Exercise and Nutrition Prehabilitation Program in Improving Outcomes for Patients with Resectable or Locally Advanced Pancreatic Cancer Undergoing Chemotherapy and Radiation before Surgery

Inclusion Criteria

• Diagnosed within 8 weeks with upfront resectable, borderline resectable, or locally advanced unresectable pancreatic ductal adenocarcinoma (PDAC) as defined by the National Comprehensive Cancer Network (NCCN).
• Planning to undergo TNT at Massachusetts General Hospital (MGH).
• Planning to receive fluorouracil, irinotecan, leucovorin and oxaliplatin (modified FOLFIRINOX) for neoadjuvant chemotherapy.
• Planning to undergo surgical resection of PDAC at MGH.
• Verbal fluency in English.

Exclusion Criteria

• Metastatic pancreas adenocarcinoma.
• Previous treatment for pancreas adenocarcinoma and no prior therapy for any cancer within 5 years.
• Known history of cognitive or psychologic impairment.
• Known history of physical impairment such as immobility, use of walking aids, or required wheelchair use.
• Known history of the following orthopedic comorbidities: advanced osteoarthritis or rheumatoid arthritis, mobility-limiting amputations, orthopedic injuries, or widespread chronic pain (e.g. fibromyalgia).
• Known history of the following pulmonary comorbidities: severe chronic obstructive pulmonary disease (COPD) defined as forced expiratory volume in 1 second (FEV1) =< 50%, emphysema, interstitial lung disease, and/or use of supplemental oxygen.
• Known history of the following cardiovascular comorbidities: uncontrolled hypertension, severe congestive heart failure (New York Heart Association [NYHA] class IV), and/or myocardial infarction within the last 6 months.
• Inability to tolerate diet through routine oral routes and/or patients with strict nutritional restrictions, allergies, and/or dietary preferences.