Impact of exercise in patients with pancreatic cancer across different treatment phases: A systematic review.

BACKGROUND

With a dismal prognosis of 8-10 % 5-year survival since diagnosis, pancreatic cancer remains one of the most aggressive oncological diseases. This work aimed to evaluate the effects of exercise medicine on safety and feasibility, physical fitness, body composition, patient-reported outcomes, and clinical outcomes across different treatment phases in patients with pancreatic cancer.

METHOD: PubMed, Cochrane, and Scopus databases were systematically screened to identify single-arm studies and randomized/non-randomized controlled trials investigating a physical exercise intervention in patients with pancreatic cancer. The RoB 2 and ROBINS-I tools were used to evaluate study quality for randomized and non-randomized studies, respectively. Qualitative and quantitative synthesis approaches were used.

RESULTS

Among the 5550 identified records, 11 randomized controlled trials and 6 non-randomized studies were considered eligible. Five investigations were conducted in the neoadjuvant setting, eight in the rehabilitative and three during palliative phases. Regarding neoadjuvant exercise, there were no significant changes in cardiorespiratory fitness and muscle strength, whilst a gain in muscle mass was detected. Similarly, in the rehabilitative setting, mixed results were observed for cardiorespiratory fitness and body composition; a positive impact was registered in strength, glucose levels, tryptophan metabolism, and quality of life after 3 months of intervention. In the palliative setting, significant improvements were observed for muscle strength and quality of life, but not for clinical outcomes.

CONCLUSION

Although physical exercise may ameliorate sequelae of pancreatic cancer, further investigation is necessary to understand the real impact of exercise medicine interventions in this population and across different treatment phases.