Effects of 6-month exercise training on quality of life in pancreatic cancer patients: Results from a randomized controlled trial

Abstract

Background: Given the poor prognosis and high symptom burden of pancreatic cancer, preservation of quality of life (QoL), physical functioning and minimization of adverse treatment effects are important treatment goals in pancreatic cancer patients. Even though exercise has proven to provide health benefits, including improvements in QoL, in patients with various cancer types, studies are rare for more aggressive cancer types like pancreatic cancer. Therefore, we conducted a randomized controlled trial to assess the efficacy of a 6‐month resistance training on QoL in pancreatic cancer patients. Methods: Sixty‐five pancreatic cancer patients, mostly stage IIb after tumor resection and during chemotherapy, were assigned to one of two progressive resistance training groups (supervised or home‐based) or to usual care for 6 months. The primary outcome, the physical functioning subscale of the EORTC QLQ‐C30, and other QoL‐related outcomes were assessed before the intervention, after 3 and 6 months. Analyses‐of‐covariance models on changes from baseline to 6 and 3 months were applied. All analyses were based on complete‐case analyses. The stability was investigated by comparing the complete‐case results to those based on multiple imputation methods. Results: Forty‐seven patients (mean age: 60.5 years, 53.2% males) completed the intervention period. After 6 months, no between‐group differences were observed. However, after 3 months, intention‐to‐treat analyses showed significant between‐group mean differences (MD) in favor for the pooled resistance training group for physical functioning (MD = 11.0; p = 0.02; effect size = 0.31), as well as for overall QoL (MD = 12.5; p = 0.02; effect size = 0.56), and several other secondary outcomes (cognitive functioning, sleep problems, physical fatigue, and reduced activity). Both modes of delivery, supervised and home‐based resistance‐training, showed similar effects. The resistance training was feasible in pancreatic cancer patients during and after cancer treatment with a mean training adherence rate of 66.5%. However, the adherence rate steadily decreased over the 6‐month intervention period. Sensitivity analyses based on further adjustments and with applying multiple imputations yielded similar results. Conclusions: This study is the first randomized controlled resistance training intervention trial in pancreatic cancer patients. Clinically relevant improvements in QoL were observed after 3 but not after 6 months. The findings indicate that resistance training may be a promising modality to relieve symptoms, improve physical functioning and QoL in pancreatic cancer patients. Given the severity of pancreatic cancer, the high symptom burden and the importance of maintaining QoL, these results will be of high practical relevance in the sense that also pancreatic cancer patients should be timely advised to perform exercise. Future research needs to focus on prolonging the positive mid‐term exercise effects, possibly through improving training adherence.