Walking wards off fatigue in pancreatic, periampullary cancers

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A home walking program significantly improves fatigue levels, physical functioning, and health-related quality of life in persons with resected pancreatic or periampullary cancer, indicate the results of a prospective, randomized controlled trial.

Fatigue is the most commonly reported symptom in all cancer patients, and exercise has been found to decrease fatigue levels and improve physical functioning in these individuals. “As patients with [pancreas and periampullary cancers] experience improved survival rates and longevity, the focus shifts toward living life while surviving cancer, managing adverse symptoms, and improving physical functioning and quality of life,” wrote Theresa P. Yeo, MPH, MSN, and colleagues in their report for Journal of the American College of Surgeons (2012;214:463-477).

The associate director of the Jefferson Pancreas Tumor Registry for the Thomas Jefferson University Hospital Department of Surgery in Philadelphia, Pennsylvania, Yeo and her research team enrolled 110 patients who had undergone surgical resections for pancreatic or periampullary cancer. Periampullary cancer forms near the ampulla of Vater (an enlargement of the ducts from the liver and pancreas where they join and enter the small intestine), according to a definition from the National Cancer Institute.

Most of the 102 participants ultimately included in the analysis were Caucasian men and women aged 66 or 67 years. They had comparable comorbidities, cancer type and staging (in most cases stage IIA or IIB), type of resection, preoperative fatigue and pain levels, adjuvant therapy, and baseline walking distance.

The patients were randomized to an intervention group or to a usual-care group. Those in the intervention group were instructed to walk for increasingly longer intervals each week for 3 months, with the goal of increasing walking time by 90 to 150 minutes per week by the end of the program. The usual-care group followed normal discharge instructions that did not include a walking or exercise routine.

At the start of the study, 85% of all participants reported moderate to severe fatigue. Three months after discharge, the intervention walking group reported a 27% improvement in fatigue, compared with an improvement of 19% for the usual-care group. The intervention patients also reported experiencing less pain to a greater degree than the others.

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