Malnutrition and patient-reported quality of life determine short-term prehabilitation outcomes and patients’ body composition – early results of the prospective EPPIC prehabilitation trial in oesophageal and pancreatic cancer

Introduction: Prehabilitation improves outcomes in several malignancies, its role in oesophageal and pancreatic cancer is unclear. The EPPIC trial evaluates an out-patient prehabilitation program in oesophageal (EC) and pancreatic (PDAC) cancer prior to resection.

Patients and Methods: The EPPIC trial is a prospective feasibility trial. Baseline parameters, frailty, nutrition status, physical fitness, and quality of life are evaluated. Prior to surgery, patients receive individualized out-patient nutrition therapy, and complete APP-based physical therapy and breathing exercises over a two-week period. Patients’ routine CT scans are automatically segmented with a validated AI-based body composition algorithm. Baseline parameters, nutrition and functional status as well as quality of life and CT-derived body composition measures were available for time of study enrolment and 3 months follow-up.

Results: 53 patients were enrolled, mean age was 65 y (STD 9.92). Preoperatvely, mean BMI was 26.9 kg/m2 (STD 5.4), mean weight loss during the past 6 months was 7.4kg (STD 7.5). 20.7% of patients were diagnosed as frail (CRF>3), malnutrition (NRS>2) was present in 26.4% of patients, and 15.1% had sarcopenia (SARC-F>3) preoperatively. Sarcopenia in functional testing (p≤0.001) and frailty (p≤0.001) were associated with impaired quality of life (EORTC-QLQ-C30). In patients with malnutrition, there was a trend for higher rates of visceral (VAT) (0.76 vs. 0.55, p=0.089) and a decrease in subcutaneous fat tissue (SAT) (0.51 vs. 0.59, p=0.048). Patients with impaired quality of life had lower overall muscle to adipose tissue ratios (0.52 vs. 0.82, p=0.050), higher levels of intramuscular fat deposits (0.24 vs. 0.16, p=0.008) and a trend for visceral fat deposits (0.037 vs. 0.032, p=0.088). At three months follow-up, patients with malnutrition were more likely to lose total muscle volume (-1.22 vs. -0.19, p=0.026). Patients with impaired quality of life at diagnosis experienced a more pronounced reduction of total (-4.64 vs. -1.11, p=0.004) and SAT (-7.63 vs. -2.59, p=0.004).

Conclusion: First results showed a close association of patients’ frailty, nutrition and functional status with patient-reported quality of life. Body composition analysis confirms unique detrimental body composition profiles for patients with malnutrition and impaired quality of life that were identified as major determinants of short-term outcomes after prehabilitation.

Publication History

Article published online:
04 September 2025