ASO Author Reflections: It is Time to Prioritize Exercise in Pancreatic Cancer Survivorship
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: It is Time to Prioritize Exercise in Pancreatic Cancer Survivorship Nathan H. Parker, MPH, PhD1, and Matthew H. G. Katz, MD2 Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX; 2Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
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PAST Evidence-based guidelines recommend that cancer survivors perform 30 min or more of moderate-intensity aerobic exercise at least three times per week, and strengthening exercises for major muscle groups at least twice per week, to enhance their physical function, fitness, and quality of life.1 Unfortunately, multidisciplinary teams caring for patients with pancreatic tumors historically place little emphasis on exercise and other survivorship interventions following potentially curative operations, likely owing to a perception that such interventions are unlikely to have a positive impact in the context of diseases that are generally characterized by poor prognosis.2 However, the long-term survival rates of people who have undergone pancreatectomy for pancreatic adenocarcinoma or pancreatic neuroendocrine tumors have improved steadily over the past few decades.3 Thus, the potential value of exercise in this setting is increasingly profound. PRESENT We have built a multidisciplinary exercise program with the aim of fully integrating exercise into the clinical management of patients with pancreatic neoplasms. To better understand these survivors’ exercise practices following surgery, we conducted a cross-sectional survey of individuals who underwent pancreatectomy.4 Only 24% of
Ó Society of Surgical Oncology 2020 First Received: 21 August 2020 Accepted: 22 August 2020 N. H. Parker, MPH, PhD e-mail: [email protected]
respondents met the consensus guidelines for both aerobic and strengthening exercise; 39% of respondents met neither guideline. Respondents who were older, had a higher body mass index (BMI), had experienced disease recurrence, or who had previously undergone pancreatoduodenectomy or total pancreatectomy were particularly unlikely to exercise sufficiently. Respondents who were intrinsically motivated to exercise and who reported an ability to overcome external barriers to exercise (i.e. barrier ‘self-efficacy’) were consistently more likely to meet the guidelines. As expected, sufficient exercise was associated with improved quality of life and reduced fatigue. FUTURE Our data clearly demonstrate that individuals who have undergone pancreatectomy do not exercise nearly as much as national guidelines recommend. These findings may not be surprising, given that Americans as a group fail to exercise as much as they should.5 However, given the benefits of exercise for cancer survivors, formal exercise programs and strategies that increase adherence are urgently needed as part of the routine clinical care of patients with pancreatic tumors. Such care should include careful screening to identify barriers or risks to exercise and early referra
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