmes that include exercise, nutrition and psychology interventions in the run up to surgery, as well as a ‘surgery school’, to improve outcomes through the Fit-4-Surgery programme.

If found to be suitable for patients with cancer of the upper gastrointestinal tract, this could help to increase their fitness and improve outcomes from surgery.