Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland.
School of Medicine, Trinity College Dublin, Dublin, Ireland.
J Cancer Surviv. 2018 Aug;12(4):601-618. doi: 10.1007/s11764-018-0696-6. Epub 2018 May 23.
The management of oesophageal and gastric cancer can cause significant physical decline, impacting on completion rates and outcomes. This systematic review aimed to (i) determine the impact of chemotherapy, chemoradiotherapy and surgery on physical function; (ii) identify associations between physical function and post-operative outcomes; and (iii) examine the effects of rehabilitation on physical function.
We included randomised controlled trials (RCT), non-RCTs of interventions and cohort studies that measured physical function by objective means in patients with oesophageal or gastric cancer. EMBASE, PubMed, CINAHL, Cochrane Library, SCOPUS, PEDro and the WHO Trial Registry were searched up to June 2016. Risk of bias assessment was performed using a suite of validated tools.
Twenty-five studies involving 1897 participants were included. A meta-analysis was not indicated due to the heterogeneity of the literature. Significant reductions in physical function occur in patients undergoing neoadjuvant treatment and in the first 3 months post-resection. Lower pre-operative exercise capacity is associated with an increased risk of post-operative pulmonary complications (PPCs). Evidence to support exercise prehabilitation and rehabilitation in these treatment pathways is currently lacking.
Chemotherapy, chemoradiation and surgery lead to reduced physical function in patients with oesophageal and gastric cancer. High quality evidence is lacking to prove the benefit of interventions that improve physical function through the treatment pathway and in recovery, and well-designed studies are required. This review was limited due to the heterogeneity of the literature, high risk of bias in some articles and the lack of high quality research encompassing sufficient time points in the patient journey.
Curative treatment for oesophago-gastric cancer can negatively impact on physical function. Rehabilitation programmes have considerable potential to enhance physical function across the oesophago-gastric cancer journey.
食管癌和胃癌的治疗可能导致显著的身体功能下降，从而影响治疗完成率和治疗结局。本系统评价旨在：（i）确定化疗、放化疗和手术对身体功能的影响；（ii）确定身体功能与术后结局之间的关系；（iii）研究康复对身体功能的影响。
我们纳入了随机对照试验（RCT）、非随机对照干预试验和队列研究，这些研究通过客观方法测量了食管癌或胃癌患者的身体功能。我们检索了 EMBASE、PubMed、CINAHL、 Cochrane Library、SCOPUS、PEDro 和世界卫生组织临床试验注册平台，检索时间截至 2016 年 6 月。使用一系列经过验证的工具评估偏倚风险。
纳入了 25 项研究，共涉及 1897 名参与者。由于文献的异质性，未进行荟萃分析。新辅助治疗和术后 3 个月内，患者的身体功能显著下降。术前运动能力较低与术后肺部并发症（PPC）风险增加相关。目前尚无证据支持在这些治疗途径中进行术前和术后康复锻炼。
化疗、放化疗和手术会降低食管癌和胃癌患者的身体功能。目前缺乏高质量证据证明通过治疗途径和恢复来改善身体功能的干预措施有益。本综述受到文献异质性、部分文章存在高偏倚风险以及缺乏涵盖患者治疗过程中足够时间点的高质量研究的限制。
食管癌和胃癌的根治性治疗可能会对身体功能产生负面影响。康复方案具有很大的潜力，可以提高整个食管癌和胃癌治疗过程中的身体功能。
