Exploring the feasibility of a supportive care intervention for patients undergoing neo-adjuvant chemotherapy for pancreatic cancer: The FEED study (a fish oil supplement, pancreatic enzyme supplement, exercise advice and individualised dietary counselling)

Abstract

Background: Cachexia is highly prevalent in pancreatic cancer. Development of potent chemotherapy agents has led to a new era in the management of locally advanced and borderline resectable pancreatic cancer. Recent work confirmed that accelerated muscle loss occurs during neoadjuvant chemotherapy, significantly increasing mortality risk. Materials and Methods: An interventional study of a multi-modal package of care designed to prevent loss of muscle in patients with pancreatic cancer, with intensive nutritional counselling, pancreatic enzyme replacement therapy (PERT), an eicosapentaenoic acid enriched oral nutritional supplement (ONS), and individualised daily step target. The primary objective was to determine the feasibility of this 12-week intervention in 20 patients receiving neoadjuvant chemotherapy. Tolerance of supplementation, PERT, and physical activity was measured, alongside barriers to acceptance. Secondary objectives were change in body composition (CT-based assessment), inflammatory cytokines (IGF-1, Il-6, TNF-a), functional capacity (grip strength, Timed-Up-and-Go), and quality of life (EORTC). Results: Between September 2017 and November 2018, 20 of 28 eligible patients undergoing neoadjuvant treatment (Folfirinox or Gemcitabine with Nab-Paclitaxel) at our institution were recruited. Fifteen patients completed the intervention to date. Preliminary analysis of the feasibility of the intervention showed that 100% of patients attended fortnightly dietetic appointments, with 93%, 53% and 67% meeting PERT, ONS and step target prescriptions respectively. Barriers to meeting ONS prescription included taste aversion/fatigue (increased compliance when PERT was established), while barriers to meeting physical activity included chemotherapy-induced neuropathy, treatment related side effects, and fear of acquiring infection. Secondary objectives will be analysed upon study completion, with the remaining three participants due to complete the intervention in February 2019. Conclusion: Preliminary data identified high patient compliance and acceptance of this multi-modal intervention.