Cancer symptom burden negatively affects health-related quality of life in patients undergoing prehabilitation prior to liver resection: results from a 12-week randomized controlled trial

This study aimed to (i) explore determinants of health-related quality of life (HRQoL) in patients with cancer awaiting liver resection and entering a prehabilitation program, and (ii) examine the effect of prehabilitation on HRQoL in both the pre-and postoperative period. We randomized patients to prehabilitation or rehabilitation. Prehabilitation began an exercise, nutrition, and relaxation intervention 4 weeks preoperatively; rehabilitation began the same intervention postoperatively. We measured the following at baseline, preoperatively, 4 weeks and 8 weeks postoperatively: HRQoL [Functional Assessment of Cancer Therapy-General (FACT-G)], nutritional status [abridged Patient-Generated Subjective Global Assessment (aPG-SGA)], cancer symptom burden [revised Edmonton Symptom Assessment System (ESAS-r)], fatigue [Brief Fatigue Inventory (BFI)] and anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], 6 min walking distance, handgrip strength, and body composition. At baseline (n = 35, prehabilitation = 17), there were significant negative associations between FACT-G and ESAS-r total score (r = -0.675, p < 0.001), HADS depression (r = -0.618, p < 0.001), BFI (r = -0.612, p < 0.001), aPG-SGA (r = -0.432, p < 0.05), and HADS anxiety (r = -0.397, p < 0.05). There were no associations between FACT-G and strength/function tests or body composition. Robust multivariate regression analysis revealed ESAS-r was the only variable to consistently remain significant and predictive of baseline FACT-G (beta = -0.67 to -0.83, p < 0.05, R-2 = 36%-41%). There were no differences in FACT-G within or between groups at any timepoint. Cancer symptom burden was predictive of poor HRQoL in patients entering a prehabilitation program prior to liver resection. Future prehabilitation studies in this patient population should test whether the addition of supportive care measures to relieve cancer-related symptoms will lead to significant improvements in HRQoL. Clinicaltrials.gov registration NCT03475966.