Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial

An T. Ngo-Huang; Nathan H. Parker; Lianchun Xiao; Keri L. Schadler; Maria Q.B. Petzel; Laura R. Prakash; Michael P. Kim; Ching Wei D. Tzeng; Jeffrey E. Lee; Naruhiko Ikoma; Robert A. Wolff; Milind M. Javle; Eugene J. Koay; Shubham D. Pant; Justin P. Folloder; Xuemei Wang; Alicia M. Cotto; Ye Rang Ju; Naveen Garg; Huamin Wang; Eduardo D. Bruera; Karen M. Basen-Engquist; Matthew H.G. Katz

doi:10.1097/SLA.0000000000005878

Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial

An T. Ngo-Huang, Nathan H. Parker, Lianchun Xiao, Keri L. Schadler, Maria Q.B. Petzel, Laura R. Prakash, Michael P. Kim, Ching Wei D. Tzeng, Jeffrey E. Lee, Naruhiko Ikoma, Robert A. Wolff, Milind M. Javle, Eugene J. Koay, Shubham D. Pant, Justin P. Folloder, Xuemei Wang, Alicia M. Cotto, Ye Rang Ju, Naveen Garg, Huamin WangEduardo D. Bruera, Karen M. Basen-Engquist, Matthew H.G. Katz

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Objective: To determine the effects of a preoperative, home-based exercise program on fitness and physical function in patients with pancreatic cancer. Background: We previously established a well-tolerated preoperative exercise program after finding a high frequency of sarcopenia and frailty in patients with pancreatic cancer. Methods: In this randomized, controlled trial (NCT03187951), patients with pancreatic cancer were randomized to Arm A: enhanced usual care or Arm B: prescribed aerobic and resistance exercise during neoadjuvant therapy. Patients received nutrition counseling and activity trackers. The primary endpoint was a 6-minute walk distance (6MWD; ≥14 meters improvement was clinically meaningful). Secondary endpoints included additional physical function tests, health-related quality of life, and clinical outcomes. Results: One hundred fifty-one patients were randomized. Objectively measured weekly activity (153.2±135.6 and 159.8±122.8 min in Arm A and B, respectively, P=0.62) and self-reported weekly moderate-to-strenuous physical activity (107.4±160.4 and 129.6±161.6 min in Arm A and Arm B, respectively, P=0.49) were similar, but weekly strength training sessions increased more in Arm B (by 1.8±1.8 vs 0.1±2.4 sessions, P<0.001). 6MWD improved in both Arm A (mean change 18.6±56.8 m, P=0.01) and Arm B (27.3±68.1 m, P=0.002). Quality of life and clinical outcomes did not significantly differ between arms. Pooling patients in both study groups, exercise, and physical activity was favorably associated with physical performance and clinical outcomes. Conclusions: In this randomized trial of prescribed exercise versus enhanced usual care during neoadjuvant therapy for pancreatic cancer, a high volume of physical activity and increased exercise capacity were observed in both arms, highlighting the importance of activity among patients preparing for surgery.

Original language	English (US)
Pages (from-to)	22-30
Number of pages	9
Journal	Annals of surgery
Volume	278
Issue number	1
DOIs	https://doi.org/10.1097/SLA.0000000000005878
State	Published - Jul 2023

Keywords

exercise oncology
pancreatic cancer
prehabilitation
preoperative exercise
preoperative optimization

ASJC Scopus subject areas

Surgery

MD Anderson CCSG core facilities

Biostatistics Resource Group
Assessment, Intervention, and Measurement

Access to Document

10.1097/SLA.0000000000005878

Cite this

Ngo-Huang, A. T., Parker, N. H., Xiao, L., Schadler, K. L., Petzel, M. Q. B., Prakash, L. R., Kim, M. P., Tzeng, C. W. D., Lee, J. E., Ikoma, N., Wolff, R. A., Javle, M. M., Koay, E. J., Pant, S. D., Folloder, J. P., Wang, X., Cotto, A. M., Ju, Y. R., Garg, N., ... Katz, M. H. G. (2023). Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial. Annals of surgery, 278(1), 22-30. https://doi.org/10.1097/SLA.0000000000005878

Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial. / Ngo-Huang, An T.; Parker, Nathan H.; Xiao, Lianchun et al.
In: Annals of surgery, Vol. 278, No. 1, 07.2023, p. 22-30.

Research output: Contribution to journal › Article › peer-review

Ngo-Huang, AT, Parker, NH, Xiao, L , Schadler, KL, Petzel, MQB, Prakash, LR , Kim, MP , Tzeng, CWD , Lee, JE , Ikoma, N , Wolff, RA , Javle, MM , Koay, EJ , Pant, SD, Folloder, JP, Wang, X, Cotto, AM, Ju, YR, Garg, N , Wang, H , Bruera, ED , Basen-Engquist, KM & Katz, MHG 2023, 'Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial', Annals of surgery, vol. 278, no. 1, pp. 22-30. https://doi.org/10.1097/SLA.0000000000005878

@article{91f87a5669bf487aab8a205218309273,

title = "Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial",

abstract = "Objective: To determine the effects of a preoperative, home-based exercise program on fitness and physical function in patients with pancreatic cancer. Background: We previously established a well-tolerated preoperative exercise program after finding a high frequency of sarcopenia and frailty in patients with pancreatic cancer. Methods: In this randomized, controlled trial (NCT03187951), patients with pancreatic cancer were randomized to Arm A: enhanced usual care or Arm B: prescribed aerobic and resistance exercise during neoadjuvant therapy. Patients received nutrition counseling and activity trackers. The primary endpoint was a 6-minute walk distance (6MWD; ≥14 meters improvement was clinically meaningful). Secondary endpoints included additional physical function tests, health-related quality of life, and clinical outcomes. Results: One hundred fifty-one patients were randomized. Objectively measured weekly activity (153.2±135.6 and 159.8±122.8 min in Arm A and B, respectively, P=0.62) and self-reported weekly moderate-to-strenuous physical activity (107.4±160.4 and 129.6±161.6 min in Arm A and Arm B, respectively, P=0.49) were similar, but weekly strength training sessions increased more in Arm B (by 1.8±1.8 vs 0.1±2.4 sessions, P<0.001). 6MWD improved in both Arm A (mean change 18.6±56.8 m, P=0.01) and Arm B (27.3±68.1 m, P=0.002). Quality of life and clinical outcomes did not significantly differ between arms. Pooling patients in both study groups, exercise, and physical activity was favorably associated with physical performance and clinical outcomes. Conclusions: In this randomized trial of prescribed exercise versus enhanced usual care during neoadjuvant therapy for pancreatic cancer, a high volume of physical activity and increased exercise capacity were observed in both arms, highlighting the importance of activity among patients preparing for surgery.",

keywords = "exercise oncology, pancreatic cancer, prehabilitation, preoperative exercise, preoperative optimization",

author = "Ngo-Huang, {An T.} and Parker, {Nathan H.} and Lianchun Xiao and Schadler, {Keri L.} and Petzel, {Maria Q.B.} and Prakash, {Laura R.} and Kim, {Michael P.} and Tzeng, {Ching Wei D.} and Lee, {Jeffrey E.} and Naruhiko Ikoma and Wolff, {Robert A.} and Javle, {Milind M.} and Koay, {Eugene J.} and Pant, {Shubham D.} and Folloder, {Justin P.} and Xuemei Wang and Cotto, {Alicia M.} and Ju, {Ye Rang} and Naveen Garg and Huamin Wang and Bruera, {Eduardo D.} and Basen-Engquist, {Karen M.} and Katz, {Matthew H.G.}",

note = "Funding Information: This study was supported by the Knox Family Foundation; the National Institutes of Health/National Cancer Institute (award number 5R21CA218732-02); the Center for Energy Balance in Cancer Prevention & Survivorship, the Duncan Family Institute for Cancer Prevention and Risk Assessment; the Cancer Prevention & Research Institute of Texas Training Grant/MD Anderson Cancer Prevention Research Training Program RP170259, (PI: Shine Chang); TREC Training Workshop R25CA203650 (PI: Melinda Irwin); and the National Institutes of Health/National Cancer Institute (award number P30CA016672; used the Clinical Trials Support Resource and the Biostatistics Resource Group). Publisher Copyright: Copyright {\textcopyright} 2023 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2023",

month = jul,

doi = "10.1097/SLA.0000000000005878",

language = "English (US)",

volume = "278",

pages = "22--30",

journal = "Annals of surgery",

issn = "0003-4932",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer

T2 - The PancFit Randomized Clinical Trial

AU - Ngo-Huang, An T.

AU - Parker, Nathan H.

AU - Xiao, Lianchun

AU - Schadler, Keri L.

AU - Petzel, Maria Q.B.

AU - Prakash, Laura R.

AU - Kim, Michael P.

AU - Tzeng, Ching Wei D.

AU - Lee, Jeffrey E.

AU - Ikoma, Naruhiko

AU - Wolff, Robert A.

AU - Javle, Milind M.

AU - Koay, Eugene J.

AU - Pant, Shubham D.

AU - Folloder, Justin P.

AU - Wang, Xuemei

AU - Cotto, Alicia M.

AU - Ju, Ye Rang

AU - Garg, Naveen

AU - Wang, Huamin

AU - Bruera, Eduardo D.

AU - Basen-Engquist, Karen M.

AU - Katz, Matthew H.G.

N1 - Funding Information: This study was supported by the Knox Family Foundation; the National Institutes of Health/National Cancer Institute (award number 5R21CA218732-02); the Center for Energy Balance in Cancer Prevention & Survivorship, the Duncan Family Institute for Cancer Prevention and Risk Assessment; the Cancer Prevention & Research Institute of Texas Training Grant/MD Anderson Cancer Prevention Research Training Program RP170259, (PI: Shine Chang); TREC Training Workshop R25CA203650 (PI: Melinda Irwin); and the National Institutes of Health/National Cancer Institute (award number P30CA016672; used the Clinical Trials Support Resource and the Biostatistics Resource Group). Publisher Copyright: Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2023/7

Y1 - 2023/7

N2 - Objective: To determine the effects of a preoperative, home-based exercise program on fitness and physical function in patients with pancreatic cancer. Background: We previously established a well-tolerated preoperative exercise program after finding a high frequency of sarcopenia and frailty in patients with pancreatic cancer. Methods: In this randomized, controlled trial (NCT03187951), patients with pancreatic cancer were randomized to Arm A: enhanced usual care or Arm B: prescribed aerobic and resistance exercise during neoadjuvant therapy. Patients received nutrition counseling and activity trackers. The primary endpoint was a 6-minute walk distance (6MWD; ≥14 meters improvement was clinically meaningful). Secondary endpoints included additional physical function tests, health-related quality of life, and clinical outcomes. Results: One hundred fifty-one patients were randomized. Objectively measured weekly activity (153.2±135.6 and 159.8±122.8 min in Arm A and B, respectively, P=0.62) and self-reported weekly moderate-to-strenuous physical activity (107.4±160.4 and 129.6±161.6 min in Arm A and Arm B, respectively, P=0.49) were similar, but weekly strength training sessions increased more in Arm B (by 1.8±1.8 vs 0.1±2.4 sessions, P<0.001). 6MWD improved in both Arm A (mean change 18.6±56.8 m, P=0.01) and Arm B (27.3±68.1 m, P=0.002). Quality of life and clinical outcomes did not significantly differ between arms. Pooling patients in both study groups, exercise, and physical activity was favorably associated with physical performance and clinical outcomes. Conclusions: In this randomized trial of prescribed exercise versus enhanced usual care during neoadjuvant therapy for pancreatic cancer, a high volume of physical activity and increased exercise capacity were observed in both arms, highlighting the importance of activity among patients preparing for surgery.

AB - Objective: To determine the effects of a preoperative, home-based exercise program on fitness and physical function in patients with pancreatic cancer. Background: We previously established a well-tolerated preoperative exercise program after finding a high frequency of sarcopenia and frailty in patients with pancreatic cancer. Methods: In this randomized, controlled trial (NCT03187951), patients with pancreatic cancer were randomized to Arm A: enhanced usual care or Arm B: prescribed aerobic and resistance exercise during neoadjuvant therapy. Patients received nutrition counseling and activity trackers. The primary endpoint was a 6-minute walk distance (6MWD; ≥14 meters improvement was clinically meaningful). Secondary endpoints included additional physical function tests, health-related quality of life, and clinical outcomes. Results: One hundred fifty-one patients were randomized. Objectively measured weekly activity (153.2±135.6 and 159.8±122.8 min in Arm A and B, respectively, P=0.62) and self-reported weekly moderate-to-strenuous physical activity (107.4±160.4 and 129.6±161.6 min in Arm A and Arm B, respectively, P=0.49) were similar, but weekly strength training sessions increased more in Arm B (by 1.8±1.8 vs 0.1±2.4 sessions, P<0.001). 6MWD improved in both Arm A (mean change 18.6±56.8 m, P=0.01) and Arm B (27.3±68.1 m, P=0.002). Quality of life and clinical outcomes did not significantly differ between arms. Pooling patients in both study groups, exercise, and physical activity was favorably associated with physical performance and clinical outcomes. Conclusions: In this randomized trial of prescribed exercise versus enhanced usual care during neoadjuvant therapy for pancreatic cancer, a high volume of physical activity and increased exercise capacity were observed in both arms, highlighting the importance of activity among patients preparing for surgery.

KW - exercise oncology

KW - pancreatic cancer

KW - prehabilitation

KW - preoperative exercise

KW - preoperative optimization

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SN - 0003-4932

VL - 278

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JO - Annals of surgery

JF - Annals of surgery

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Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial

Abstract

Keywords

ASJC Scopus subject areas

MD Anderson CCSG core facilities

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