Exercise Medicine in the Management of Pancreatic Cancer

Luo, Hao; Galvão, Daniel A.; Newton, Robert U.; López, Pedro; Tang, Colin; Fairman, Ciaran M.; Spry, Nigel; Taaffe, Dennis R.

doi:10.1097/mpa.0000000000001753

Cited by 25 publications

(17 citation statements)

References 92 publications

(337 reference statements)

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“…In contrast to Steindorf et al [ 17 ], we can report long-term benefits on physical functioning and health-related QoL even after 6 months follow-up period with prescribed home-based exercises. Our data demonstrate the need for exercise prescriptions to preserve or improve physical functioning during and after pancreatic cancer treatment, and we can show that it’s safe and feasible, given the fact that quite a number of the patients with pancreatic cancer present themselves with frailty or fatigue, sarcopenia and / or weight loss, which generally reduces patients’ QoL and thus having a negative effect on overall survival [ 9 , 40 ]. Furthermore, no negative scores in patients undergoing chemotherapy compared to those without chemotherapy was observed.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…To date, there are only seven individual published studies focusing exclusively on patients with PanCa. [22][23][24] Of them, only three studies (all without control) have been conducted in patients during NAT (including one single-arm study, 53 one case series 25 and one case report. 26 In addition, among the ongoing exercise trials for patients with PanCa in ClinicalTrial.…”

Section: Discussionmentioning

confidence: 99%

“…57 As a result, a multicomponent programme consisting of clinical-based resistance and aerobic exercises and adapted sport activities will be adopted given the promising results in patients with PanCa undergoing NAT through a combined exercise programme. 24 An exercise intervention of this format has recently been shown to be safe and effective in maintaining…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21] Despite the benefits associated with exercise in cancer management, only seven exercise trials have been undertaken in patients with PanCa with over half being case reports or a case series. [22][23][24] Although a recent systematic review by our team found that exercise may be safe and feasible in patients with PanCa, 24 most of the patients enrolled in the studies were highly selected having already successfully completed NAT and surgical resection. Additionally, a case series 25 and a case report 26 of patients with borderline resectable or locally advanced PanCa during NAT performing supervised exercise training showed promising results that warrant further investigation with a more rigorous study design.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and efficacy of a multicomponent exercise medicine programme in patients with pancreatic cancer undergoing neoadjuvant therapy (the EXPAN trial): study protocol of a dual-centre, two-armed phase I randomised controlled trial

Luo

Galvão

Newton

et al. 2021

BMJ Open Gastroenterol

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IntroductionExercise is emerging as a therapy in oncology for its physical and psychosocial benefits and potential effects on chemotherapy tolerability and efficacy. However, evidence from randomised controlled trials (RCTs) supporting exercise in patients with borderline resectable or locally advanced pancreatic cancer (PanCa) undergoing neoadjuvant therapy (NAT) are lacking.Methods and analysisThe EXPAN trial is a dual-centre, two-armed, phase I RCT. Forty patients with borderline resectable or locally advanced PanCa undergoing NAT will be randomised equally to an exercise intervention group (individualised exercise+standard NAT) or a usual care control group (standard NAT). The exercise intervention will be supervised and consist of moderate to vigorous intensity resistance and aerobic-based training undertaken two times a week for 45–60 min per session for a maximum period of 6 months. The primary outcome is feasibility. Secondary outcomes are patient-related and treatment-related endpoints, objectively measured physical function, body composition, psychological health and quality of life. Assessments will be conducted at baseline, prior to potential alteration of treatment (~4 months postbaseline), at completion of the intervention (maximum 6 months postbaseline) and 3-month and 6-month postintervention (maximum 9 and 12 months postbaseline).Ethics and disseminationThe EXPAN trial has been approved by Edith Cowan University (reference no.: 2020-02011-LUO), Sir Charles Gairdner Hospital (reference no.: RGS 03956) and St John of God Subiaco Hospital (reference no.: 1726). The study results will be presented at national/international conferences and submitted for publications in peer-reviewed journals.Trial registration numberACTRN12620001081909.

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“…Despite promising findings, there is a paucity of clinical data concerning exercise in PanCa. In a recent systematic review by our team (9), we identified only seven separate trials involving only 201 patients with over half being case reports or case series. Although a few trials (10,11) have been reported since our review also favoring exercise in PanCa, there has been no evidence from a setting where broader inclusion criteria and more flexible programs are used as compared with clinical trials under tightly controlled conditions (i.e., explanatory trials).…”

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Evaluation of a Clinic-Based Exercise Program in Patients with Pancreatic Cancer Undergoing Nonsurgical Treatment

Luo¹,

Galvão²,

Newton³

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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IntroductionEvidence regarding the role of exercise in pancreatic cancer (PanCa) is limited and is derived exclusively under tightly controlled research conditions. This study aimed to quantify adherence, adverse events, and changes in physical and psychological outcomes in any patients with PanCa referred to undertake exercise during nonsurgical treatment.MethodsThe study involved 22 patients with localized or metastatic PanCa undertaking a clinic-based exercise program during chemotherapy or chemoradiotherapy. The program included supervised aerobic and resistance exercise undertaken twice weekly for 12 wk and a 12-wk follow-up with supervised exercise optional dependent on patient preference and condition. Patients were monitored for adherence and adverse events. Objective and patient-reported outcomes were assessed at baseline, 12 wk, and 24 wk.ResultsA total of 251 sessions were attended by 19 patients over the first 12 wk (attendance rate, 55%). Complete case analyses indicated significant (P < 0.05) improvements in functional ability (5.2%–17.2%), muscle strength (16.9%–25.1%), and static balance (6.8%). There were no significant changes in body composition or patient-reported outcomes except for sleep quality, which deteriorated; however, at an individual level, several patients had clinically relevant improvements in cancer-related fatigue and quality of life. Patients who continued with supervised exercise to week 24 largely preserved improvements in functional ability, muscle strength, and static balance. No serious adverse events resulted from the exercise program.ConclusionsIndividualized, supervised aerobic and resistance exercise in a clinic-based setting appears to be safe and may improve or maintain physical and psychological health in patients with PanCa undergoing nonsurgical treatment.

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Exercise Medicine in the Management of Pancreatic Cancer

Abstract: Supplemental digital content is available in the text.

Cited by 25 publications

References 92 publications

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

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

Feasibility and efficacy of a multicomponent exercise medicine programme in patients with pancreatic cancer undergoing neoadjuvant therapy (the EXPAN trial): study protocol of a dual-centre, two-armed phase I randomised controlled trial

Evaluation of a Clinic-Based Exercise Program in Patients with Pancreatic Cancer Undergoing Nonsurgical Treatment

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