Preonditioning for patients who will undergo esophaguscardiaresection

The incidence of esophageal cancer has strongly increased the last 15 year,
from 5.4 to 9.5 per 100.000. The 5-year survival rate after curative therapy
seems to increase slowly from ±15% to ±35%.
Because of agreements in the region, curative esophaguscardiaresections (OCR)
of Southern Limburg are situated at AtriumMC, Heerlen. On yearly basis an
amount of 40-45 patients is expected.

The purpose of this research is to investigate the effect and feasability of
multimodal preconditioning for patients who will undergo
esophaguscardiaresection.

This will be a prospective pilot study where 10 patients will follow the
preconditioning protocol compared to 10 patients who will receive the usual
care during the period between neoadjuvant therapy and surgery.

Nutrition: Weekly consults consisting of nutritional assessment, MUST score,
measurement of energy and protein intake and BMI. If there is (a risk of)
malnutrition, the patient will get an individualized nutrition plan, consisting
not only of advice, but also strict nutritional support. During the treatment
the objective is nutrition consisting of sufficient protein and energy values
according to the CBO guidelines of perioperative nourishment.
Physiotherapy: Daily physiotherapy for 15 minutes with an inspiratory threshold
device. Supervised physiotherapy with walking, cycling and muscle training two
times a week two hours in the AtriumMC. A single referral to the smoking
cessation outpatient department when necessary. Check up with twice a long
function investigation and mouth pressure measurement, weekly muscle force
measurements.
Psychology: Before chemo and/or radiotherapy starts, patients will visit the
psycologist. After neoadjuvant therapy they will get a prolonged intake where
questionnaires regarding complaints, quality of life, anxiety and depression
will be filled out. On a daily basis patients will perform visualization
exercises with the use of a relaxation therapy CD. When necessary, patients
will receive a consult every two weeks.

This research is moderately aggravating for patients. Time investment needs to
be made and it might take some physical effort. There are no known risks for
this research.