Deconditioning, Pancreas Adenocarcinoma (MSI-H)
Conditions
Keywords
prehabilitation, rehabilitation, exercise
Brief summary
Pancreatic cancer surgery (Whipple's procedure) is a major operation that can lead to reduced physical fitness, delayed recovery, and difficulty starting chemotherapy after surgery. Exercise before and after surgery may help improve recovery, but it is not known whether a personalised exercise programme delivered throughout the surgical pathway is practical or acceptable for patients. The Exercise to Improve Outcomes in Pancreatic Cancer (ExO-PanC) study is a single-arm feasibility study that will recruit adults with suspected pancreatic ductal adenocarcinoma who are scheduled to undergo Whipple's procedure. Participants will receive an individualised exercise programme before surgery, during their hospital stay, and after discharge until the start of adjuvant chemotherapy. The programme will include aerobic exercise and resistance training prescribed according to each participant's fitness level. The primary objective is to determine whether this exercise programme is feasible by assessing recruitment, participant adherence, compliance with the prescribed exercise programme, and retention. Secondary exploratory objectives include evaluating surgical complications, initiation of adjuvant chemotherapy, physical fitness, quality of life, nutritional status, and blood, stool, and tumour biomarkers associated with clinical outcomes. Findings from this feasibility study will inform the design of a future multicentre randomised controlled trial evaluating the effectiveness of the ExO-PanC programme.
Detailed description
Pancreatic ductal adenocarcinoma (PDAC) is associated with poor survival, reduced physical function, and a high burden of treatment-related morbidity. Patients undergoing pancreaticoduodenectomy (Whipple's procedure) often experience substantial declines in cardiorespiratory fitness and muscle function before and after surgery, which may contribute to postoperative complications, delayed recovery, and reduced likelihood of receiving adjuvant chemotherapy. While prehabilitation programmes are increasingly incorporated into routine care, current approaches are not typically individualised using objective measures of physical fitness and generally do not extend across the entire perioperative pathway. The Exercise to Improve Outcomes in Pancreatic Cancer (ExO-PanC) study has been developed to evaluate the feasibility of a personalised exercise programme delivered before surgery, during hospital admission, and throughout postoperative recovery until the commencement of adjuvant chemotherapy. Exercise prescriptions will be individualised using cardiopulmonary exercise testing (CPET), muscle strength assessments, and functional performance measures, allowing exercise intensity and progression to be tailored to each participant's physiological capacity. Participants will undergo repeated assessments of cardiorespiratory fitness, physical function, muscle strength, nutritional status, quality of life, and biological sampling throughout the study. Blood, stool, and surgically resected tumour tissue will be collected to explore biomarkers associated with clinical outcomes and responses to exercise. The primary objective of this feasibility study is to determine whether the ExO-PanC intervention can be successfully delivered across the perioperative pathway by evaluating participant recruitment, adherence, compliance with prescribed exercise, and study retention. Exploratory analyses will investigate surgical complications, initiation of adjuvant chemotherapy, changes in physical fitness and quality of life, and relationships between biological markers and clinical outcomes. Results from this study will establish the feasibility of implementing a personalised perioperative exercise programme for patients undergoing pancreatic cancer surgery and will provide essential data to inform the design of a future adequately powered multicentre randomised controlled trial evaluating the effectiveness of the ExO-PanC intervention.
Interventions
BEHAVIORALExO-PanC Personalised Exercise Programme
Participants will receive the ExO-PanC personalised exercise programme alongside standard perioperative care. The intervention comprises four phases delivered across the surgical pathway: (1) prehabilitation before surgery, (2) supervised exercise during postoperative hospital admission, (3) structured home-based recovery following hospital discharge, and (4) rehabilitation before the commencement of adjuvant chemotherapy. Exercise prescriptions are individualised using cardiopulmonary exercise testing (CPET), muscle strength, and functional assessments. The programme includes aerobic, resistance, flexibility, and home-based exercise, with intensity and progression tailored to each participant's fitness level. Exercise may be delivered in supervised or semi-supervised formats, with heart rate monitoring used to support exercise prescription and progression. Participants continue to receive all standard NHS perioperative care throughout the study.
Sponsors
University of Surrey
Royal Surrey County Hospital NHS Foundation Trust
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older. * Planned to undergo upfront pancreatoduodenectomy (Whipple's procedure) for a suspected malignant periampullary mass. * Able and willing to provide written informed consent.
Exclusion criteria
* \<18 years age * Cardiopulmonary exercise test (CPET) contraindications * Physical inability to perform CPET or undertake the program. * Lacking the capacity to consent * Unable to understand instructions in English * Not scheduled for surgery * A new diagnosis of Type 1 or Type 3c diabetes requiring management with insulin prescription will be excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of the ExO-PanC exercise programme | From enrolment until completion of the intervention (approximately 16-24 weeks) | Feasibility will be assessed using participant recruitment, adherence to the prescribed exercise programme (target \>85% of prescribed sessions completed), compliance with prescribed exercise intensity, duration and type (target \>80%), and participant retention (target \<20% withdrawal for non-clinical reasons). Feasibility will be evaluated separately across the preoperative, perioperative and postoperative phases of the intervention. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative surgical complications | Up to approximately 6 weeks following surgery. | Occurrence and severity of postoperative complications, including pancreatic fistula and other clinically relevant surgical complications |
| Commencement and completion of adjuvant chemotherapy | From surgery until planned commencement and completion of adjuvant chemotherapy. | Proportion of participants who commence planned adjuvant chemotherapy following pancreaticoduodenectomy and proportion who complete it |
| Cardiorespiratory fitness (CRF) measured by cardiopulmonary excercise testing (CPET) | Baseline through completion of the intervention (approximately 16-24 weeks) | Difference in anaerobic threshold (mL/kg/min) and peak oxygen uptake (VO₂peak, mL/kg/min) measured during CPET. |
| Muscle strength | Baseline through completion of the intervention (approximately 16-24 weeks). | Changes in upper and lower body muscle strength measured using standardised strength assessments. |
| Change in health-related quality of life measured using the EORTC QLQ-C30 | Serial measurements from baseline through completion of the intervention (approximately 16-24 weeks). | Health-related quality of life assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Change in EORTC QLQ-C30 global health status, functional scales and symptom scales. Scores range from 0-100. |
| Nutritional status | Baseline through completion of the intervention (approximately 16-24 weeks). | Nutritional status assessed using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). |
| Change in pancreatic cancer-specific quality of life measured using the EORTC QLQ-PAN26 | This will be measured at five timepoints from recruitment through to commencement of adjuvant chemotherapy | Serial changes in EORTC QLQ-PAN26 symptom scores. Scores range from 0-100. |
Countries
United Kingdom
Contacts
CONTACTTarak AM Chouari, BSc (Hons) MBChB
PRINCIPAL_INVESTIGATORAdam E Frampton, PhD
University of Surrey
Outcome results
None listed