Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer

Tateaki Naito, Shuichi Mitsunaga, Satoru Miura, Noriatsu Tatematsu, Toshimi Inano, Takako Mouri, Tetsuya Tsuji, Takashi Higashiguchi, Akio Inui, Taro Okayama, Teiko Yamaguchi, Ayumu Morikawa, Naoharu Mori, Toshiaki Takahashi, Florian Strasser, Katsuhiro Omae, Keita Mori, Koichi Takayama

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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 ≥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 (Lifecorder ® , 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 Power ® , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥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 ≥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.

Original languageEnglish
Pages (from-to)73-83
Number of pages11
JournalJournal of Cachexia, Sarcopenia and Muscle
Volume10
Issue number1
DOIs
Publication statusPublished - 01-02-2019

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Non-Small Cell Lung Carcinoma
Exercise
Compliance
Counseling
Neoplasms
Japan
Safety
Drug Therapy
Branched Chain Amino Acids
Resistance Training
Myalgia
Arthralgia
Feasibility Studies
Appetite
Dyspnea
Health Status

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Physiology (medical)

Cite this

Naito, Tateaki ; Mitsunaga, Shuichi ; Miura, Satoru ; Tatematsu, Noriatsu ; Inano, Toshimi ; Mouri, Takako ; Tsuji, Tetsuya ; Higashiguchi, Takashi ; Inui, Akio ; Okayama, Taro ; Yamaguchi, Teiko ; Morikawa, Ayumu ; Mori, Naoharu ; Takahashi, Toshiaki ; Strasser, Florian ; Omae, Katsuhiro ; Mori, Keita ; Takayama, Koichi. / Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer. In: Journal of Cachexia, Sarcopenia and Muscle. 2019 ; Vol. 10, No. 1. pp. 73-83.
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abstract = "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 ≥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 (Lifecorder {\circledR} , 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 Power {\circledR} , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥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 ≥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.",
author = "Tateaki Naito and Shuichi Mitsunaga and Satoru Miura and Noriatsu Tatematsu and Toshimi Inano and Takako Mouri and Tetsuya Tsuji and Takashi Higashiguchi and Akio Inui and Taro Okayama and Teiko Yamaguchi and Ayumu Morikawa and Naoharu Mori and Toshiaki Takahashi and Florian Strasser and Katsuhiro Omae and Keita Mori and Koichi Takayama",
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Naito, T, Mitsunaga, S, Miura, S, Tatematsu, N, Inano, T, Mouri, T, Tsuji, T, Higashiguchi, T, Inui, A, Okayama, T, Yamaguchi, T, Morikawa, A, Mori, N, Takahashi, T, Strasser, F, Omae, K, Mori, K & Takayama, K 2019, 'Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer', Journal of Cachexia, Sarcopenia and Muscle, vol. 10, no. 1, pp. 73-83. https://doi.org/10.1002/jcsm.12351

Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer. / Naito, Tateaki; Mitsunaga, Shuichi; Miura, Satoru; Tatematsu, Noriatsu; Inano, Toshimi; Mouri, Takako; Tsuji, Tetsuya; Higashiguchi, Takashi; Inui, Akio; Okayama, Taro; Yamaguchi, Teiko; Morikawa, Ayumu; Mori, Naoharu; Takahashi, Toshiaki; Strasser, Florian; Omae, Katsuhiro; Mori, Keita; Takayama, Koichi.

In: Journal of Cachexia, Sarcopenia and Muscle, Vol. 10, No. 1, 01.02.2019, p. 73-83.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer

AU - Naito, Tateaki

AU - Mitsunaga, Shuichi

AU - Miura, Satoru

AU - Tatematsu, Noriatsu

AU - Inano, Toshimi

AU - Mouri, Takako

AU - Tsuji, Tetsuya

AU - Higashiguchi, Takashi

AU - Inui, Akio

AU - Okayama, Taro

AU - Yamaguchi, Teiko

AU - Morikawa, Ayumu

AU - Mori, Naoharu

AU - Takahashi, Toshiaki

AU - Strasser, Florian

AU - Omae, Katsuhiro

AU - Mori, Keita

AU - Takayama, Koichi

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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 ≥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 (Lifecorder ® , 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 Power ® , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥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 ≥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.

AB - 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 ≥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 (Lifecorder ® , 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 Power ® , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥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 ≥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.

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