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Table of Contents
LETTER TO EDITOR
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 193-194

Preparation is key: Prehabilitation for patients receiving high-dose chemotherapy and autologous stem cell transplant


1 Department of Clinical Hematology and Stem Cell Transplantation, Dayanand Medical College, Ludhiana, Punjab, India
2 Department of Cardiac Critical Care, Dayanand Medical College, Ludhiana, Punjab, India

Date of Submission18-Jan-2022
Date of Decision24-Jan-2022
Date of Acceptance25-Jan-2022
Date of Web Publication24-Feb-2022

Correspondence Address:
Suvir Singh
Department of Clinical Hematology and Bone Marrow Transplantation, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_35_22

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How to cite this article:
Singh S, Kaur G. Preparation is key: Prehabilitation for patients receiving high-dose chemotherapy and autologous stem cell transplant. Cancer Res Stat Treat 2022;5:193-4

How to cite this URL:
Singh S, Kaur G. Preparation is key: Prehabilitation for patients receiving high-dose chemotherapy and autologous stem cell transplant. Cancer Res Stat Treat [serial online] 2022 [cited 2022 May 28];5:193-4. Available from: https://www.crstonline.com/text.asp?2022/5/1/193/342445



Crowe et al. recently published an interventional study describing the impact of a multidisciplinary allied health intervention in patients with hematologic malignancies undergoing autologous stem cell transplantation (ASCT).[1] A total of 116 patients underwent evaluation and intervention in the domains of physical exercise, nutrition, and clinical psychology before proceeding with ASCT. Exercise interventions were based on the Exercise and Sports Science Australia guidelines and included up to 150 min of moderate activity per week, along with resistance training. The nutritional intervention consisted of dietary consultations, with the assessment of baseline dietary patterns and use of therapeutic diets where indicated. Psychology interventions included a 60 min baseline assessment followed by repeat appointments to maintain motivation and manage worry and treatment-related pain. The interventions were well accepted and resulted in clinically relevant benefits in physical function, nutritional status, and patient-reported quality-of-life scores. Although statistical analysis of effectiveness was not possible due to patient attrition, this concept introduces a novel pre-ASCT intervention and merits further evaluation.

High-dose high-dose chemotherapy and ASCT represent major physiological stressors. It leads to significant disturbances in nutrition and physical functioning. It has been observed that the process of transplant is associated with a median of 79% reduction in oral intake with a 4%–5% weight loss at the time of discharge.[2] Adult patients at risk of malnutrition are at risk of a more extended hospital stay and a higher risk of nosocomial infections, indicating a potential role of prior nutritional intervention.[3] Reduction in oral intake during transplantation often prompts the initiation of parenteral nutrition, which is associated with several complications, including central venous catheter placement and a greater need for empiric antifungals.[4] These problems lead to a significant increase in cost, a major challenge for resource-constrained settings.

Similar difficulties are also noted in the domain of physical activity. Patients undergoing allogeneic transplantation with a more extended hospital stay and need for immunosuppression have a well-described association between physical activity and transplant-related complications and quality-of-life scores.[5] A similar phenomenon is now known to occur in patients undergoing ASCT, as reduced physical activity during the period of admission for ASCT was significantly associated with a lower quality-of-life.[6] In an elegant study from Japan, significant muscle wasting was observed in patients admitted for ASCT for lymphoma after a median hospital stay of 24 days.[7] These symptoms are not inconsequential, as several patients report significant fatigue several years following transplantation, leading to adverse physical functioning and quality-of-life.[8] Even if physical functioning gradually improves, it continues to be lower than pre-transplant levels. For this reason, initiation of physical activity appears to be most beneficial when initiated before admission for ASCT.[9]

Even in countries with higher per capita income than India, up to 33% of patients have been observed to be at risk for malnutrition during or following chemotherapy.[10] Several tools enable the identification of high-risk patients and screening for malnutrition and can be incorporated into routine practice as part of the pre-transplant assessment.[11]

ASCT in India was initially fraught with a high transplant-related mortality, but now, outcomes have been reported to be similar to Western data. It is probably time to breach the next barrier of quality-of-life and long-term survivorship issues among patients undergoing ASCT in India. A holistic multi-departmental approach to patient evaluation appears to be the next step forward.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Crowe J, Francis JJ, Edbrooke L, Loeliger J, Joyce T, Prickett C, et al. Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre. Support Care Cancer 2022;30:1841-52.  Back to cited text no. 1
    
2.
Singh S, Singh K, Singh J, Paul D, Jain K. Altered oral intake during hematopoietic stem cell transplantation: Patterns and countermeasures. Indian J Med Spec 2021;12:137-41.  Back to cited text no. 2
  [Full text]  
3.
Lazarow H, Nicolo M, Compher C, Kucharczuk CR, Stadtmauer EA, Landsburg DJ. Nutrition-related outcomes for autologous stem cell transplantation patients. Clin Lymphoma Myeloma Leuk 2019;19:e393-8.  Back to cited text no. 3
    
4.
Guièze R, Lemal R, Cabrespine A, Hermet E, Tournilhac O, Combal C, et al. Enteral versus parenteral nutritional support in allogeneic haematopoietic stem-cell transplantation. Clin Nutr 2014;33:533-8.  Back to cited text no. 4
    
5.
Morishita S, Tsubaki A, Hotta K, Fu JB, Fuji S. The benefit of exercise in patients who undergo allogeneic hematopoietic stem cell transplantation. J Int Soc Phys Rehabil Med 2019;2:54-61.  Back to cited text no. 5
  [Full text]  
6.
Baldeo C, Moreno VY, Khurana S, Iqbal M, Azzouqa AG, Sher T, et al. Decreased physical activity in autologous stem cell recipients leads to reduced QOL scores during hospitalization. Blood 2018;132:5895.  Back to cited text no. 6
    
7.
Hirota K, Matsuse H, Koya S, Hashida R, Bekki M, Yanaga Y, et al. Risks of muscle atrophy in patients with malignant lymphoma after autologous stem cell transplantation. Phys Ther Res 2021;24:69-76.  Back to cited text no. 7
    
8.
Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN. Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: A review of the literature. Psychooncology 2009;18:113-27.  Back to cited text no. 8
    
9.
Liang Y, Zhou M, Wang F, Wu Z. Exercise for physical fitness, fatigue and quality of life of patients undergoing hematopoietic stem cell transplantation: A meta-analysis of randomized controlled trials. Jpn J Clin Oncol 2018;48:1046-57.  Back to cited text no. 9
    
10.
Álvaro Sanz E, Abilés J, Garrido Siles M, Rivas Ruíz F, Tortajada Goitia B, Domínguez AR. Evaluation of a protocol to detect malnutrition and provide nutritional care for cancer patients undergoing chemotherapy. Sci Rep 2020;10:21186.  Back to cited text no. 10
    
11.
Shirodkar M, Mohandas KM. Subjective global assessment: A simple and reliable screening tool for malnutrition among Indians. Indian J Gastroenterol 2005;24:246-50.  Back to cited text no. 11
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