JMIR Publications

ABSTRACT

Background:

Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT) as reported in our previous research.

Objective:

We prospectively tested the effectiveness of a health coaching mobile application in preventing malnutrition and muscle loss in this patient population.

Methods:

Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used a health coaching mobile application, the Noom®, that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured on computed tomography, and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes of SMI, nutritional and inflammatory factors between the patients who used a mobile application (Noom group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the application.

Results:

Two patients dropped out of the study (no application use [n=1]; treatment changed to a definitive aim [n=1]). The use (or activation) of the application was noted in approximately 70% of patients (36 patients) until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with age, primary tumor location, tumor stage, pre-RT body mass index, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (-6.7 vs. -9.8, P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (∆SMI/50 days > 10%). In patients with excessive muscle loss, walk steps significantly decreased in the last four weeks compared to those in the first four weeks. Age affected the absolute number of walk steps (P=.01), while pre-RT sarcopenia was related to the recovery of reduced walk steps (P=.03).

Conclusions:

For esophageal cancer patients receiving NACRT, an interactive health coaching mobile application helped nutritional self-care with less decrease in PNI, although it did not prevent excessive muscle loss. Low physical activity estimated by the number of walking steps did not recover even a few weeks after the end of NACRT in patients with old age or pretreatment sarcopenia. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition.