Home-Based Exercise Prehabilitation During Preoperative Treatment for Pancreatic Cancer Is Associated With Improvement in Physical Function and Quality of Life

An Ngo-Huang, Nathan H Parker, Eduardo Bruera, Rebecca E Lee, Richard Simpson, Daniel P O'Connor, Maria Q B Petzel, Rhodora C Fontillas, Keri Schadler, Lianchun Xiao, Xuemei Wang, David Fogelman, Sunil K Sahai, Jeffrey E Lee, Karen Basen-Engquist, Matthew H G Katz, An Ngo-Huang, Nathan H Parker, Eduardo Bruera, Rebecca E Lee, Richard Simpson, Daniel P O'Connor, Maria Q B Petzel, Rhodora C Fontillas, Keri Schadler, Lianchun Xiao, Xuemei Wang, David Fogelman, Sunil K Sahai, Jeffrey E Lee, Karen Basen-Engquist, Matthew H G Katz

Abstract

Purpose: To investigate relationships among physical activity, changes in physical function, and health-related quality of life (HRQOL) among patients with pancreatic adenocarcinoma enrolled in a home-based exercise prehabilitation program. Methods: Patients with resectable pancreatic adenocarcinoma receiving preoperative chemotherapy and/or chemoradiation were enrolled on this prospective, single-arm trial and were advised to perform ≥60 minutes each of moderate-intensity aerobic exercise and strengthening exercise weekly. Activity was measured via self-report and accelerometers, including moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary activity (SA). Physical function measures at baseline and restaging follow-up included 6-minute walk test (6MWT), 5 times sit-to-stand (5×STS), handgrip strength (HGS), 3-m walk for gait speed (GS), and the PROMIS Physical Function Short Form. HRQOL was measured via the FACT-Hep questionnaire. Results: Fifty participants with mean age 66 years (standard deviation = 8 years) were enrolled. The 6MWT, 5×STS, and GS significantly improved from baseline to restaging follow-up (P=.001, P=.049, and P=.009, respectively). Increases in self-reported aerobic exercise, weekly MVPA, and LPA were associated with improvement in 6MWT (β=.19, P=.048; β=.18, P=.03; and β=.08, P=.03, respectively) and self-reported physical functioning (β=.02, P=.03; β=.03, P=.005; and β=.01, P=.02, respectively). Increased weekly LPA was associated with increased HRQOL (β=.03, P=.02). Increased SA was associated with decreased HRQOL (β=-.02,P=.01). Conclusions: Patients with potentially resectable pancreatic cancer exhibit meaningful improvement in physical function with prehabilitation; physical activity was associated with improved physical function and HRQOL. These data highlight the importance of physical activity during treatment for pancreatic cancer.

Trial registration: ClinicalTrials.gov NCT02295956.

Keywords: outcome measures; pancreatic cancer; physical function; prehabilitation; preoperative exercise.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study schema and progression of patients. Preoperative treatment included chemotherapy and/or chemoradiation followed by a preoperative rest period. Abbreviations: PROMIS, Patient-Reported Outcomes Measurement Information System Physical Function 12a Short Form; FACT-Hep, Functional Assessment of Cancer Therapy–Hepatobiliary.

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