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INPACT: Implementation of Nutritional Support and Physical Activity During Cancer Treatment

4. November 2026 aktualisiert von: General Hospital Groeninge

The INPACT study investigates whether a structured program combining physical exercise, nutritional support, and breathing exercises can improve physical fitness and recovery in patients undergoing liver surgery for cancer.

Approximately 103 adult patients with primary liver cancer or liver metastases who are scheduled for liver resection will participate. Participants will be randomly assigned to one of two groups. The control group will receive usual care, including general advice on maintaining physical activity and a healthy diet. The intervention group will follow a structured prehabilitation and rehabilitation program consisting of supervised and home-based exercise, nutritional support including protein supplementation, and daily breathing exercises.

The program starts approximately four weeks before surgery and continues after surgery during the rehabilitation period. Both groups will undergo assessments of physical fitness, muscle strength, nutritional status, quality of life, and other health outcomes at several time points before and after surgery.

The primary aim of the study is to determine whether the multimodal prehabilitation program improves patients' functional capacity before surgery. The study will also evaluate physical performance, nutritional status, quality of life, postoperative recovery and complications, safety, and adherence to the program.

Studienübersicht

Status

Noch keine Rekrutierung

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

INPACT (Implementation of Nutritional Support and Physical Activity during Cancer Treatment) is a prospective randomized controlled trial investigating the role of multimodal prehabilitation in patients undergoing oncological liver resection for primary liver cancer or liver metastases.

Patients undergoing liver surgery frequently present with impaired physical fitness, nutritional deficits, reduced physiological reserve, and the consequences of previous cancer treatments. These factors may negatively affect their ability to tolerate major surgery and recover adequately afterwards. Functional capacity has been identified as an important indicator of physiological reserve and has been associated with postoperative outcomes in surgical oncology populations.

Prehabilitation aims to optimize patients before surgery by improving their physical condition and nutritional status during the period between diagnosis and surgery. This interval represents a potential window of opportunity to enhance a patient's resilience to surgical stress. Previous studies have shown that multimodal prehabilitation programs combining exercise training, nutritional support, and psychological or respiratory interventions may improve preoperative functional capacity and patient wellbeing. However, evidence remains limited in patients undergoing oncological liver resection, particularly in highly optimized healthcare settings where enhanced recovery pathways and minimally invasive surgical techniques are already routinely implemented.

The INPACT study evaluates a multimodal program consisting of structured exercise training, nutritional support, and breathing exercises initiated before surgery and continued during postoperative rehabilitation. The study aims to determine whether this approach can improve patients' functional capacity before surgery and contribute to improved recovery following liver resection.

In addition to evaluating the direct effects of prehabilitation on functional capacity, the study will provide further insight into nutritional status, patient-reported outcomes, postoperative recovery, healthcare utilization, biological markers of inflammation and recovery, and long-term oncological outcomes. The results may contribute to the development and implementation of evidence-based prehabilitation programs for patients undergoing major oncological surgery.

Studientyp

Interventionell

Einschreibung (Geschätzt)

103

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienkontakt

Studienorte

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

18 Jahre und älter (Erwachsene, Älterer Erwachsener)

Akzeptiert gesunde Freiwillige

Nein

Studienberechtigte Geschlechter

Alle

Beschreibung

Inclusion Criteria:

  • Age ≥18 years
  • Diagnosed with a primary liver cancer or metastases of the liver.
  • Patients who need elective surgery (resection)
  • Understanding and able to write Dutch or French
  • Able and willing to provide written informed consent

Exclusion Criteria:

  • Paralytic or immobilised patients who are not able to perform exercises
  • Patients scheduled for an ablation
  • Kidney dialyse
  • Impossibility to wait for 4/5 weeks for elective surgery
  • Underlying medical conditions or orthopedic impairments which in the opinion of the investigator places the patient at an unacceptable risk for participation in the study
  • Logistic reasons preventing the patient to participate in the pre- and rehabilitation program.
  • Unable to perform 6 MWT
  • Active cardiac ischemia

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Unterstützende Pflege
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Keine (Offenes Etikett)

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: Multimodal Prehabilitation and Rehabilitation

Participants in the intervention group will follow a structured multimodal prehabilitation and rehabilitation program consisting of physical exercise, nutritional support with protein supplementation, and daily breathing exercises. The prehabilitation program starts approximately four weeks before surgery. After surgery, the program is gradually resumed during the rehabilitation phase according to the patient's recovery and individual capacity.

The multimodal program combines physical exercise, nutritional support, and breathing exercises. During the approximately four-week preoperative period, participants perform two supervised in-hospital exercise sessions per week and three home-based cycling sessions per week. Participants also receive nutritional support including daily protein supplementation and perform daily breathing exercises using a Moonbird device. After surgery, the program is gradually resumed during the rehabilitation phase according to the patient's postoperative recovery and individual capacity.

Aktiver Komparator: Usual Care

Participants in the control group will receive usual care. Patients are encouraged to remain physically active and receive general advice regarding physical activity and healthy nutrition, but no individualized structured exercise and nutritional program is prescribed or monitored.

Participants receive usual care for patients undergoing oncologic liver surgery. As part of usual care, patients are encouraged to remain physically active and receive general advice regarding physical activity and healthy nutrition. No individualized structured prehabilitation and rehabilitation program is prescribed or monitored.

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Functional capacity measured by the 6-Minute Walk Test (6MWT)
Zeitfenster: 4 weeks after baseline, prior to surgery

Functional capacity will be assessed using the 6-Minute Walk Test (6MWT). The distance walked during 6 minutes will be recorded in meters. The 6MWT distance at the preoperative assessment will be compared between the multimodal prehabilitation group and the usual care group.

4 weeks after baseline, prior to surgery

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Change in functional capacity measured by the 6-Minute Walk Test (6MWT)
Zeitfenster: From baseline to 4 weeks after baseline and 6 weeks after surgery

Change in distance walked during the 6-Minute Walk Test (6MWT), expressed in meters, will be assessed and compared between the intervention and usual care groups.

From baseline to 4 weeks after baseline and 6 weeks after surgery
Cardiorespiratory fitness measured by VO2max
Zeitfenster: Baseline, 4 weeks after baseline, and 6 weeks after surgery

Cardiorespiratory fitness will be assessed using cardiopulmonary exercise testing (CPET). Maximum oxygen uptake (VO2max) will be compared between the intervention and usual care groups.

Baseline, 4 weeks after baseline, and 6 weeks after surgery
Handgrip strength
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Upper-body muscle strength will be assessed using a handgrip strength test and expressed in kilograms. Results will be compared between groups over time.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Lower-extremity muscle strength measured by Biodex
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Lower-extremity muscle strength will be assessed using Biodex dynamometry and compared between the intervention and usual care groups over time.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Single-leg calf raise performance
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Lower-extremity muscle performance will be assessed using the single-leg calf raise test and compared between groups over time.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Sit-to-stand performance
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Functional lower-extremity performance will be assessed using the Sit-to-Stand Test. Participants are instructed to stand up and sit down 10 times as quickly as possible from a chair without using their hands. The outcome measure is the time required to complete 10 repetitions, expressed in seconds. Scores range from 0 seconds to no predefined maximum value. Lower completion times indicate better lower-extremity functional performance, whereas higher completion times indicate worse functional performance.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Health-related quality of life measured by EORTC QLQ-C30
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Health-related quality of life will be assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Scores are linearly transformed to a 0-100 scale according to the EORTC scoring manual. For the Global Health Status/Quality of Life scale and functional scales, higher scores indicate better quality of life and functioning. For symptom scales and single-item symptom measures, higher scores indicate greater symptom burden and worse quality of life.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Health-related quality of life measured by EQ-5D
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Health-related quality of life and general health status will be assessed using the EuroQol 5-Dimension Questionnaire (EQ-5D). The EQ-5D descriptive system generates an index score ranging from less than 0 (health states considered worse than death) to 1.0 (perfect health), with higher scores indicating better health-related quality of life. The EQ-5D also includes a Visual Analogue Scale (EQ VAS), ranging from 0 to 100, where higher scores indicate better perceived health status.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Postoperative complications measured by the Comprehensive Complication Index (CCI)
Zeitfenster: within 90 days after surgery

Postoperative morbidity will be assessed using the Comprehensive Complication Index (CCI), which summarizes all postoperative complications weighted according to their severity. The CCI score ranges from 0 to 100, where 0 indicates no postoperative complications and 100 indicates death. Higher scores indicate a greater overall burden of postoperative complications and therefore a worse postoperative outcome.

within 90 days after surgery
Length of hospital stay
Zeitfenster: From the date of surgery until hospital discharge, assessed up to 90 days after surgery

Length of postoperative hospital stay will be recorded as the number of days from the date of surgery until discharge from the hospital and compared between the intervention and usual care groups.

From the date of surgery until hospital discharge, assessed up to 90 days after surgery
Nutritional status measured by PG-SGA SF
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Nutritional status will be assessed using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). The total PG-SGA SF score ranges from 0 to 36, with higher scores indicating a greater risk of malnutrition and a worse nutritional status. Lower scores indicate a better nutritional status.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Compliance with nutritional supplementation
Zeitfenster: From baseline until 6 weeks after surgery

Compliance with the prescribed nutritional supplementation will be assessed using the patient diary in participants allocated to the intervention group.

From baseline until 6 weeks after surgery
Safety assessed by adverse events and serious adverse events
Zeitfenster: From baseline until 6 weeks after surgery

Safety will be assessed by recording the total number of adverse events (AEs) and serious adverse events (SAEs), as well as the proportion of participants experiencing an AE or SAE.

From baseline until 6 weeks after surgery
Compliance with the exercise program
Zeitfenster: Throughout the prehabilitation and rehabilitation program, up to 6 weeks after surgery

Adherence to the exercise program will be assessed using the patient exercise diary and expressed as the percentage of prescribed exercise sessions completed. Perceived exertion during training will be assessed using the Borg Rating of Perceived Exertion Scale. The Borg Rating of Perceived Exertion Scale ranges from 6 to 20, with higher scores indicating greater perceived exercise intensity and exertion.

Throughout the prehabilitation and rehabilitation program, up to 6 weeks after surgery
Three-year disease-free survival
Zeitfenster: 3 years after surgery

Disease-free survival is defined as the time from surgery to the first occurrence of disease recurrence. Participants without recurrence will be censored at the time of last follow-up.

3 years after surgery
Three-year overall survival
Zeitfenster: 3 years after surgery

Overall survival is defined as the time from surgery to death. Participants who are alive will be censored at the time of last follow-up.

3 years after surgery

Andere Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Health-economic impact of the multimodal program (sing EQ-5D utility scores and Quality-Adjusted Life Years (QALYs)
Zeitfenster: Through study completion, up to 6 weeks after surgery

An exploratory health-economic analysis will be performed using EQ-5D utility scores to estimate Quality-Adjusted Life Years (QALYs). The health-economic impact of the multimodal prehabilitation and rehabilitation program will be evaluated by comparing QALYs and healthcare resource utilization between the intervention and usual care groups.

Through study completion, up to 6 weeks after surgery
Patient perceptions of breathing exercises
Zeitfenster: At or after 6 weeks after surgery

Participants' perceptions and experiences regarding the breathing exercises using the Moonbird device will be explored through semi-structured interviews. Responses will undergo qualitative thematic analysis. This is a qualitative outcome measure and no numerical score will be calculated.

At or after 6 weeks after surgery
C-Reactive Protein (CRP)
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Serum C-reactive protein (CRP) concentration (mg/L) will be measured and compared between groups. Higher values indicate a greater systemic inflammatory response.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
White Blood Cell Count (WBC)
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

White blood cell count (WBC) (×10^9/L) be measured and compared between groups. Higher values indicate a greater inflammatory response.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Interleukin-6 (IL-6)
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Plasma interleukin-6 (IL-6) (pg/mL) will be measured and compared between groups. Higher values indicate a greater inflammatory response.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Interleukin-8 (IL-8)
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Plasma interleukin-8 (IL-8) concentration (pg/mL) will be measured and compared between groups.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Interleukin-10 (IL-10)
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Plasma interleukin-10 (IL-10) concentration (pg/mL) will be measured and compared between groups.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Tumor Necrosis Factor Alpha (TNF-α)
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Tumor Necrosis Factor Alpha (TNF-α) concentration (pg/mL) will be measured and compared between groups.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Troponin
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Serum troponin concentration (ng/L) will be measured and compared between groups.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Ferritin
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Serum ferritin concentration (µg/L) will be measured and compared between groups.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery
Albumin
Zeitfenster: Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Serum albumin concentration (g/L) will be measured and compared between groups. Lower values may indicate impaired nutritional status.

Baseline, 4 weeks after baseline, 2 weeks after surgery, and 6 weeks after surgery

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Geschätzt)

1. November 2026

Primärer Abschluss (Geschätzt)

1. April 2028

Studienabschluss (Geschätzt)

1. November 2030

Studienanmeldedaten

Zuerst eingereicht

16. Oktober 2026

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

4. November 2026

Zuerst gepostet (Tatsächlich)

10. November 2026

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

10. November 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

4. November 2026

Zuletzt verifiziert

1. November 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Andere Studien-ID-Nummern

  • AZGS2026054

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Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt

Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

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