Effects of intensive physiotherapy on Quality of Life (QoL) after pancreatic cancer resection: a randomized controlled trial

Abstract

Background Patients have significantly lower QoL scores after pancreatic resection due to cancer in the physical and psychological domains compared to healthy controls or other cancer patients. Intensified physiotherapy or physical training can increase QoL by reducing fatigue levels and improving physical functioning. However, data on the long-term effects of intensive or supervised physiotherapy is lacking. The aim of this exploratory study is the assessment of QoL in the intervention group, using various QoL questionnaires in their validated German translations and gather data on its feasibility in the context of chemotherapy with a follow-up of 12 months (and develop concepts to improve QoL after pancreatic cancer resection). Methods Fifty-six patients (mean age: 66.4 ± 9.9 years) were randomized in this study to intervention (cohort A, n = 28) or control group (cohort B, n = 28). Intervention of intensified physiotherapy program consisted of endurance and muscle force exercises using cycle ergometer. In the control group physiotherapy was limited to the duration of the hospital stay and was scheduled for 20 min on 5 days per week. The clinical visits took place 2 days preoperatively, 1 week, 3 months, 6 months and 12 months postoperatively. Both groups attended the follow-up program. QoL was evaluated using the Short Physical Performance Battery (SPPB), Short Form-8 Health Survey (SF-8) and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and pancreatic cancer‐specific module QLQ-PAN26 questionnaires. The course of QoL was evaluated using a repeated measures ANOVA and a per protocol design. Results Of the initial 56 randomized patients, 34 finished the 12 months follow-up period. There were no adverse events due to the intervention and 80% of patients in the intervention group where adherent. There was no significant influence on physical performance as measured by SPPB and SF-8 questionnaire. However, after 6 months patients in the intervention group regained their prior physical condition, whereas the control group did not. Intensive physiotherapy significantly influenced various factors of QoL measured with the C30 questionnaire positively, such as physical functioning (p = 0.018), role functioning (p = 0.036), and appetite loss (p = 0.037), even after 6 months. No negative effects in patients undergoing chemotherapy compared to those without chemotherapy was observed. Conclusion This first randomized controlled study with a 12-month follow-up shows that supervised physiotherapy or prescribed home-based exercise after pancreatic cancer resection is safe and feasible and should be proposed and started as soon as possible to improve certain aspects of QoL. Trial Registration German Clinical Trials Register (No: DRKS00006786); Date of registration: 01/10/2014.

Global status of research on gastrointestinal cancer patients’ quality of life: A bibliometric and visual analysis from 2003 to 2023

“…What's more, exercise interventions on the QoL for GI cancer survivors have also attracted researchers' interest. Aerobic exercise, resistance exercise, and strengthening exercise, each or the combination of which were common exercise interventions, have been proven to improve fatigue, functional status, and QoL [ 52 , 53 ]. The underlying pathways may include enhancing QoL via modulating circadian rhythms [ 54 ] and improving sleep quality [ 55 ] and self-efficacy [ 56 ] in GI cancer survivors.…”

Physical activity and pain in people with cancer: a systematic review and meta-analysis

“…All RCTs scored high for performance bias as it is not possible to blind participants from their exercise intervention status. Other reasons for bias in RCTs included unclear bias arising from randomisation procedures [ 31 , 47 – 52 , 55 , 65 , 71 , 77 , 80 , 88 , 98 , 99 , 105 , 106 , 113 , 116 , 122 , 130 , 138 – 140 , 151 , 156 ] and unclear or high bias for greater than 10% attrition or less than 90% intervention adherence [ 1 , 2 , 6 – 9 , 11 , 15 – 19 , 21 , 23 , 24 , 26 , 29 , 32 , 40 , 41 , 49 , 50 , 55 , 61 , 67 – 71 , 75 , 76 , 79 , 80 , 84 , 86 – 88 , 93 , 94 , 98 , 103 , 106 , 109 , 110 , 112 – 114 , 118 , 119 , 129 , 133 , 138 , 143 , 150 , 151 , 153 , 154 , 157 ]. I...…”

Effects of Exercise Training on Patient-Specific Outcomes in Pancreatic Cancer Patients: A Scoping Review

“…Figure 1 provides detailed information on the reasons for exclusion and the selection process. In total, seven articles were included in this review [24][25][26][27][28][29][30], which included a total of 396 patients. Based on our inclusion criteria, all trials were randomized controlled trials (RCT).…”

“…Stage I and II were the most common stages, and only six patients (barely 2%) had metastatic/stage IV diseases. Therefore, nearly all included patients underwent surgery [24][25][26][27][28][29][30]. One trial included a preoperative exercise intervention concurrent with neoadjuvant treatment [29], and four trials included a postoperative intervention [24][25][26][27][28]30].…”

“…Therefore, nearly all included patients underwent surgery [24][25][26][27][28][29][30]. One trial included a preoperative exercise intervention concurrent with neoadjuvant treatment [29], and four trials included a postoperative intervention [24][25][26][27][28]30]. Most patients received adjuvant or neoadjuvant chemotherapy [24][25][26][27][28][29][30].…”