Abstract

Pancreatic cancer is a deadly disease with few curative treatment options. Therefore, preserving health-related quality of life (HRQoL) is significant. Factors that may negatively affect HRQoL include malnutrition and muscle wasting, which are prevalent in patients with pancreatic cancer. However, little is known regarding the role of diet and exercise interventions in maintaining HRQoL. A scoping review of the literature was performed to identify what is already known, and the research gaps that remain, surrounding diet and exercise interventions in patients with pancreatic cancer (Chapter 3). Studies (n=62) were heterogenous in the types of interventions investigated and the main outcomes studied. Seven research gaps were identified to guide the design of future studies. In response to the research gaps presented, Chapters 4 and 5 explored HRQoL outcomes in patients undergoing multimodal prehabilitation (prehab) prior to hepato-pancreato-biliary (HPB) surgery. Prehab included a diet, exercise and relaxation intervention that began 4 weeks prior to surgery. A control group (rehab) was observed for the 4-week preoperative period and began the same program right after surgery; both groups were followed for 8 weeks postoperatively. Chapter 4 explored associations between HRQoL and nutritional status, physical strength/function, muscle mass and cancer symptoms in the subset of patients awaiting pancreatic resection. There were strong, negative relationships between cancer symptoms (r=-0.832) and malnutrition (r=-0.697, p<0.001) at baseline, but not with physical strength/function or body composition. There was no difference in HRQoL outcomes between prehab or rehab over the study period. However, both groups achieved baseline HRQoL levels at 8-weeks postoperatively, quicker than the expected 3 to 6 months. Chapter 5 outlined the effectiveness of dietary counselling to meet protein recommendations and relationships between nutritional status and HRQoL in patients awaiting HPB surgery. In the preoperative period prehab, but not rehab, significantly increased protein intake (+0.3+/-0.1 g/kg, p<0.001). Additionally, nutritional status was negatively associated with HRQoL only in those who did not experience a minimally important HRQoL improvement (B:-2.83, p<0.001). This dissertation demonstrates a positive effect on HRQoL from diet and exercise interventions in patients awaiting pancreatic resection. Future research directions arising from this study are explored in Chapter 6.