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Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M, Eden M, Hayek S, Reigle B, Kerkman A, Neves R, Jablonoski K, Hacker ED, Sun V, Newman R, McDonnell KK, L'Hotta A, Schoenhals A, Dpt NLS. Systematic Review of Functional Outcomes in Cancer Rehabilitation. Arch Phys Med Rehabil 2022; 103:1807-1826. [PMID: 35104445 PMCID: PMC9339032 DOI: 10.1016/j.apmr.2022.01.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
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Affiliation(s)
- Alix Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars Sinai Cancer, Los Angeles, California, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States.
| | - Lynn H Gerber
- College of Health and Human Services, George Mason University, Fairfax County, Virginia, United States; Inova Health System, Inova Medicine Services, Falls Church, Virginia, United States
| | | | - Alicia Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, New York, United States; Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United States; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
| | - Shana Harrington
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States; Robert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
| | - Aneesha Virani
- Rehabilitation Department, Northside Hospital, Atlanta, Georgia, United States
| | - Xiaorong Hu
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United States; Rehabilitation Medicine School, Nanjing Medical University, Nanjing, China
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona, United States
| | - Samah Hayek
- Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel
| | - Beverly Reigle
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anya Kerkman
- Lincoln Cancer Rehabilitation, Lincoln, Nebraska, United States; CHI Health St Elizabeth, Lincoln, Nebraska, United States
| | - Raquel Neves
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Kathleen Jablonoski
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Eileen Danaher Hacker
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, United States
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, United States; Department of Surgery, City of Hope, Duarte, California, United States
| | - Robin Newman
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - Karen Kane McDonnell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Allison L'Hotta
- Department of Occupational Therapy, Washington University in St Louis, St Louis, Missouri, United States
| | - Alana Schoenhals
- Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, United States
| | - Nicole L Stout Dpt
- West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United States; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
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Huang CH, Peng TC, Cheng YT, Huang YT, Chang BS. Perioperative exercise intervention in patients with lung cancer: A systematic literature review of randomized controlled trials. Tzu Chi Med J 2021; 33:412-418. [PMID: 34760640 PMCID: PMC8532582 DOI: 10.4103/tcmj.tcmj_273_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/04/2021] [Accepted: 02/20/2021] [Indexed: 12/09/2022] Open
Abstract
Objectives: During perioperative, lung cancer (LC) patients are often left to experience debilitating disease-related symptoms, impaired physical activity and health-related quality of life (HRQoL), and social difficulties, despite the progress achieved in terms of treatment efficacy. Nonpharmacological intervention, such as exercise, has been identified as an effective strategy in LC patients before and after lung resection. Therefore, we aimed to assess evidence of the effect of perioperative exercise among patients with LC. Materials and Methods: Seven databases were searched from January 1998 to September 2020. All randomized controlled trials (RCTs) that evaluated the effect of exercise on the physical and psychological status of patients with LC during the perioperative period were reviewed. Two reviewers independently assessed the quality of all studies included here using the revised Cochrane risk of bias tool for RCTs. Results: Seventeen RCTs (1199 participants) published between 2011 and 2019 met for this literature review. The outcome measures that emerged from these studies included subjective outcomes, such as HRQoL, pain score, fatigue, and objective effects, such as cardiorespiratory fitness, pulmonary function, physical activity, and biological markers. Overall, these studies suggest that exercise should be an optimal option for LC; however, its efficacy and effectiveness regarding HRQoL should be investigated further. Conclusion: Perioperative exercise could be included in the rehabilitation program of patients with LC. More extensive, high-quality RCTs evidence is needed on the ideal exercise type, duration, intensity, and timing across the LC perioperative care.
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Affiliation(s)
- Chun-Hou Huang
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Tai-Chu Peng
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Yi-Tso Cheng
- Department of Cardiovascular Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bee-Song Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Thoracic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Covington KR, Hidde MC, Pergolotti M, Leach HJ. Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence. Support Care Cancer 2019; 27:4435-4450. [PMID: 31418074 DOI: 10.1007/s00520-019-05022-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Based on randomized controlled trials, exercise is an efficacious strategy to improve quality of life (QOL) among cancer survivors. However, the effectiveness of exercise programs to improve QOL in real-world settings is unknown, as are factors related to external validity. This hinders dissemination and scalability. This scoping review synthesized published research on community-based exercise programs for cancer survivors and reported on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). METHODS A systematic literature search identified community-based exercise programs for adult cancer survivors (1980-March 2018), that met the following inclusion criteria: at least one face-to-face exercise session, the primary aim of program evaluation (i.e., feasibility/effectiveness), and pre/post measure of QOL. Data were coded using the RE-AIM framework. The effect size was calculated for overall QOL. RESULTS Electronic database search yielded 553 articles; 31 studies describing unique programs were included for review. All studies described at least one element of implementation and most (80.6%) reported a significant (p < .05) improvement in at least one subscale, or total QOL. Few studies reported on indicators of reach (16.1%), adoption (6.5%), individual (16.1%), or system-level maintenance (32.3%). CONCLUSIONS Community-based exercise programs are effective for improving QOL in adult cancer survivors. Recommendations are provided to improve reporting across RE-AIM dimensions, which is an important step to enhance the scalability of programs and thus, the potential for exercise to be fully integrated into system-level standard care for cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Community-based exercise programs are a resource to improve QOL for adult cancer survivors.
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Affiliation(s)
- Kelley R Covington
- Department of Occupational Therapy, Colorado State University, Occupational Therapy Building, 1573 Campus Delivery, Fort Collins, CO, 80523-1573, USA.
- ReVital Cancer Rehabilitation, Select Medical, 4714, Gettysburg Road, Mechanicsburg, PA, 17055, USA.
| | - Mary C Hidde
- Department of Health and Exercise Science, Colorado State University, 220 Moby Complex B, 1592 Campus Delivery, Fort Collins, CO, 80523-1582, USA
| | - Mackenzi Pergolotti
- Department of Occupational Therapy, Colorado State University, Occupational Therapy Building, 1573 Campus Delivery, Fort Collins, CO, 80523-1573, USA
- ReVital Cancer Rehabilitation, Select Medical, 4714, Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, 220 Moby Complex B, 1592 Campus Delivery, Fort Collins, CO, 80523-1582, USA
- Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
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Avancini A, Sartori G, Gkountakos A, Casali M, Trestini I, Tregnago D, Bria E, Jones LW, Milella M, Lanza M, Pilotto S. Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled? Oncologist 2019; 25:e555-e569. [PMID: 32162811 PMCID: PMC7066706 DOI: 10.1634/theoncologist.2019-0463] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022] Open
Abstract
Lung cancer remains the leading cause of cancer‐related death worldwide. Affected patients frequently experience debilitating disease‐related symptoms, including dyspnea, cough, fatigue, anxiety, depression, insomnia, and pain, despite the progresses achieved in term of treatment efficacy. Physical activity and exercise are nonpharmacological interventions that have been shown to improve fatigue, quality of life, cardiorespiratory fitness, pulmonary function, muscle mass and strength, and psychological status in patients with lung cancer. Moreover, physical fitness levels, especially cardiorespiratory endurance and muscular strength, are demonstrated to be independent predictors of survival. Nevertheless, patients with lung cancer frequently present insufficient levels of physical activity and exercise, and these may contribute to quality of life impairment, reduction in functional capacity with skeletal muscle atrophy or weakness, and worsening of symptoms, particularly dyspnea. The molecular bases underlying the potential impact of exercise on the fitness and treatment outcome of patients with lung cancer are still elusive. Counteracting specific cancer cells’ acquired capabilities (hallmarks of cancer), together with preventing treatment‐induced adverse events, represent main candidate mechanisms. To date, the potential impact of physical activity and exercise in lung cancer remains to be fully appreciated, and no specific exercise guidelines for patients with lung cancer are available. In this article, we perform an in‐depth review of the evidence supporting physical activity and exercise in lung cancer and suggest that integrating this kind of intervention within the framework of a global, multidimensional approach, taking into account also nutritional and psychological aspects, might be the most effective strategy. Implications for Practice Although growing evidence supports the safety and efficacy of exercise in lung cancer, both after surgery and during and after medical treatments, most patients are insufficiently active or sedentary. Engaging in exercise programs is particularly arduous for patients with lung cancer, mainly because of a series of physical and psychosocial disease‐related barriers (including the smoking stigma). A continuous collaboration among oncologists and cancer exercise specialists is urgently needed in order to develop tailored programs based on patients’ needs, preferences, and physical and psychological status. In this regard, benefit of exercise appears to be potentially enhanced when administered as a multidimensional, comprehensive approach to patients’ well‐being. The potential effect of physical activity in lung cancer is not fully understood, and no specific exercise guidelines for lung cancer patients are available. This article reviews the evidence supporting physical activity and exercise in lung cancer and suggests that this type of intervention, along with considerations for the nutritional and psychological aspects of such an intervention, might be the most effective strategy.
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Affiliation(s)
- Alice Avancini
- Section of Clinical and Experimental Biomedical Science, Department of Medicine, University of VeronaItaly
| | - Giulia Sartori
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Anastasios Gkountakos
- Department of Diagnostics and Public Health, University and Hospital Trust of VeronaVeronaItaly
| | - Miriam Casali
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Ilaria Trestini
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Daniela Tregnago
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Emilio Bria
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)RomeItaly
- Università Cattolica Del Sacro CuoreRomeItaly
| | - Lee W. Jones
- Department of Medicine, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Michele Milella
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of VeronaItaly
| | - Sara Pilotto
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
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5
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Bade BC, Hyer JM, Bevill BT, Pastis A, Rojewski AM, Toll BA, Silvestri GA. A Patient-Centered Activity Regimen Improves Participation in Physical Activity Interventions in Advanced-Stage Lung Cancer. Integr Cancer Ther 2018; 17:921-927. [PMID: 29900753 PMCID: PMC6142103 DOI: 10.1177/1534735418781739] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Physical activity (PA) is a potential therapy to improve quality of life in patients with advanced-stage lung cancer (LC), but no PA regimen has been shown to be beneficial, clinically practical, and sustainable. We sought to test the hypothesis that a patient-centered activity regimen (PCAR) will improve patient participation and PA more effectively than weekly phone calls. METHODS In patients with advanced-stage LC, we implemented a walking-based activity regimen and motivated patients via either weekly phone calls (n = 29; FitBit Zip accelerometer) or PCAR (n = 15; FitBit Flex, an educational session, and twice-daily gain-framed text messages). Data collection over a 4-week period was compared, and a repeated-measures, mixed-effects model for activity level was constructed. RESULTS Subjects receiving PCAR more frequently used the device (100% vs 79%) and less frequently had missing data (11% vs 38%). "More active" and "less active" groups were created based on mean step count in the first week. "Less active" patients in the PCAR group increased their PA level, whereas PA level fell in the "more active" group. Most subjects found PCAR helpful (92%) and would participate in another activity study (85%). DISCUSSION Compared with weekly phone calls, PCAR has higher patient participation, is more likely to improve PA in "less active" subjects, and has high patient satisfaction. A multifaceted PA regimen may be a more efficacious mechanism to study PA in advanced LC. PCAR should be used in a randomized controlled trial to evaluate for improvements in symptom burden, quality of life, and mood.
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Affiliation(s)
| | - J Madison Hyer
- 2 Medical University of South Carolina, Charleston, SC, USA
| | | | - Alex Pastis
- 3 Academic Magnet High School, North Charleston, SC, USA
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Bayly J, Wakefield D, Hepgul N, Wilcock A, Higginson IJ, Maddocks M. Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis. Psychooncology 2018; 27:1675-1694. [DOI: 10.1002/pon.4684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation; King's College London; London UK
| | - Dominique Wakefield
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation; King's College London; London UK
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation; King's College London; London UK
| | - Andrew Wilcock
- University of Nottingham and Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation; King's College London; London UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation; King's College London; London UK
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Cannioto R, Etter JL, LaMonte MJ, Ray AD, Joseph JM, Al Qassim E, Eng KH, Moysich KB. LIFETIME PHYSICAL INACTIVITY IS ASSOCIATED WITH LUNG CANCER RISK AND MORTALITY. Cancer Treat Res Commun 2018; 14:37-45. [PMID: 29632898 DOI: 10.1016/j.ctarc.2018.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Investigations of the independent associations of physical inactivity with cancer endpoints have been mounting in the epidemiological literature, in part due to the high prevalence of physical inactivity among cancer patients and to evidence that inactivity associates with carcinogenesis via pathways independent of obesity. Yet, physical inactivity is not currently recognized as a well-established risk or prognostic factor for lung cancer. As such, we examined the associations of lifetime physical inactivity with lung cancer risk and mortality in a hospital-based, case-control study. PRESENTATION OF CASE Materials and Methods: The analyses included data from 660 lung cancer patients and 1335 matched cancer-free controls. Multivariable logistic regression analyses were utilized to assess the association between lifetime physical inactivity and lung cancer risk, and Cox proportional hazards models were utilized to estimate the association between lifetime physical inactivity and mortality among lung cancer cases.Results: We observed a significant positive association between lifetime physical inactivity and lung cancer risk: [Odds ratio (OR)=2.23, 95% confidence interval (CI): 1.77-2.81]; the association remained significant among never smokers (OR=3.00, 95% CI:1.33-6.78) and non-smokers (OR=2.33, 95% CI: 1.79-3.02). We also observed a significant positive association between lifetime physical inactivity and lung cancer mortality [Hazard ratio (HR)=1.40, 95% CI: 1.14-1.71]; the association remained significant in non-smokers (HR=1.51, 95% CI: 1.16-1.95). DISCUSSION/CONCLUSION These data add to the body of evidence suggesting that physical inactivity is an independent risk and prognostic factor for cancer. Additional research utilizing prospectively collected data is needed to substantiate the current findings.
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Affiliation(s)
- Rikki Cannioto
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, New York 14263, United States of America
| | - John Lewis Etter
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, New York 14263, United States of America
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, 273 Farber Hall, Buffalo, New York 14214, United States of America
| | - Andrew D Ray
- Department of Rehabilitation Science, University at Buffalo, 632 Kimball Tower, Buffalo, New York 14214, United States of America
| | - Janine M Joseph
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, New York 14263, United States of America
| | - Emad Al Qassim
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, New York 14263, United States of America
| | - Kevin H Eng
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, New York 14263, United States of America
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, New York 14263, United States of America
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Driessen EJ, Peeters ME, Bongers BC, Maas HA, Bootsma GP, van Meeteren NL, Janssen-Heijnen ML. Effects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: A systematic review. Crit Rev Oncol Hematol 2017; 114:63-76. [DOI: 10.1016/j.critrevonc.2017.03.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/22/2017] [Indexed: 01/24/2023] Open
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Granger CL, Connolly B, Denehy L, Hart N, Antippa P, Lin KY, Parry SM. Understanding factors influencing physical activity and exercise in lung cancer: a systematic review. Support Care Cancer 2016; 25:983-999. [PMID: 27900549 DOI: 10.1007/s00520-016-3484-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite evidence and clinical practice guidelines supporting physical activity (PA) for people with lung cancer, this evidence has not translated into clinical practice. This review aims to identify, evaluate and synthesise studies examining the barriers and enablers for patients with lung cancer to participate in PA from the perspective of patients, carers and health care providers (HCPs). METHODS Systematic review of articles using electronic databases: MEDLINE (1950-2016), CINAHL (1982-2016), EMBASE (1980-2016), Scopus (2004-2016) and Cochrane (2016). Quantitative and qualitative studies, published in English in a peer-reviewed journal, which assessed the barriers or enablers to PA for patients with lung cancer were included. Registered-PROSPERO (CRD4201603341). RESULTS Twenty-six studies (n = 9 cross-sectional, n = 4 case series, n = 11 qualitative) including 1074 patients, 23 carers and 169 HCPs were included. Barriers and enablers to PA were identified (6 major themes, 18 sub-themes): Barriers included patient-level factors (physical capability, symptoms, comorbidities, previous sedentary lifestyle, psychological influences, perceived relevance), HCP factors (time/knowledge to deliver information) and environmental factors (access to services, resources, timing relative to treatment). Enablers included anticipated benefits, opportunity for behaviour change and influences from HCPs and carers. CONCLUSION This systematic review has identified the volume of literature demonstrating that barriers and enablers to PA in lung cancer are multidimensional and span diverse factors. These include patient-level factors, such as symptoms, comorbidities, sedentary lifestyle, mood and fear, and environmental factors. These factors should be considered to identify and develop suitable interventions and clinical services in attempt to increase PA in patients with lung cancer.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia. .,Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia. .,Institute for Breathing and Sleep, Bowen Centre, 145 Studley Road, Hiedelberg, VIC, 3084, Australia.
| | - Bronwen Connolly
- Guy's and St. Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, Strand, London, WC2R 2LS, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.,Centre of Human and Aerospace Physiological Sciences, King's College London, Strand, London, WC2R 2LS, UK
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia.,Institute for Breathing and Sleep, Bowen Centre, 145 Studley Road, Hiedelberg, VIC, 3084, Australia
| | - Nicholas Hart
- Guy's and St. Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, Strand, London, WC2R 2LS, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.,Division of Asthma, Allergy and Lung Biology, King's College London, Strand, London, WC2R 2LS, UK
| | - Phillip Antippa
- Department of Thoracic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Kuan-Yin Lin
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia
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Increasing physical activity and exercise in lung cancer: reviewing safety, benefits, and application. J Thorac Oncol 2016; 10:861-71. [PMID: 25831230 DOI: 10.1097/jto.0000000000000536] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lung cancer continues to be a difficult disease frequently diagnosed in late stages with a high mortality and symptom burden. In part because of frequent lung comorbidity, even lung cancer survivors often remain symptomatic and functionally limited. Though targeted therapy continues to increase treatment options for advanced-stage disease, symptom burden remains high with few therapeutic options. In the last several decades, exercise and physical activity have arisen as therapeutic options for obstructive lung disease and lung cancer. To date, exercise has been shown to reduce symptoms, increase exercise tolerance, improve quality of life, and potentially reduce length of stay and postoperative complications. Multiple small trials have been performed in perioperative non-small-cell lung cancer patients, although fewer studies are available for patients with advanced-stage disease. Despite the increased interest in this subject over the last few years, a validated exercise regimen has not been established for perioperative or advanced-stage disease. Clinicians underutilize exercise and pulmonary rehabilitation as a therapy, in part because of the lack of evidence-based consensus as to how and when to implement increasing physical activity. This review summarizes the existing evidence on exercise in lung cancer patients.
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Leach HJ, Devonish JA, Bebb DG, Krenz KA, Culos-Reed SN. Exercise preferences, levels and quality of life in lung cancer survivors. Support Care Cancer 2015; 23:3239-47. [PMID: 25832895 DOI: 10.1007/s00520-015-2717-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/23/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Lung cancer poses multiple challenges to adopting an exercise (EX) program, and the ideal timing of an EX program to improve quality of life (QoL) is unknown. This study explored the EX counselling and programming preferences of lung cancer survivors and examined the association of EX before diagnosis, during treatment and after treatment on QoL. METHODS Cross-sectional, retrospective survey design in a sample of lung cancer survivors. EX preferences were compared between patients who had received radical chest radiation or lung surgery versus those who had not. EX was measured by self-report using the Godin Leisure Time Exercise Questionnaire (GLTEQ). Separate linear regression models, controlling for significant covariates, examined the association of EX at each time point with scores on QoL measures and subscales. RESULTS Participants (N = 66, M age 66.4 ± 9.1) were between 4 months and 11.5 years after lung cancer diagnosis (M = 31.7 ± 22.9 months). Patients who had lung surgery were more likely to prefer to start an EX program during adjuvant treatment than those who did not have surgery (t(33) = 2.43, p = .025). Compared to prediagnosis EX (M = 36.7 ± 56.0 MET h/week), EX levels declined significantly during (M = 12.4 ± 25.0 MET h/week) and after (M = 12.3 ± 17.4 MET h/week) treatment (p < .05). After controlling for disease stage and income, regression models were not significant, but EX after treatment was a significant individual predictor of fatigue (β = .049, p = .006) and QoL measured by the Chronic Respiratory Disease Questionnaire (β = .163, p = .025). CONCLUSIONS Lung cancer patient preferences indicate that EX program timing should take into account whether the patient has undergone surgery. Lung cancer survivors' EX levels declined after diagnosis and engaging in EX after treatment may improve fatigue and QoL.
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Affiliation(s)
- H J Leach
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - J A Devonish
- Medical University of the Americas, Calgary, AB, Canada.
| | - D G Bebb
- Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
| | - K A Krenz
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - S N Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada. .,Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada.
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