Discussion
muscle mass, cancers, GI cancers, cancer, sarcopenia, GI cancer, insomnia, pancreatic cancers, Cancer
CANCERS, CANCER, SARCOPENIA, GI CANCER, PANCREATIC CANCERS, CANCER
This study provided valuable data concerning the feasibility and safety of an EIP during palliative chemotherapy in patients with advanced GI cancers. In patients with advanced GI cancers treated with cytotoxic chemotherapy, 63.3% of patients exercised during the six weeks. The mean exercise time was 41.4 min. Most patients mainly performed aerobic and moderate-intensity exercises at home or near home.We were able to successfully recruit advanced GI cancer patients that were receiving palliative chemotherapy. In another study, Solhemi et al. reported a randomized phase II study on multimodal intervention in patients with advanced non-small cell and pancreatic cancers [Cancer patients undergo multiple cycles of chemotherapy, and as the cycle number increased, the number of patients who exercised decreased. Although the number of patients who performed the exercises was small, those who exercised during the third cycle significantly increased their mean exercise time to 55 min. An EIP during palliative chemotherapy may be helpful for patients accustomed to exercising during chemotherapy.Aerobic exercises were performed more than resistant exercises, as expected by the researchers. Although many patients only did aerobic exercises, there was also a proportion that did both aerobic and resistant exercises. Moderate-intensity exercise was mainly performed at the patient’s house or near their home except for exercising at the hospital while hospitalized. We were concerned about the safety of performed resistant exercise and high intensity exercise during chemotherapy. However, some patients were able to safely perform resistant and high-intensity EIP program.This feasibility study had three other outcomes. First, there was a significant decrease in the overall SMI in the enrolled patients, measured by CT. However, the SMI in the good compliance group was not significantly decreased. Second, the good compliance group had significantly improved OS compared with the poor compliance group. Third, the quality of life of patients that exercised showed improvements in insomnia.Compared with other papers, the advantage of this paper is that patients with GI cancer received concurrent palliative chemotherapy and EIP. Previous studies showed that when patients with GI cancers received palliative chemotherapy, the SMI measured by CT significantly decreased after six weeks of chemotherapy, and the mean SMI decreased by – 5.3 cmIn a previous study, the decreased SMI group had significantly shorter OS rates [In another previous study, CRP and albumin were measured, and there were no differences between the control and exercise groups [However, through this study, we suggested that sarcopenia was still occurring during chemotherapy, even with an EIP. Therefore, we have planned a further study to overcome this limitation. The authors are currently conducting a study on an exercise and nutrition combination therapy to prevent the decreased in SMI for older cancer patients during palliative chemotherapy.In conclusion, an EIP during palliative chemotherapy in advanced GI cancer patients had a good compliance. In the good compliance group, muscle mass and physical functions were maintained for six weeks. The exercise intervention was safe, and the quality of life was maintained. The good compliance group had significantly improved OS compared with the poor compliance group. Based on this study, further research is needed.