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Christopher CN, Kang DW, Wilson RL, Gonzalo-Encabo P, Ficarra S, Heislein D, Dieli-Conwright CM. Exercise and Nutrition Interventions for Prehabilitation in Hepato-Pancreato-Biliary Cancers: A Narrative Review. Nutrients 2023; 15:5044. [PMID: 38140303 PMCID: PMC10745391 DOI: 10.3390/nu15245044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Gastrointestinal (GI) cancers constitute over 25% of global cancer cases annually, with hepato-pancreato-biliary (HPB) cancers presenting particularly poor prognosis and challenging surgical treatments. While advancements in clinical care have improved post-operative outcomes over time, surgery for HPB cancers remains associated with high morbidity and mortality rates. Patients with HPB cancer are often older, diagnosed at later stages, and have a higher prevalence of co-morbid conditions, leading to reduced life expectancy, suboptimal post-operative recovery, and increased recurrence risk. Exercise and nutrition interventions have emerged as safe non-pharmacological strategies to enhance clinical outcomes among cancer survivors, but their potential in the pre-operative period for patients with HPB cancer remains underexplored. This narrative review evaluates existing evidence on exercise and nutritional interventions during pre-operative prehabilitation for HPB cancer populations, focusing on clinically relevant post-operative outcomes related to frailty and malnutrition. We conducted a literature search in PubMed and Google Scholar databases to identify studies utilizing a prehabilitation intervention in HPB cancer populations with exercise and nutritional components. The currently available evidence suggests that incorporating exercise and nutrition into prehabilitation programs offers a critical opportunity to enhance post-operative outcomes, mitigate the risk of comorbidities, and support overall survivorship among HPB cancer populations. This review underscores the need for further research to optimize the timing, duration, and components of pre-operative prehabilitation programs, emphasizing patient-centered, multidisciplinary approaches in this evolving field.
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Affiliation(s)
- Cami N. Christopher
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Dong-Woo Kang
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Rebekah L. Wilson
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Paola Gonzalo-Encabo
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Harvard Medical School, Boston, MA 02115, USA
- Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28801 Madrid, Spain
| | - Salvatore Ficarra
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90133 Palermo, Italy
| | - Diane Heislein
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
| | - Christina M. Dieli-Conwright
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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Yu J, Refsum E, Helsingen LM, Folseraas T, Ploner A, Wieszczy P, Barua I, Jodal HC, Melum E, Løberg M, Blom J, Bretthauer M, Adami H, Kalager M, Ye W. Risk of hepato-pancreato-biliary cancer is increased by primary sclerosing cholangitis in patients with inflammatory bowel disease: A population-based cohort study. United European Gastroenterol J 2022; 10:212-224. [PMID: 35107865 PMCID: PMC8911542 DOI: 10.1002/ueg2.12204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is continued uncertainty regarding the risks of hepato-pancreato-biliary cancers in patients with inflammatory bowel disease (IBD) with or without concomitant primary sclerosing cholangitis (PSC). OBJECTIVE To give updated estimates on risk of hepato-pancreato-biliary cancers in patients with IBD, including pancreatic cancer, hepatocellular carcinoma, gall bladder cancer, and intra - and extrahepatic cholangiocarcinoma. METHODS In a population-based cohort study, we included all patients diagnosed with IBD in Norway and Sweden from 1987 to 2016. The cohort comprised of 141,960 patients, identified through hospital databases and the National Patient Register. Participants were followed through linkage to national cancer, cause of death, and population registries. We calculated absolute risk and standardized incidence ratios (SIRs) of hepato-pancreato-biliary cancers by PSC and other clinical characteristics. RESULTS Of the 141,960 IBD patients, 3.2% were diagnosed with PSC. During a median follow-up of 10.0 years, we identified 443 biliary tract cancers (SIR 5.2, 95% confidence interval [CI] 4.8-5.7), 161 hepatocellular carcinomas (SIR 2.4, 95% CI 2.0-2.7) and 282 pancreatic cancers (SIR 1.3, 95% CI 1.2-1.5). The relative risks were considerably higher in PSC-IBD patients, with SIR of 140 (95% CI 123-159) for biliary tract, 38.6 (95% CI 29.2-50.0) for hepatocellular, and 9.0 (95% CI 6.3-12.6) for pancreatic cancer. The SIRs were still slightly increased in non-PSC-IBD patients, compared to the general population. For biliary tract cancer, the cumulative probability at 25 years was 15.6% in PSC-IBD patients, and 0.4% in non-PSC-IBD patients. CONCLUSIONS The dramatically increased risks of hepato-pancreato-biliary cancers in PSC-IBD patients support periodic surveillance for these malignancies. While much lower, the excess relative risks in non-PSC-IBD patients were not trivial compared to non-IBD related risk factors.
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Affiliation(s)
- Jingru Yu
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Erle Refsum
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Lise M. Helsingen
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Trine Folseraas
- Department of Transplantation MedicineNorwegian PSC Research CenterDivision of Surgery, Inflammatory Diseases and TransplantationOslo University HospitalRikshospitaletOsloNorway
- Section of GastroenterologyDepartment of Transplantation MedicineDivision of Surgery, Inflammatory Medicine and TransplantationOslo University HospitalRikshospitaletOsloNorway
| | - Alexander Ploner
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Paulina Wieszczy
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
- Department of Gastroenterology, Hepatology and Clinical OncologyCentre of Postgraduate Medical EducationWarsawPoland
| | - Ishita Barua
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Henriette C. Jodal
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Espen Melum
- Department of Transplantation MedicineNorwegian PSC Research CenterDivision of Surgery, Inflammatory Diseases and TransplantationOslo University HospitalRikshospitaletOsloNorway
- Section of GastroenterologyDepartment of Transplantation MedicineDivision of Surgery, Inflammatory Medicine and TransplantationOslo University HospitalRikshospitaletOsloNorway
- Research Institute of Internal MedicineDivision of Surgery, Inflammatory Diseases and TransplantationOslo University HospitalOsloNorway
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Hybrid Technology Hub‐Centre of ExcellenceInstitute of Basic Medical SciencesFaculty of MedicineUniversity of OsloOsloNorway
| | - Magnus Løberg
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Johannes Blom
- Department of Clinical Science and EducationSödersjukhusetKarolinska InstitutetStockholmSweden
| | - Michael Bretthauer
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Hans‐Olov Adami
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Mette Kalager
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Weimin Ye
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouChina
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