Exercise prehabilitation program for patients under neoadjuvant treatment for rectal cancer: A pilot study.

CONTEXT: Prehabilitation is emerging as a method of preparing patients physically and mentally for the often disabling effects of cancer treatment. AIMS: This study aims to assess the feasibility and to explore the potential effects of a prehabilitation program consisting of educational physical exercise sessions in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy treatment (NCRT). SETTINGS AND DESIGN: This was a pilot study with 12 patients (3 males and 9 females, age 61 ± 7 years). SUBJECTS AND METHODS: The program included six educational sessions of exercise during NCRT. Adherence to the intervention; quality of life (QoL); anxiety and depression; body mass index; physical fitness (peak oxygen uptake (VO2peak), handgrip and dynamic leg strength); and physical activity (PA) levels were measured. STATISTICAL ANALYSIS USED: Data are reported as the mean ± standard deviation or medians and interquartile ranges for questionnaire-derived data. Secondary outcome measures were compared using the nonparametric Wilcoxon test. The threshold P value for significance was calculated after correction for multiple comparisons using the Bonferroni method. RESULTS: Adherence to the program was 64 of 72 possible exercise education sessions completed, i.e., 89%. We detected a trend toward a significant improvement in VO2peak after the intervention (P = 0.015), together with reduced scores for both depression (P = 0.017) and the QoL domain "emotional function" (P = 0.027). Mean levels of moderate to vigorous PA tended to increase after the exercise program (P = 0.091). CONCLUSIONS: Exercise might be an effective prehabilitation strategy for surgery during the period of NCRT.

The role of immunonutritional support in cancer treatment: Current evidence.

The significant role of the immune system in cancer treatment has given rise to an emerging field of study within oncology, and one that is attracting increasing attention from researchers. Immunotherapy has demonstrated that the immune system is crucial in the fight against cancer. This challenge has led researchers to analyze whether the immune influencing capacity of immunonutrition may aid in improving immune status, modulate the acquired immune response, decrease the treatment toxicity and improve patient outcomes. Immunonutrition, new developed formulas has been demonstrated to improve outcome in surgical patients. This improvement is related to the modulation of the inflammatory response in the peri-operative period. The aim of this review is to analyze current evidence on the benefit of immunonutrition in patients undergoing pro-inflammatory processes in cancer, such as receiving chemotherapy or radiation treatment. With this aim, authors have analyzed the problem studying different aspects: the role of the immune system in cancer treatment, current evidence regarding immunonutrition in perioperative period, current evidence regarding immunonutrition in cancer patients and the relation between immunity and radiotherapy. The conclusions of this review confirm that immunonutrition formulas could modulate inflammatory and immune response in cancer patients. This effect decreases acute toxicity, although the pathways and the measure of this immune response are unclear. Immunonutrition is an emerging field in oncology, and further research is needed.