Multidisciplinary Lifestyle Intervention to Manage Pancreatic cancer-related Cachexia: a Case Report

Abstract

Pancreatic cancer remains an aggressive disease, with a poor prognosis and a high risk of incurring into cachexia. Supportive care, such as exercise, nutritional and psychological support, may be effective in reducing functional loss, psychological distress and improving nutritional status. We report the effect of 12 weeks of multimodal lifestyle intervention in a 55-year-old female, diagnosed with unresectable body/tail pancreatic cancer and metastasis in the liver, bone, lymph node and lung, to counteract cachexia. The multimodal program resulted safe and feasible. Over 12 weeks, considerable improvements were found in body weight, health-related physical fitness, nutritional status, distress scores, anxiety and depression levels. These findings highlight the potential role of integrated supportive interventions to manage metastatic cancer and cancer-induced cachexia.

Lay abstract

Pancreatic cancer has an unfavorable prognosis and a high risk of developing cachexia. Cachexia is a complex syndrome, manifesting with weight and muscle mass loss, usually leading to important metabolic disorders. To date, no effective treatments are available to reverse cancer-related cachexia, that it is also associated with a reduced probability of survival. In this report, we describe the benefits of an integrated intervention, including exercise, nutritional and psychological counseling, as a strategy to support a cachectic patient affected by metastatic pancreatic cancer.

Keywords:

• cachexia
• exercise
• lifestyle intervention
• metastatic disease
• nutrition
• pancreatic cancer
• psychological support

Author contributions

A Avancini contributed to research idea development, study design, data collection, data analysis, manuscript writing and manuscript editing; I Trestini contributed to research idea development, data collection, data analysis and manuscript writing; D Tregnago contributed to research idea development, data collection, data analysis, and manuscript writing; C Bonaiuto contributed to data collection and manuscript editing; A Cavallo contributed to data collection and manuscript editing; M Bragato contributed to data collection and manuscript editing; M Lanza and C Bonaiuto contributed to study design and manuscript editing; M Milella contributed to research idea development, study design, manuscript writing and manuscript editing; S Pilotto contributed to research idea development, study design, data collection, data analysis, and manuscript writing. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.

Financial & competing interests disclosure

S Pilotto is supported by the Italian Association for Cancer Research (AIRC-IG 20583) and by the International Association for Lung Cancer (IASLC). M Milella reports personal fees from Pfizer, EUSA Pharma and Astra Zeneca, outside the submitted manuscript. S Pilotto received honoraria or speakers’ fee from Astra-Zeneca, Eli-Lilly, BMS, Boehringer Ingelheim, MSD and Roche, outside the submitted manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. The authors state that they have obtained verbal and written informed consent from the patient for the inclusion of medical and treatment history within this case report.