A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients. Recommended Citation Yeo, Theresa; Burrell, Sherry A; Sauter, Patricia K; Kennedy, Eugene P; Lavu, Harish; Leiby, Benjamin E; and Yeo, Charles, "A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients." (2012 Methods:One hundred and two patients with resected PPC consented to participate in this study and were randomized to either an Intervention Group (IG) or a Usual Care Group (UCG).Subjects completed visual analog scales, the FACIT-Fatigue Scale (FFS) and the Short Form36v2® after surgery and again 3 to 6 months after hospital discharge. Results:Patients in the IG and UCG were comparable with regard to demographics, comorbidities, cancer type and staging, type of resection, pre-op fatigue and pain levels, adjuvant therapy and baseline walking distance. Patients in the IG had significantly improved scores on the FFS at study completion, improved fatigue and pain scores, as well as overall physical functioning and mental health composite scores. At study completion, participants in the IG were walking twice as far and were significantly more likely to have continued walking or another form of exercise as compared to the UCG. Using hierarchical cluster analysis three mutually exclusive symptom groupings were identified in the cohort. Kaplan-Meier survival analysis did not indicate an overall survival benefit for the IG. Conclusion:This is the first prospective, randomized and controlled trial to report that participation in a home walking program confers a significant benefit in resected PPC patients

Background Ethanol celiac plexus neurolysis (ECPN) has been shown to be effective in reducing cancer-related pain in patients with locally advanced pancreatic and periampullary adenocarcinoma (PPA). This study examined its efficacy in patients undergoing PPA resection. Study Design 485 patients participated in this prospective, randomized, double blind placebo controlled trial. Patients were stratified by preoperative pain and disease resectability. They received either ECPN (50% ethanol) or 0.9% normal saline placebo control. The primary endpoint was short and long-term pain and secondary endpoints included postoperative morbidity, QOL and overall survival. Results Data from 467 patients were analyzed. The primary endpoint, the percentage of PPA patients experiencing a worsening of pain compared to preoperative baseline for resectable patients, was not different between the ethanol and saline groups in either the resectable/pain stratum (22% vs 18%, RR 1.23 (0.34, 4.46)), or the resectable/no pain stratum (37% vs 34%, RR 1.10 (0.67, 1.81)). On multivariable analysis of resected pancreatic ductal adenocarcinoma (PDA) patients, there was a significant reduction in pain in the resectable/pain group, suggesting that surgical resection of the malignancy alone (independent of ECPN) decrements pain to a significant degree. Conclusions In this study, we have demonstrated a significant reduction in pain following surgical resection of PPA. However the addition of ECPN did not synergize to result in a further reduction in pain, and in fact its effect may have been masked by surgical resection. Given this, we cannot recommend the use of ECPN to mitigate cancer related pain in resectable PPA patients.

Findings may be used to provide anticipatory patient and family guidance and to inform clinical assessments of symptoms and symptom clusters in this population.

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