PP306 - A MULTIMODAL PREHABILITATION RCT IN SURGICAL PATIENTS WITH LUNG CANCER: MUSCLE STRENGTH OUTCOMES

PP306

A MULTIMODAL PREHABILITATION RCT IN SURGICAL PATIENTS WITH LUNG CANCER: MUSCLE STRENGTH OUTCOMES

A. Moyen^1,2,*, M. Macasaet^1,2, C. Fleurent-Grégoire^1,2, A. Daher^1,2, R. Zaks^2,3, F. Carli⁴, C. Scheede-Bergdahl⁵, C. Gillis^1,4, S. Chevalier^1,2,6

¹School of Human Nutrition, McGill University, ²Research Institute of the McGill University Health Centre, ³Department of Surgical and Interventional Sciences, ⁴Department of Anesthesia, ⁵Department of Kinesiology and Physical Education, ⁶Department of Medicine, McGill University, Montreal, Canada

Rationale: Low muscle mass and malnutrition are often seen in patients with non-small cell lung cancer (NSCLC) eligible for surgical resection, increasing postoperative morbidity. Prehabilitation aims to prepare patients for surgery and improve recovery. In a 3-arm RCT, we tested the effect of a mixed-nutrient supplement alone (NUT) or combined with exercise (MM, multimodal), compared with placebo-control (CTL), on pre- and postop change in muscle mass and strength in patients with NSCLC.

Methods: NUT and MM participants received supplements (whey protein, leucine, vitamin D and fish oil) for a median of 8.3 [IQR 5.3] wk pre- and 6 wk postop. MM also included daily moderate-intensity aerobic activity and resistance training 3 d/wk. Muscle strength (30-s sit-to-stand, 30-s arm curl, and handgrip tests) and estimated muscle mass (bioelectrical impedance) were assessed at baseline, pre- and postop. Preliminary intent-to-treat analysis assessed outcome changes using linear mixed-effects adjusted for age, sex, BMI.

Results: 94 participants (mean 69.9, SD 6.5 y; 32% males) were included. Preoperatively, arm and leg strength improved within MM (+2.0 [95%CI 0.8, 3.1] and 1.4 [0.5, 2.3], respectively) and NUT (+2.0 [0.7, 3.3]; and +1.1 [0.1, 2.1]), but not in CTL. Handgrip strength and muscle mass did not change significantly. Postoperatively, leg strength remained improved from baseline (+1.3 [0.4, 2.2]) in MM, but not more than CTL (p=0.45). Arm strength remained improved (+2.0 [0.9, 3.1]) more than CTL (p=0.02). NUT maintained improvements in arm strength (+2.0 [0.6, 3.3]). Handgrip recovered similarly across groups (75%).

Conclusion: Multimodal prehabilitation improved arm and leg strength before and preserved gains after surgery in patients with NSCLC. Nutritional supplements alone improved and maintained arm strength, which may support functional independence after surgery. Full trial data will confirm these findings.

Disclosure of Interest: None declared