Are physical performance and frailty assessments useful in targeting and improving access to adjuvant therapy in patients undergoing resection for pancreatic cancer?

S Powell-Brett*, J Hodson, R Pande, S Mann, Alice Freer, Zoe Wyrko, Clare Hughes, J Isaac, R P Sutcliffe, K Roberts

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Downloads (Pure)

Abstract

Background: Many patients fail to receive adjuvant chemotherapy following pancreatic cancer surgery. This study implemented a multimodal, multidisciplinary approach to improving recovery after pancreatoduodenectomy (the ‘Fast Recovery’ programme) and measured its impact on adjuvant chemotherapy uptake and nutritional decline. The predictive accuracies of a bundle of frailty and physical performance assessments, with respect to the recipient of adjuvant chemotherapy, were also evaluated. Results: The N = 44 patients treated after the introduction of the ‘Fast Recovery’ programme were not found to have a significantly higher adjuvant chemotherapy uptake than the N = 409 treated before the pathway change (80.5 vs. 74.3%, p = 0.452), but did have a significantly lower average weight loss at six weeks post-operatively (mean: 4.3 vs. 6.9 kg, p = 0.013). Of the pre-operative frailty and physical performance assessments tested, the 6-min walk test was found to be the strongest predictor of the receipt of adjuvant chemotherapy (area under the ROC curve: 0.91, p = 0.001); all patients achieving distances ≥ 360 m went on to receive adjuvant chemotherapy, compared to 33% of those walking < 360 m. Conclusions: The multimodal ‘Fast Recovery’ programme was not found to significantly improve access to adjuvant chemotherapy, but did appear to have benefits in reducing nutritional decline. Pre-operative assessments were found to be useful in identifying patients at risk of non-receipt of adjuvant therapies, with markers of physical performance appearing to be the best predictors. As such, these markers could be useful in targeting pre- and post-habilitation measures, such as physiotherapy and improved dietetic support.
Original languageEnglish
Article number88
JournalLangenbeck's archives of surgery
Volume408
Issue number1
DOIs
Publication statusPublished - 14 Feb 2023

Bibliographical note

© 2023. The Author(s).

Keywords

  • Humans
  • Frailty
  • Combined Modality Therapy
  • Pancreatic Neoplasms/drug therapy
  • Chemotherapy, Adjuvant/methods
  • Adjuvant chemotherapy
  • Nutrition
  • Prehabilitation
  • Pancreatic cancer
  • Research
  • Pancreatic exocrine insufficiency

Fingerprint

Dive into the research topics of 'Are physical performance and frailty assessments useful in targeting and improving access to adjuvant therapy in patients undergoing resection for pancreatic cancer?'. Together they form a unique fingerprint.

Cite this