Perioperative Physical Activity Levels Among PDAC Patients is Associated with Biomarkers of Cancer Prognosis

Introduction: Previous research has shown an association between physical activity and improvements in cancer biomarkers. We sought to evaluate if an association exists in patients with pancreatic ductal adenocarcinoma (PDAC). Method: From March 2019 – December 2020, patients undergoing surgery for PDAC wore a remote telemonitoring device for 3-4 weeks preoperatively. The device provided real-time patient activity data (step count). Patient demographics, neoadjuvant treatment, Cancer Antigen 19-9 (CA19-9) values, surgical pathology, and time to resumption of therapy were analyzed. Results: Sixty-five patients were enrolled; 52 completed surgery for PDAC. 56.9% were female, 86.2% were Caucasian, and average age was 64.9 years (SD=10.1). Patients wore the remote telemonitoring device on average 31 days (SD=10.1) preoperatively, taking on average 5,059.4 (SD=2,490.7) steps per day. Thirty patients received neoadjuvant chemotherapy (Folfirinox=20; Gemcitabine/Abraxane=10). The mean CA19-9 was 488.65 (SD=718.3) on presentation, and 194.4 (SD=322.1) after neoadjuvant therapy but before surgery. Thirty-four patients received adjuvant chemotherapy starting at a mean of 58 (SD=16.9) days after surgery. The average steps taken per day was positively correlated with CA19-9 response from neoadjuvant therapy (r2=0.493; p=0.017), and negatively correlated with CA19-9 post-surgery (r2= -0.483; p=0.004) and time to adjuvant chemotherapy (r2= -0.385; p=0.039). Conclusions: We demonstrate a moderate association between physical activity and CA19-9 levels among patients undergoing resection for PDAC. Physical activity may be a marker for higher functional status and/or may increase the effectiveness of therapy for PDAC. Improving physical activity is a targetable public health intervention and may improve outcomes at relatively low risk and cost.