Pancreatic cancer: adapted physical activity beneficial for patients

A prospective randomized study

The physical activity which invites itself to the podium of the congress of the American Society of Clinical Oncology (ASCO), the international high mass of cancerology, whose 2022 edition was held from June 3 to 7, in Chicago (United States), it was last Sunday. At the desk, Dr. Cindy Neuzillet, gastroenterologist and specialist in digestive cancers at the Institut Curie.

She is the co-coordinator of a phase III study, called APACaP, which shows the effectiveness of adapted physical activity (APA) on many parameters related to the quality of life of patients with advanced pancreatic cancer. . Initiated ten years ago, with 300 patients, this study is original in the sense that it is prospective, and not retrospective, as is most often the case in this type of follow-up. Clearly, this is a randomized study, with on the one hand a group of patients treated with chemotherapy alone, and another who, in addition to chemotherapy, was given appropriate physical activity.

Better disease control

The patients of the second group were evaluated by physical fitness tests carried out by a teacher specialized in APA. Objective: establish for each of them a personalized program of endurance exercises (walking, cycling) and muscle strengthening, to limit sarcopenia, generally the 2 pillars of APA, whatever the disease. They were then followed in video, for 4 months, in order to readjust the program, as and when the evolution, progress or difficulties of the patients. Note that a member of their entourage has been appointed to support them and maintain their motivation. In the end, fewer symptoms such as fatigue, pain, nausea and loss of appetite, resulting from the treatments, in short, better tolerance of the treatments.

“In addition to the beneficial effects on patients’ quality of life (physical, emotional and cognitive functioning), we also show a non-significant trend towards improvement in overall progression-free survival and treatment response rate, welcomes Dr. Neuzillet, in a press release from the Institut Curie. We also confirm that APA is feasible and safe in these patients..” It is even one of the rare treatments without side effects, if it is adapted, personalized and duly supervised.

Each year, 14,000 new cases of pancreatic cancer are diagnosed in France. Their frequency has doubled since the 1980s. But, apart from chemotherapy, and in rare cases (5-10%), targeted therapies, no treatment can, to date, effectively treat this disease.

APA historically ahead at Curie

On the strength of these results, Dr. Neuzillet has just launched a phase II clinical trial which this time aims to evaluate the interest of an individualized program of APA and nutrition in patients who suffer from advanced bronchial or digestive cancers and who are in a fragile situation.

That adapted physical activity is the subject of pioneering studies is part of a history specific to the Institut Curie which, very early on, highlighted APA as supportive care. In 2011, a program, then called “Activ”, was launched, initially offered to patients after treatment for breast cancer. “The idea was to combine dietary monitoring with collective APA classes, in a very educational way, so that the women could continue on their own.”, says Dr. Carole Bouleuc, head of the interdisciplinary department of supportive care for oncology patients (Disspo). Over the past two years, this complementary care has not only been extended to other cancers, but has also been refocused on patients undergoing treatment. The objective of this new program, called “starter”, being to optimize the effects of the treatment.

It is in this context that the first APA awareness day was born, organized on June 8 at the Parisian institute, which also received the “Sport Santé” label, in order to bring more patients to register for this program, and also to convince their loved ones to support them in this active process: “It’s also important to mobilize those around you, because patients need to be trained and encouraged. And their loved ones can really help them to practice this physical activity”, observes Dr. Bouleuc. Round tables, meetings and demonstrations of rugby, fencing and Nordic walking are offered during this event. “In 2021, 200 patients followed the Starter course, our wish is to double the number of participants”, indicates the specialist.

Regain confidence in your body

Dr. Bouleuc is inexhaustible on the benefits of adapted physical activity, and this on many levels: in terms of physical well-being, of course, but also psychological. “It is an important way, she adds, to be an actor of his illness, to take care of his body, to regain confidence in his body, and to note that the perimeter widens, and thus to regain autonomy”. The opportunity to remember that having cancer does not prevent you from moving, in an appropriate way, of course. The interest in terms of relapse prevention is substantial, up to more than 30% reduction in the risk of recurrence, depending on the type of cancer.

And nothing is forbidden. “The sport-leisure dimension is important so that this approach pleases the patient and can thus be sustained over time.”, specifies the head of the Disspo. And to make adapted physical activity sustainable, more and more structures have seen, and continue to see the light of day, between the clubs of the League against cancer, scattered throughout the territory, the nursing homes, the labeled clubs sport health, the Maison Rose up or the Cognacq-Jay workshop in Paris. Institut Curie has produced a booklet containing all this information, designed for patients. There is also the address of a site that will allow you to find your way wherever you live, whatever your chronic pathology: www.prescriforme.fr