51
|
Exercise behavior and physical fitness in patients with advanced lung cancer. Support Care Cancer 2018; 26:2725-2736. [PMID: 29480444 DOI: 10.1007/s00520-018-4105-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/11/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this work was to evaluate exercise behavior and physical fitness of advanced lung cancer patients shortly after primary diagnosis. METHODS Between November 2013 and December 2016, advanced lung cancer patients (n = 227, mean age 62.2 years) were enrolled shortly after diagnosis and 211 patients were tested for endurance capacity (six-minute walk test) and strength performance (maximum voluntary isometric contraction of upper and lower extremities). Current and previous exercise and walking behavior were assessed using a self-reported questionnaire regarding type, frequency, intensity, and duration. Paired Student's t tests were used to compare physical fitness to reference data. The relation of potential determinants with physical fitness was assessed using linear regression analysis. RESULTS Exercise behavior was superior in the year before diagnosis compared to the time of study enrollment. Patients reduced frequency, intensity, and duration of sports/exercise after their lung cancer diagnosis. We observed significantly lower endurance capacity (p < .01) and strength performance in lower extremities (p < .01) in male and female patients compared to age and sex-matched reference data. We found significant correlations of previous exercise and walking behavior with physical fitness shortly after diagnosis in patients with advanced lung cancer. CONCLUSION Patients with advanced lung cancer showed impaired physical fitness regarding endurance and strength capacity. The strong decline in participation of sports/exercise shortly after diagnosis supports early implementation of physical exercise during anti-cancer treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02055508.
Collapse
|
52
|
Sheill G, Guinan EM, Peat N, Hussey J. Considerations for Exercise Prescription in Patients With Bone Metastases: A Comprehensive Narrative Review. PM R 2018; 10:843-864. [DOI: 10.1016/j.pmrj.2018.02.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 12/17/2022]
|
53
|
Dittus KL, Gramling RE, Ades PA. Exercise interventions for individuals with advanced cancer: A systematic review. Prev Med 2017; 104:124-132. [PMID: 28716654 DOI: 10.1016/j.ypmed.2017.07.015] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 01/24/2023]
Abstract
Despite improvements in therapy a large proportion of individuals with cancer will have a shortened life expectancy because of advanced or metastatic disease. Advances in therapy have however, extended life in those with advanced cancer thus heightening the importance of living well and preventing decline. The burdens of disease and cancer therapy impair aerobic fitness, strength, physical function and quality of life (QOL). Fatigue, the most common side effect of cancer and cancer therapy can further deteriorate QOL. Exercise has the potential to improve aerobic fitness, physical function, control fatigue and enhance QOL. However, exercise interventions are not routinely provided to those with advanced cancer. We present a systematic literature review of outcomes from interventions that include exercise for patients with advanced cancer. Studies were reviewed if they included an advanced cancer population and an intervention with a component of exercise. Overall, exercise containing interventions resulted in improvements in measures of aerobic capacity (14 of 19 studies) strength (11 of 12 studies), and components of physical function (9 of 9 studies). Fatigue and QOL were identified to improve in slightly over half of all evaluated studies (11 of 19 studies and 10 of 19 studies for fatigue and QOL respectively). The numbers of total participants reporting improvements in QOL (60%) were greater than fatigue (45%). Exercise provided to individuals with advanced cancer maintains or improves fitness and physical function and may diminish fatigue and enhance QOL and should be considered as an intervention to prevent further health complications.
Collapse
Affiliation(s)
- Kim L Dittus
- Department of Internal Medicine, Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, United States.
| | - Robert E Gramling
- Palliative Medicine, University of Vermont Larner College of Medicine, United States
| | - Philip A Ades
- Department of Internal Medicine, Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, United States
| |
Collapse
|
54
|
Edbrooke L, Aranda S, Granger CL, McDonald CF, Krishnasamy M, Mileshkin L, Irving L, Braat S, Clark RA, Gordon I, Denehy L. Benefits of home-based multidisciplinary exercise and supportive care in inoperable non-small cell lung cancer - protocol for a phase II randomised controlled trial. BMC Cancer 2017; 17:663. [PMID: 28962608 PMCID: PMC5622453 DOI: 10.1186/s12885-017-3651-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 09/22/2017] [Indexed: 12/31/2022] Open
Abstract
Background Lung cancer is one of the most commonly diagnosed cancers, and is a leading cause of cancer mortality world-wide. Due to lack of early specific symptoms, the majority of patients present with advanced, inoperable disease and five-year relative survival across all stages of non-small cell lung cancer (NSCLC) is 14%. People with lung cancer also report higher levels of symptom distress than those with other forms of cancer. Several benefits for survival and patient reported outcomes are reported from physical activity and exercise in other tumour groups. We report the protocol for a study investigating the benefits of exercise, behaviour change and symptom self-management for patients with recently diagnosed, inoperable, NSCLC. Methods This multi-site, parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aims to assess functional and patient-reported outcomes of a multi-disciplinary, home-based exercise and supportive care program for people commencing treatment. Ninety-two participants are being recruited from three tertiary-care hospitals in Melbourne, Australia. Following baseline testing, participants are randomised using concealed allocation, to receive either: a) 8 weeks of home-based exercise (comprising an individualised endurance and resistance exercise program and behaviour change coaching) and nurse-delivered symptom self-management intervention or b) usual care. The primary outcome is the between-group difference in the change in functional exercise capacity (six-minute walk distance) from baseline to post-program assessment. Secondary outcomes include: objective and self-reported physical activity levels, physical activity self-efficacy, behavioural regulation of motivation to exercise and resilience, muscle strength (quadriceps and grip), health-related quality of life, anxiety and depression and symptom interference. Discussion There is a lack of evidence regarding the benefit of exercise intervention for people with NSCLC, particularly in those with inoperable disease receiving treatment. This trial will contribute to evidence currently being generated in national and international trials by implementing and evaluating a home-based program including three components not yet combined in previous research, for people with inoperable NSCLC receiving active treatment and involving longer-term follow-up of outcomes. This trial is ongoing and currently recruiting. Trial registration This trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12614001268639: (4/12/14). Electronic supplementary material The online version of this article (10.1186/s12885-017-3651-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Level 7, 161 Barry St, Parkville, VIC, 3010, Australia.
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, NSW, Australia.,Department of Nursing, The University of Melbourne, Parkville, VIC, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Level 7, 161 Barry St, Parkville, VIC, 3010, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Department of Physiotherapy, Melbourne Health, Parkville, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Mei Krishnasamy
- Department of Nursing, The University of Melbourne, Parkville, VIC, Australia.,The University of Melbourne Centre for Cancer Research, Parkville, VIC, Australia
| | - Linda Mileshkin
- The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, Melbourne Health, Parkville, VIC, Australia
| | - Sabine Braat
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ross A Clark
- University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Ian Gordon
- Statistical Consulting Centre, The University of Melbourne, Parkville, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Level 7, 161 Barry St, Parkville, VIC, 3010, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| |
Collapse
|
55
|
Lehto RH. Psychosocial challenges for patients with advanced lung cancer: interventions to improve well-being. LUNG CANCER-TARGETS AND THERAPY 2017; 8:79-90. [PMID: 28814906 PMCID: PMC5546827 DOI: 10.2147/lctt.s120215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As compared to other cancers, lung malignancies are associated with high symptom burden, poorer prognosis, and stigmatization. Such factors increase psychological distress and negatively impact quality of life. Research has documented the efficacy of psychosocial interventions to alleviate psychological distress and promote well-being among patients with cancer. This article summarizes the current literature on psychosocial interventions in lung cancer. Major types of psychosocial interventions in lung cancer include cognitive-behavioral therapies, psycho-education, mind-body, exercise, and supportive or palliative care strategies. Discussion relative to the purpose, sample, research design, outcomes, and quality of the studies is presented. Findings may be useful in clinical environments as a resource to help health providers better understand mental health treatment options and care for patients facing lung cancer. The need to direct future research toward the advancement of science and improve well-being and quality of life outcomes for patients with advanced lung cancer and their family members is discussed.
Collapse
Affiliation(s)
- Rebecca H Lehto
- Michigan State University College of Nursing, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
56
|
Heywood R, McCarthy AL, Skinner TL. Safety and feasibility of exercise interventions in patients with advanced cancer: a systematic review. Support Care Cancer 2017; 25:3031-3050. [PMID: 28741176 DOI: 10.1007/s00520-017-3827-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 07/10/2017] [Indexed: 01/24/2023]
Abstract
GOALS OF WORK The beneficial effects of exercise in cancer patients are reasonably well-established, although research in this field has predominantly investigated cancer patients in the earlier stages of disease. However, the most recent evidence surrounding exercise interventions in advanced cancer populations has yet to be systematically evaluated. This review critically analyses the safety and feasibility of exercise interventions in patients with advanced cancer. METHODS All randomised, non-randomised and prospective observational trials of exercise training interventions in patients with advanced cancer were included. 'Safety' was defined as the number and severity of reported adverse events during exercise training. 'Feasibility' was determined by participant adherence, attendance and/or study completion rates. RESULTS A total of 25 studies involving 1088 patients were included: 16 randomised controlled and nine prospective observational cohort trials. Seven studies included advanced lung cancer patients exclusively, while eight involved patients with various cancer diagnoses. Aerobic exercise was investigated in five studies, resistance training in two studies and combination training (aerobic and resistance) in 14 studies. Six minor adverse events were reported due to exercise. All of these were musculoskeletal in nature, resulting in two participants' withdrawal from the study. Exercise adherence ranged from 65 to 89% but was only described in nine studies. Attendance at each exercise session was described in a further nine studies, ranging from 59 to 100%. CONCLUSIONS Implementation of exercise interventions appears to be safe and feasible in advanced cancer clinical practice, although targeted studies are required to determine the optimal exercise dose for specific cancer diagnoses.
Collapse
Affiliation(s)
- Reginald Heywood
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | | | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
57
|
Peddle‐McIntyre CJ, Singh F, Thomas R, Newton RU, Galvão DA, Cavalheri V. Exercise training for advanced lung cancer. Cochrane Database Syst Rev 2017; 2017:CD012685. [PMCID: PMC6481894 DOI: 10.1002/14651858.cd012685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary aim of this study is to investigate the effects of exercise training on exercise capacity in adults with advanced lung cancer. Exercise capacity is defined as the Six‐Minute Walk Distance (6MWD; in meters) measured during a 6MWT (i.e. how far an individual can walk in 6 minutes on a flat course) or the peak oxygen uptake (i.e. VO₂peak) measured during a maximal incremental CPET. The secondary aims are to determine the effects of exercise training on the force‐generating capacity of peripheral muscles, HRQoL, dyspnea, fatigue, feelings of anxiety and depression, lung function, and physical activity levels in adults with advanced lung cancer.
Collapse
|
58
|
Clauss D, Tjaden C, Hackert T, Schneider L, Ulrich CM, Wiskemann J, Steindorf K. Cardiorespiratory fitness and muscle strength in pancreatic cancer patients. Support Care Cancer 2017; 25:2797-2807. [PMID: 28417202 DOI: 10.1007/s00520-017-3694-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/31/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Cancer patients frequently experience reduced physical fitness due to the disease itself as well as treatment-related side effects. However, studies on physical fitness in pancreatic cancer patients are missing. Therefore, we assessed cardiorespiratory fitness and muscle strength of pancreatic cancer patients. METHODS We included 65 pancreatic cancer patients, mostly after surgical resection. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing (CPET) and 6-min walk test (6MWT). Hand-held dynamometry was used to evaluate isometric muscle strength. Physical fitness values were compared to reference values of a healthy population. Associations between sociodemographic and clinical variables with patients' physical fitness were analyzed using multiple regression models. RESULTS Cardiorespiratory fitness (VO2peak, 20.5 ± 6.9 ml/min/kg) was significantly lower (-24%) compared to healthy reference values. In the 6MWT pancreatic cancer patients nearly reached predicted values (555 vs. 562 m). Maximal voluntary isometric contraction (MVIC) of the upper (-4.3%) and lower extremities (-13.8%) were significantly lower compared to reference values. Overall differences were larger in men than those in women. Participating in regular exercise in the year before diagnosis was associated with greater VO2peak (p < .05) and MVIC of the knee extensors (p < .05). CONCLUSIONS Pancreatic cancer patients had significantly impaired physical fitness with regard to both cardiorespiratory function and isometric muscle strength, already in the early treatment phase (median 95 days after surgical resection). Our findings underline the need to investigate exercise training in pancreatic cancer patients to counteract the loss of physical fitness.
Collapse
Affiliation(s)
- Dorothea Clauss
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases and German Cancer Research Center, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Christine Tjaden
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lutz Schneider
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Cornelia M Ulrich
- Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- Department of Population Health Sciences, Huntsman Cancer Institute and University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases and Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases and German Cancer Research Center, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| |
Collapse
|
59
|
A comparison of the effects of medical Qigong and standard exercise therapy on symptoms and quality of life in patients with advanced cancer. Support Care Cancer 2017; 25:1749-1758. [PMID: 28102437 DOI: 10.1007/s00520-017-3579-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/09/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Patients with advanced cancer frequently experience anxiety, depression and poor quality of life (QOL), as well as physical symptoms such as fatigue and weakness. Physical exercise has potential to help control these symptoms but the optimal training prescription is still not clear. We performed a study comparing medical Qigong (QG) and standard endurance and strength training (SET) in patients with advanced stage non-small cell lung (NSCLC) and gastrointestinal (GI) cancers. METHODS A randomized, cross-over study was performed in patients with advanced NSCLC and GI cancers receiving or eligible for chemotherapy. Patients received supervised QG or SET twice-weekly for 6 weeks. Psychological functioning, QOL, symptoms and physical functioning were assessed before and after each intervention period. RESULTS Nineteen patients completed both interventions. Comparing interventions revealed no difference between QG and SET on change in anxiety or depression scores or QOL. However, SET treatment was better at improving perceived strength (P = 0.05) and walking distance (P = 0.02). The order in which interventions were performed had a significant impact on the improvement in certain symptoms (sleep quality, breathlessness, P < 0.05), QOL (P = 0.01) and walking distance (P = 0.008). In all cases, the beneficial effects of the exercise interventions were markedly reduced during the second interval. CONCLUSIONS QG and SET are equivalent in their impact on many aspects of psychological function in cancer patients. However, SET leads to greater improvements in exercise capacity and helps reduce some symptoms. The reduction in beneficial effect of SET on exercise function when offered as the second intervention is a new finding that warrants further study.
Collapse
|
60
|
Clinical Implementation of Exercise Guidelines for Cancer Patients: Adaptation of ACSM’s Guidelines to the Italian Model. J Funct Morphol Kinesiol 2017. [DOI: 10.3390/jfmk2010004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
61
|
Fairman CM, Hyde PN, Focht BC. Resistance training interventions across the cancer control continuum: a systematic review of the implementation of resistance training principles. Br J Sports Med 2016; 51:677-685. [DOI: 10.1136/bjsports-2016-096537] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/03/2022]
|
62
|
Sommer MS, Trier K, Vibe-Petersen J, Missel M, Christensen M, Larsen KR, Langer SW, Hendriksen C, Clementsen PF, Pedersen JH, Langberg H. Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA): A Feasibility Study. Integr Cancer Ther 2016; 15:455-466. [PMID: 27151595 PMCID: PMC5739160 DOI: 10.1177/1534735416635741] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction Surgical resection in patients with non-small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting, with focus on high-intensity interval exercise. Methods Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, University of Copenhagen, were randomly assigned to 1 of 4 groups (3 intervention groups and 1 control group). The preoperative intervention consisted of a home-based exercise program, while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling. The study endpoints were inclusion rate, adherence, and number of adverse events. Results Forty patients (of 124 screened; 32%) were included and randomized into the 4 groups. The postoperative exercise was completed by 73% of the patients randomized to this intervention. No adverse events were observed, indicating that the early postoperative exercise program is safe. The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery. Conclusion The early postoperative exercise program for patients with NSCLC was safe and feasible, but in a fast-track set up, a preoperative home-based exercise program was not feasible for this population.
Collapse
Affiliation(s)
- Maja S Sommer
- Copenhagen Centre for Cancer and Health, City of Copenhagen, Copenhagen, Denmark
| | - Karen Trier
- Copenhagen Centre for Cancer and Health, City of Copenhagen, Copenhagen, Denmark
| | - Jette Vibe-Petersen
- Copenhagen Centre for Cancer and Health, City of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | - Paul Frost Clementsen
- University of Copenhagen, Copenhagen, Denmark
- Gentofte University Hospital, Hellerup, Denmark
| | | | | |
Collapse
|
63
|
Titz C, Hummler S, Thomas M, Wiskemann J. Physical exercise in advanced cancer patients undergoing palliative treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2016.1251292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
64
|
Wiskemann J, Hummler S, Diepold C, Keil M, Abel U, Steindorf K, Beckhove P, Ulrich CM, Steins M, Thomas M. POSITIVE study: physical exercise program in non-operable lung cancer patients undergoing palliative treatment. BMC Cancer 2016; 16:499. [PMID: 27430336 PMCID: PMC4949758 DOI: 10.1186/s12885-016-2561-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Patients with advanced stage non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) often experience multidimensional impairments, affecting quality of life during their course of disease. In lung cancer patients with operable disease, several studies have shown that exercise has a positive impact on quality of life and physical functioning. There is limited evidence regarding efficacy for advanced lung cancer patients undergoing palliative treatment. Therefore, the POSITIVE study aims to evaluate the benefit of a 24-week exercise intervention during palliative treatment in a randomized controlled setting. Methods/design The POSITIVE study is a randomized, controlled trial investigating the effects of a 24-week exercise intervention during palliative treatment on quality of life, physical performance and immune function in advanced, non-operable lung cancer patients. 250 patients will be recruited in the Clinic for Thoracic Diseases in Heidelberg, enrolment begun in November 2013. Main inclusion criterion is histologically confirmed NSCLC (stage IIIa, IIIb, IV) or SCLC (Limited Disease-SCLC, Extensive Disease-SCLC) not amenable to surgery. Patients are randomized into two groups. Both groups receive weekly care management phone calls (CMPCs) with the goal to assess symptoms and side effects. Additionally, one group receives a combined resistance and endurance training (3x/week). Primary endpoints are quality of life assessed by the Functional Assessment of Cancer Therapy for patients with lung cancer (FACT-L, subcategory Physical Well-Being) and General Fatigue measured by the Multidimensional Fatigue Inventory (MFI-20). Secondary endpoints are physical performance (maximal voluntary isometric contraction, 6-min walk distance), psychosocial (depression and anxiety) and immunological parameters and overall survival. Discussion The aim of the POSITIVE trial is the evaluation of effects of a 24-week structured and guided exercise intervention during palliative treatment stages. Analysis of various outcomes (such as quality of life, physical performance, self-efficacy, psychosocial and immunological parameters) will contribute to a better understanding of the potential of exercise in advanced lung cancer patients. In contrast to other studies with advanced oncological patients the POSITIVE trial provides weekly phone calls to support patients both in the intervention and control group and to segregate the impact of physical activity on quality of life. Trial registration ClinicalTrials.gov NCT02055508 (Date: December 12, 2013)
Collapse
Affiliation(s)
- Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and University Clinic Heidelberg, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany.
| | - Simone Hummler
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Clinic for Thoracic Diseases, Department of Pneumology and Intensive Care Unit, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christina Diepold
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Melanie Keil
- Immune Monitoring Unit (G808), National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,CCU Neuroimmunology and Brain Tumor Immunology, National Center for Tumor Diseases, (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Abel
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Karen Steindorf
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Philipp Beckhove
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | | | - Martin Steins
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Thomas
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| |
Collapse
|
65
|
Ha D, Mazzone PJ, Ries AL, Malhotra A, Fuster M. The Utility of Exercise Testing in Patients with Lung Cancer. J Thorac Oncol 2016; 11:1397-410. [PMID: 27156441 DOI: 10.1016/j.jtho.2016.04.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 12/25/2022]
Abstract
The harm associated with lung cancer treatment include perioperative morbidity and mortality and therapy-induced toxicities in various organs, including the heart and lungs. Optimal treatment therefore entails a need for risk assessment to weigh the probabilities of benefits versus harm. Exercise testing offers an opportunity to evaluate a patient's physical fitness/exercise capacity objectively. In lung cancer, it is most often used to risk-stratify patients undergoing evaluation for lung cancer resection. In recent years, its use outside this context has been described, including in nonsurgical candidates and lung cancer survivors. In this article we review the physiology of exercise testing and lung cancer. Then, we assess the utility of exercise testing in patients with lung cancer in four contexts (preoperative evaluation for lung cancer resection, after lung cancer resection, lung cancer prognosis, and assessment of efficiency of exercise training programs) after systematically identifying original studies involving the most common forms of exercise tests in this patient population: laboratory cardiopulmonary exercise testing and simple field testing with the 6-minute walk test, shuttle walk test, and/or stair-climbing test. Lastly, we propose a conceptual framework for risk assessment of patients with lung cancer who are being considered for therapy and identify areas for further studies in this patient population.
Collapse
Affiliation(s)
- Duc Ha
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California.
| | | | - Andrew L Ries
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California
| | - Mark Fuster
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California; Pulmonary and Critical Care Medicine Section, Veterans Administration San Diego Healthcare System, San Diego, California
| |
Collapse
|
66
|
Wang H, Liu X, Rice SJ, Belani CP. Pulmonary Rehabilitation in Lung Cancer. PM R 2016; 8:990-996. [PMID: 27060645 DOI: 10.1016/j.pmrj.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/18/2016] [Accepted: 03/30/2016] [Indexed: 12/25/2022]
Abstract
Lung cancer remains a challenging disease with high morbidity and mortality despite targeted therapy. Symptom burden related to cancer impairs quality of life and functional status in patients with lung cancer and in survivors. Pulmonary rehabilitation has been recognized as an effective, noninvasive intervention for patients with chronic respiratory disease. It is well established that pulmonary rehabilitation benefits patients with chronic obstruction pulmonary disease through improved exercise capacity and symptoms. Evidence is increasing that the benefit of pulmonary rehabilitation can be applied to patients with lung cancer. Comprehensive pulmonary rehabilitation has made its way as a cornerstone of integrated care for patients with lung cancer. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Hongmei Wang
- Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Xin Liu
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA
| | - Shawn J Rice
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA
| | - Chandra P Belani
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, 500 University Dr, Hershey, PA 17033
| |
Collapse
|
67
|
Hanson ED, Wagoner CW, Anderson T, Battaglini CL. The Independent Effects of Strength Training in Cancer Survivors: a Systematic Review. Curr Oncol Rep 2016; 18:31. [DOI: 10.1007/s11912-016-0511-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
68
|
Berkman AM, Lakoski SG. The potential of aerobic exercise training in mitigating cardiovascular side effects of cancer therapy. Future Cardiol 2015; 11:407-11. [DOI: 10.2217/fca.15.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Amy M Berkman
- Office of Health Promotion Research, University of Vermont, Burlington, VT 05401, USA
| | - Susan G Lakoski
- Department of Internal Medicine, University of Vermont, Burlington, VT 05446, USA
- Vermont Center on Behavior Health & Vermont Cancer Center, Burlington, VT 05401, USA
| |
Collapse
|
69
|
Wolff G, Davidson SJ, Wrobel JK, Toborek M. Exercise maintains blood-brain barrier integrity during early stages of brain metastasis formation. Biochem Biophys Res Commun 2015; 463:811-7. [PMID: 26056010 DOI: 10.1016/j.bbrc.2015.04.153] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Abstract
Tumor cell extravasation into the brain requires passage through the blood-brain barrier, which is a highly protected microvascular environment fortified with tight junction (TJ) proteins. TJ integrity can be regulated under physiological and pathophysiological conditions. There is evidence that exercise can modulate oxidation status within the brain microvasculature and protect against tumor cell extravasation and metastasis formation. In order to study these events, mature male mice were given access to voluntary exercise on a running wheel (exercise) or access to a locked wheel (sedentary) for five weeks. The average running distance was 9.0 ± 0.2 km/day. Highly metastatic tumor cells (murine Lewis lung carcinoma) were then infused into the brain microvasculature through the internal carotid artery. Analyses were performed at early stage (48 h) and late stage (3 weeks) post tumor cell infusion. Immunohistochemical analysis revealed fewer isolated tumor cells extravasating into the brain at both 48 h and 3 weeks post surgery in exercised mice. Occludin protein levels were reduced in the sedentary tumor group, but maintained in the exercised tumor group at 48 h post tumor cell infusion. These results indicate that voluntary exercise may participate in modulating blood-brain barrier integrity thereby protecting the brain during metastatic progression.
Collapse
Affiliation(s)
- Gretchen Wolff
- Department of Biochemistry and Molecular Biology, University of Miami, Miller School of Medicine, 1011 NW 15th, St., Miami, FL 33136, USA.
| | - Sarah J Davidson
- Department of Biochemistry and Molecular Biology, University of Miami, Miller School of Medicine, 1011 NW 15th, St., Miami, FL 33136, USA.
| | - Jagoda K Wrobel
- Department of Biochemistry and Molecular Biology, University of Miami, Miller School of Medicine, 1011 NW 15th, St., Miami, FL 33136, USA.
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami, Miller School of Medicine, 1011 NW 15th, St., Miami, FL 33136, USA; Jerzy Kukuczka Academy of Physical Education, ul. Mikołowska 72a, Katowice 40-065, Poland.
| |
Collapse
|