A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients.
BACKGROUND
As patients with pancreas and periampullary cancer (PPC) experience improved survival rates and longevity, the focus shifts toward living life while surviving cancer. Fatigue is the most commonly reported symptom in all cancer patients. Exercise has been found to effectively decrease fatigue levels and improve physical functioning in cancer patients.


METHODS
One hundred two patients with resected PPC consented to participate in this study and were randomized to either an intervention group (IG) or a usual care group (UCG). Subjects completed visual analog scales, the FACIT-Fatigue Scale and the Short Form-36v2 after surgery and again 3 to 6 months after hospital discharge.


RESULTS
Patients in the IG and UCG were comparable with regard to demographics, comorbidities, cancer type and staging, type of resection, preoperative fatigue and pain levels, adjuvant therapy, and baseline walking distance. Patients in the IG had significantly improved scores on the FACIT-Fatigue Scale at study completion, improved fatigue and pain scores, as well as overall physical functioning and mental health composite scores. At study completion, participants in the IG were walking twice as far and were significantly more likely to have continued walking or another form of exercise as compared with the UCG. Using hierarchical cluster analysis, 3 mutually exclusive symptom groupings were identified in the cohort. Kaplan-Meier survival analysis did not indicate an overall survival benefit for the IG.


CONCLUSIONS
This is the first prospective, randomized controlled trial to report that participation in a home walking program confers a significant benefit in resected PPC patients with regard to fatigue levels, physical functioning, and health-related quality of life.
Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA. theresa.yeo@jefferson.edu
Theresa P
TP
Yeo
Sherry A
SA
Burrell
Patricia K
PK
Sauter
Eugene P
EP
Kennedy
Harish
H
Lavu
Benjamin E
BE
Leiby
Charles J
CJ
Yeo
D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005081:Exercise Therapy / Q000379:methods*; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome; D016138:Walking