Prehabilitation for Advanced Ovarian Cancer Patients

• ClinicalTrials.gov Identifier: NCT05047926
• Recruitment Status: Recruiting
• First Posted: September 17, 2021
• Last Update Posted: February 27, 2023
• Sponsor: Mayo Clinic
• Information provided by (Responsible Party): Amanika Kumar, M.D., Mayo Clinic

Study Description

Brief Summary:

Physical activity plays an important role in reducing the adverse effects of cancer treatment. There are few studies using prehabilitation to improve peri-operative outcomes in patients undergoing cancer surgery. This study will pilot a program of structured activity for women undergoing neoadjuvant chemotherapy with the intent to improve their physical state prior to surgical intervention and thus improve outcomes.

It has been shown that patients with advanced ovarian cancer may suffer from high levels of cancer -specific distress, depression and anxiety. It has also been proposed that psychological resilience can favorably affect psychological and treatment-related outcomes in cancer patients. Most current studied mindfulness-based interventions are limited by the time commitment required by the patient, which is difficult for patients with advanced cancer undergoing treatment, therefore a virtual program has been created that is more easily accessible.

Frailty is thought to be mediated by senescent cells and their dynamic secretome, referred to as the senescence-associated secretory phenotype (SASP). Senescent cells contribute to age-related tissue deterioration, inflammation, and fibrosis. A group of novel frailty biomarkers obtained at the time of diagnosis has been examined in advanced OC patients. Preliminary data show that these biomarkers strongly correlate with the clinical frailty phenotype, and define a frail subgroup of patients with higher treatment related morbidity and worse survival. These markers may represent important surrogate clinical trial endpoints, as well as deepen the understanding of aging in women with ovarian cancer. In this pilot, these markers and other surrogate endpoints for future novel translational research in the science of aging will be explored.

Condition or disease	Intervention/treatment	Phase
Ovarian Cancer	Behavioral: Exercise - Physical Activity; Behavioral: Resiliency Training; Dietary Supplement: Protein Supplementation	Not Applicable

Detailed Description:

With a rapidly growing older American population, the overall incidence of cancer, including ovarian cancer (OC) is rising. Addressing aging in older OC patients represents a clinically important unmet need. Interventions designed to improve resilience against loss of function, psychological distress, complications and premature mortality in older patients are lacking in OC treatment. Current OC treatment strategies are purely tumor-directed, and do not address host factors. Our overall goal is to test whether a holistic prehabilitation program can be implemented alongside standard tumor-directed therapy in the older OC patient and will improve function, quality of life, and reduce morbidity and mortality. The 12-week period of neoadjuvant chemotherapy prior to cytoreductive surgery is an ideal window of opportunity to utilize such a strategy. Prehabilitation must be: i) practicable at the institutional level, ii) feasible at the participant level, and iii) provide demonstrable benefits.

This pilot trial will examine baseline function of all patients diagnosed with advanced ovarian cancer who are intending on curative intent treatment. Patients will have a range of assessments including functional, psychologic, and biomarkers. Patients undergoing primary debulking surgery will be in an observational arm alone. Patients undergoing neoadjuvant chemotherapy will be assigned to a trimodal prehabilitation program that involves exercise, resilience training, and nutritional support. Patient will be evaluated on this arm at baseline, prior to surgery, post-operatively and at the completion of treatment.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 60 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Supportive Care
• Official Title: Prehabilitation for Advanced Ovarian Cancer Patients
• Actual Study Start Date: October 1, 2021
• Estimated Primary Completion Date: June 15, 2023
• Estimated Study Completion Date: September 15, 2023

Arms and Interventions

Arm	Intervention/treatment
No Intervention: Primary Cytoreductive Surgery; Women diagnosed with or having a high suspicion for ovarian cancer and undergoing primary surgical intervention for debulking of tumor.
Experimental: Neoadjuvant Chemotherapy prior to Cytoreductive Surgery; Women diagnosed with or having a high suspicion for ovarian cancer and recommended to have Neoadjuvant Chemotherapy (NACT) prior to undergoing an interval debulking surgical intervention.	Behavioral: Exercise - Physical Activity; The recommended exercise program will consist walking for 30 mins per day, 3 days per week, at any pace in any environment. In addition the subjects will be given resistance bands and instruction on following the REST program, a home-based upper and lower body strength program that uses resistance bands to improve strength and balance.; Behavioral: Resiliency Training; The Resilient Living program is modified from the Stress Management and Resiliency Training (SMART) program; which has been shown to be effective in improving resiliency, perceived stress, anxiety, and overall quality of life in a variety of populations.; Dietary Supplement: Protein Supplementation; Increased protein intake is recommended for persons with advance cancer due to malnutrition and low albumin levels. Protein intake recommendations are 1.2 -1.5 g/kg/day. A daily protein recommendation will be calculated at the time of enrollment and subjects will be allowed to select their preferred protein supplement.

Outcome Measures

Primary Outcome Measures :

1. Exercise compliance [ Time Frame: 9 weeks ]
   This will evaluate patients ability to follow the prehabilitation program. Each day in which the participant completed >75% of the recommended exercise will be counted as compliant. The goal will be 60% compliance over the course of 9 weeks
2. Nutrition compliance [ Time Frame: 9 weeks ]
   This will evaluate patients ability to follow the prehabilitation program. Each day in which the participant drank 75% of the recommended protein supplement will be counted as compliant. The goal will be for 60% compliance over the course of 9 weeks

Secondary Outcome Measures :

1. Short Physical Performance Battery differences [ Time Frame: baseline ]
   Short Physical Performance Battery will be evaluated at baseline between the two cohorts.
2. Short Physical Performance Battery change [ Time Frame: 26 weeks +/- 12 weeks ]
   Short Physical Performance Battery will be evaluated from baseline to pre-operative and baseline to end of treatment.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer based on imaging and physician diagnosis
• Suspected Stage IIIC or IV disease based on clinician staging and imaging
• Curative intent treatment with platinum-based chemotherapy
• Planned surgical intervention at some point during treatment course.
• Ability to read English
• No diagnosed severe cognitive impairment
• Ability to provide consent
• Ability to utilize technology to watch online modules for the Resilient Living Program

Exclusion Criteria:

• Hemiplegia or paraplegia
• Current pregnancy

Contacts and Locations

Contacts

Contact: Karen P Ishitani, MSN; 507-538-5355; ishitani.karen@mayo.edu

Contact: Maureen A Lemens, BSN; 507-293-1487; lemens.maureen@mayo.edu

Locations

United States, Minnesota

Mayo Clinic; Recruiting

Rochester, Minnesota, United States, 55905

Contact: Karen P Ishitani, MSN, RN 507-538-5535 ishitani.karen@mayo.edu

Contact: Clinical Trials Referral Office 855-776-0015 mayocliniccancerstudies@mayo.edu

Principal Investigator: Amanika Kumar, M.D.

Sponsors and Collaborators

Mayo Clinic

Investigators

• Principal Investigator: Amanika Kumar, MD; Mayo Clinic

More Information

• Responsible Party: Amanika Kumar, M.D., Principal Investigator, Mayo Clinic
• ClinicalTrials.gov Identifier: NCT05047926
• Other Study ID Numbers: 21-005226; NCI-021-09494 ( Registry Identifier: CTRP (Clinical Trials Reporting Program) )
• First Posted: September 17, 2021
• Last Update Posted: February 27, 2023
• Last Verified: February 2023

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Amanika Kumar, M.D., Mayo Clinic:

Ovarian Cancer; Fallopian Tube Cancer; Primary Peritoneal Cancer; Primary Cytoreductive Surgery; Neoadjuvant Chemotherapy; Interval Depbulking Surgery

Additional relevant MeSH terms:

Ovarian Neoplasms; Carcinoma, Ovarian Epithelial; Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Ovarian Diseases; Adnexal Diseases; Genital Neoplasms, Female; Urogenital Neoplasms; Endocrine System Diseases; Gonadal Disorders; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type