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Watanabe G, Shimizu Y, Mataki Y, Tokeji K, Hada Y. A Multidisciplinary Rehabilitation Approach for a Patient With Diffuse Large B-cell Lymphoma and Bone Metastasis: A Case Report. Cureus 2024; 16:e60713. [PMID: 38903364 PMCID: PMC11186799 DOI: 10.7759/cureus.60713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Cancer is often accompanied by bone metastasis, which may lead to skeletal-related events (SREs), such as pain, hypercalcemia, pathological fractures, spinal cord compression, orthopedic surgical intervention, and palliative radiation directed at the bone. Herein, we report the case of a 75-year-old female patient diagnosed with diffuse large B-cell lymphoma (DLBCL) with bone metastasis and a pathological fracture of the right iliac bone. The management strategy and follow-up were determined by a multidisciplinary cancer board comprising physicians, physiatrists, orthopedic surgeons, radiologists, and rehabilitation therapists. A conservative approach was chosen, incorporating a bone-modifying agent and weight-bearing restrictions for the right leg, along with rehabilitation therapy and post-discharge support. A multidisciplinary rehabilitation approach for two months enabled the patient to walk independently upon discharge. She maintains her activities of daily living (ADL) for over six months after discharge without any skeletal issues. This case highlights the effectiveness of a multidisciplinary approach in managing bone metastasis or involvement in patients with lymphoma.
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Affiliation(s)
- Gaku Watanabe
- Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, JPN
| | - Yukiyo Shimizu
- Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Yuki Mataki
- Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, JPN
| | - Kayo Tokeji
- Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, JPN
| | - Yasushi Hada
- Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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Kendall F, Silva G, Drummond M, Viana P, Eusébio E, Pinho P, Oliveira J, Bastos PT. Predictors of prolonged hospital stay in patients undergoing lung resection. Disabil Rehabil 2024:1-7. [PMID: 38166526 DOI: 10.1080/09638288.2023.2297936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 12/16/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. MATERIALS AND METHODS This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. RESULTS The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. CONCLUSION Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection.
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Affiliation(s)
- Filipa Kendall
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
- CESPU, Polytechnic Health Institute of the North, Gandra (PRD), Portugal
| | - Gustavo Silva
- Research Center in Sports Sciences, Health and Human Development (CIDESD), University of Maia (UMaia), Maia, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Viana
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Health School, Polytechnic Institute of Porto, Porto, Portugal
| | | | - Paulo Pinho
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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Navntoft S, Andreasen J, Petersen KS, Rossau HK, Jørgensen L. Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives. Disabil Rehabil 2023:1-13. [PMID: 37961874 DOI: 10.1080/09638288.2023.2280073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. MATERIALS AND METHODS Two systematic searches were conducted in five databases mapping peer-reviewed research literature. RESULTS In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. CONCLUSION From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.
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Affiliation(s)
- Sophie Navntoft
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Jane Andreasen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Jørgensen
- Clinic for Surgery and Cancer Treatment & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Chen Z, Jia J, Gui D, Liu F, Li J, Tu J. Functional and postoperative outcomes after high-intensity interval training in lung cancer patients: A systematic review and meta-analysis. Front Oncol 2023; 12:1029738. [PMID: 36741720 PMCID: PMC9895778 DOI: 10.3389/fonc.2022.1029738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 01/22/2023] Open
Abstract
Objective The study evaluated the effects of high-intensity interval training (HIIT) on postoperative complications and lung function in patients with lung cancer compared to usual care. Methods We searched electronic databases in April 2022, including PubMed, Embase, the Cochrane Library, Web of Science, and the China National Knowledge Infrastructure (CNKI). Two authors independently applied the Cochrane Risk of Bias tool to assess the quality of RCTs. The postoperative complications, length of hospitalization, and cardiopulmonary functions from the studies were pooled for statistical analysis. Results A total of 12 randomized controlled trials were eligible for inclusion and were conducted in the meta-analysis. HIIT significantly increased VO2peak (MD = 2.65; 95% CI = 1.70 to 3.60; I2 = 40%; P <0.001) and FEV1 (MD = 0.12; 95% CI = 0.04 to 0.20; I2 = 51%; P = 0.003) compared with usual care. A subgroup analysis of studies that applied HIIT perioperatively showed significant improvement of HIIT on FEV1 (MD = 0.14; 95% CI = 0.08 to 0.20; I2 = 36%; P <0.0001). HIIT significantly reduced the incidence of postoperative atelectasis in lung cancer patients compared with usual care (RD = -0.16; 95% CI = -0.24 to -0.08; I2 = 24%; P <0.0001). There was no statistically significant effect of HIIT on postoperative arrhythmias (RD = -0.05; 95% CI = -0.13 to 0.03; I2 = 40%; P = 0.22), length of hospitalization (MD = -1.64; 95% CI = -3.29 to 0.01; P = 0.05), and the six-minute walk test (MD = 19.77; 95% CI = -15.25 to 54.80; P = 0.27) compared to usual care. Conclusion HIIT may enhance VO2peak and FEV1 in lung cancer patients and reduce the incidence of postoperative atelectasis. However, HIIT may not reduce the incidence of postoperative arrhythmia, shorten the length of hospitalization, or improve the exercise performance of patients with lung cancer. Systematic review registration PROSPERO, CRD42022335441.
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Affiliation(s)
- Zihao Chen
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Junqiang Jia
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Dongmei Gui
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Feng Liu
- Department of Gastroenterology, Jining No. 1 People’s Hospital, Jining, China
| | - Jun Li
- Training Department, Nanjing Sport Institute, Nanjing, China
| | - Jiayuan Tu
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China,*Correspondence: Jiayuan Tu,
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Caruana E, Steiner MC. Perioperative rehabilitation in thoracic surgery: get up and go! Thorax 2023; 78:1-2. [PMID: 36192146 DOI: 10.1136/thorax-2022-219474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Edward Caruana
- Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Michael C Steiner
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, Leics, UK
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Effectiveness of Outpatient Pulmonary Rehabilitation in Patients with Surgically Resected Lung Cancer: A Retrospective Real-World Analysis. Cancers (Basel) 2022; 14:cancers14143479. [PMID: 35884540 PMCID: PMC9322504 DOI: 10.3390/cancers14143479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 01/27/2023] Open
Abstract
Patients with lung cancer frequently suffer from physical deconditioning, low exercise capacity, and reduced quality of life. There is little evidence on the effects of a structured outpatient pulmonary rehabilitation program (OPR) on exercise capacity and symptom load in these patients. We performed a retrospective, single-center analysis of surgically resected lung cancer patients, who underwent a multiprofessional 6-week OPR. The primary endpoint was a change in the six-minute walk test distance (6 MWT). Secondary endpoints included changes in maximal workload and constant work-rate test results during cycle-ergometry, upper and lower extremity strength, and inspiratory muscle strength. The COPD Assessment Test (CAT) was used to assess symptom burden. Fifty-seven patients were included. Of those, fifty-two (91.2%) completed the full 6 weeks of OPR. The mean age was 56.4 (SD 9.2) years, and 58% were female. At completion of OPR, there was a statistically significant mean of a 50 m (95% CI, 29.6−70.7; p < 0.001) increase in 6 MWT. Significant improvements were also seen in all other exercise and strength tests (p < 0.001), accompanied by a significant reduction in the CAT score (mean difference −3.1, p = 0.001). No adverse effects were reported. OPR for surgically resected lung cancer patients was safe and effective and showed high adherence in the current study.
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7
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Zhou L, Zhang Z, Nice E, Huang C, Zhang W, Tang Y. Circadian rhythms and cancers: the intrinsic links and therapeutic potentials. J Hematol Oncol 2022; 15:21. [PMID: 35246220 PMCID: PMC8896306 DOI: 10.1186/s13045-022-01238-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/16/2022] [Indexed: 02/07/2023] Open
Abstract
The circadian rhythm is an evolutionarily conserved time-keeping system that comprises a wide variety of processes including sleep-wake cycles, eating-fasting cycles, and activity-rest cycles, coordinating the behavior and physiology of all organs for whole-body homeostasis. Acute disruption of circadian rhythm may lead to transient discomfort, whereas long-term irregular circadian rhythm will result in the dysfunction of the organism, therefore increasing the risks of numerous diseases especially cancers. Indeed, both epidemiological and experimental evidence has demonstrated the intrinsic link between dysregulated circadian rhythm and cancer. Accordingly, a rapidly increasing understanding of the molecular mechanisms of circadian rhythms is opening new options for cancer therapy, possibly by modulating the circadian clock. In this review, we first describe the general regulators of circadian rhythms and their functions on cancer. In addition, we provide insights into the mechanisms underlying how several types of disruption of the circadian rhythm (including sleep-wake, eating-fasting, and activity-rest) can drive cancer progression, which may expand our understanding of cancer development from the clock perspective. Moreover, we also summarize the potential applications of modulating circadian rhythms for cancer treatment, which may provide an optional therapeutic strategy for cancer patients.
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Affiliation(s)
- Li Zhou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Sciences and Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, China
| | - Zhe Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Sciences and Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, China
| | - Edouard Nice
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, 3800, Australia
| | - Canhua Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Sciences and Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, China. .,School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Wei Zhang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China. .,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yong Tang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Acupuncture and Chronobiology Laboratory of Sichuan Province, Chengdu, 610075, China.
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8
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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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Impact of an Animation Education Program on Promoting Compliance With Active Respiratory Rehabilitation in Postsurgical Lung Cancer Patients: A Randomized Clinical Trial. Cancer Nurs 2021; 44:106-115. [PMID: 31714266 DOI: 10.1097/ncc.0000000000000758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-small cell lung cancer is the most common type of lung cancer. Lung resection is proven to be the most effective curative treatment for early-stage non-small cell lung cancer (stages I-IIIA). Studies show evidence-based pulmonary rehabilitation is critical for improving exercise capacity and pulmonary function, reducing burden of cancer-related symptoms, and facilitating quality of life following a lung resection. OBJECTIVE To explore the effectiveness of an animation education program to promote respiratory rehabilitation outcomes for postsurgical lung cancer patients. INTERVENTIONS/METHODS Eighty lung cancer patients who had undergone lung resection were equally randomized to 2 groups with 40 participants in each group. The intervention group received animation education. The control group received traditional face-to-face education. The training-related knowledge and exercise compliance were evaluated at baseline, 3 days after education, and the day of discharge, along with related pulmonary functional indicators. RESULTS Eighty of 99 eligible participants were enrolled (80.8%). Mean scores of training-related knowledge and exercise compliance in the intervention group were higher than those of the control group. Occurrences of postoperative pulmonary complications and the indwelling time of thoracic drainage tube were lower, and 6-minute walk distance was longer compared with the control group. No statistical differences in other pulmonary functional indicators were found. CONCLUSIONS Educational animation is effective for promoting training-related knowledge and exercise compliance with active respiratory rehabilitation in postsurgical lung cancer patients. IMPLICATIONS FOR PRACTICE Oncology nurses can implement animation as an innovative educational method for improving cancer patients' uptake and compliance on health education.
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Fukushima T, Tsuji T, Watanabe N, Sakurai T, Matsuoka A, Kojima K, Yahiro S, Oki M, Okita Y, Yokota S, Nakano J, Sugihara S, Sato H, Kawakami J, Kagaya H, Tanuma A, Sekine R, Mori K, Zenda S, Kawai A. The current status of inpatient cancer rehabilitation provided by designated cancer hospitals in Japan. Jpn J Clin Oncol 2021; 51:1094-1099. [PMID: 33989400 DOI: 10.1093/jjco/hyab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/26/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This survey was conducted to clarify the current status of inpatient cancer rehabilitation provided by designated cancer hospitals in Japan. METHODS A survey questionnaire was sent to 427 designated cancer hospitals in Japan. Information was sought regarding whether inpatient cancer rehabilitation was provided by the center, and if so, whether respondents regarded such provision as satisfactory. RESULTS Responses were obtained from 235/427 surveyed institutions (55.0%). Cancer rehabilitation was provided in inpatient settings by 97.4%. Two-thirds of respondents (67.7%) regarded inpatient cancer rehabilitation provision as still inadequate. The primary reasons claimed for this inadequacy were a lack of human resources, a lack of rehabilitation professionals with the requisite knowledge/skills and patients who would benefit from cancer rehabilitation present but not prescribed. The total number of rehabilitation staff was identified as associated factor of inadequate inpatient cancer rehabilitation in multivariate analysis (odds ratio = 0.979, 95% confidence interval = 0.96-1.00, P = 0.009). CONCLUSIONS In order to provide adequate cancer rehabilitation, a sufficient supply of rehabilitation staff, education and recognition of the need for cancer rehabilitation within oncology units are necessary.
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Affiliation(s)
- Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Noriko Watanabe
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Takuro Sakurai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Aiko Matsuoka
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Kojima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Sachiko Yahiro
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Mami Oki
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Yokota
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Nakano
- Department of Physical Therapy, Kansai Medical University, Osaka, Japan
| | - Shinsuke Sugihara
- Department of Orthopedic Oncology and Rehabilitation, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Juichi Kawakami
- Department of Rehabilitation Medicine, Shiga Prefectural Rehabilitation Center, Shiga, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Akira Tanuma
- Department of Rehabilitation Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Ryuichi Sekine
- Department of Pain and Palliative Care, Kameda Medical Center, Chiba, Japan
| | - Keita Mori
- Department of Clinical Research Center, Shizuko Cancer Center, Shizuoka, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
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Ma RC, Yin YY, Liu X, Wang YQ, Xie J. Effect of Exercise Interventions on Quality of Life in Patients With Lung Cancer: A Systematic Review of Randomized Controlled Trials. Oncol Nurs Forum 2021; 47:E58-E72. [PMID: 32301933 DOI: 10.1188/20.onf.e58-e72] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PROBLEM IDENTIFICATION Improving quality of life (QOL) is a key issue for patients with lung cancer. Exercise interventions could positively affect patients' QOL; however, there is no clear-cut understanding of the role of exercise in improving QOL in patients with lung cancer. LITERATURE SEARCH The PubMed®, Embase®, Cochrane Library, and Web of Science electronic databases were searched from inception to September 6, 2019. DATA EVALUATION 16 randomized controlled trials met the inclusion criteria. A qualitative synthesis method was used to identify the effect of exercise interventions on QOL in patients with lung cancer. SYNTHESIS This review indicates that exercise interventions may have beneficial effects on the QOL of patients with lung cancer. The effectiveness seems to be affected by the duration of the intervention, as well as exercise frequency, intensity, and adherence. IMPLICATIONS FOR PRACTICE Exercise interventions can be integrated into management plans for patients with lung cancer to improve their QOL. Healthcare providers should consider developing optimal exercise prescriptions to maximize the results for this population.
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12
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Attention to the Principles of Exercise Training in Exercise Studies of Persons With Lung Cancer: A Systematic Review. J Aging Phys Act 2021; 29:1042-1052. [PMID: 33963092 DOI: 10.1123/japa.2020-0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/10/2020] [Accepted: 12/06/2020] [Indexed: 11/18/2022]
Abstract
The authors systematically reviewed and summarized exercise trials in persons with lung cancer on (a) attention to the principles of exercise training (specificity, progression, overload, initial values, reversibility, and diminishing returns); (b) methodological reporting of FITT (frequency, intensity, time, and type) components; and (c) reporting on participant adherence to prescribed FITT. Randomized controlled trials of exercise that reported on ≥1 physical fitness, physical function, or body composition outcome in persons with lung cancer were included. Of 20 trial arms, none incorporated all principles of exercise training. Specificity was included by 95%, progression by 45%, overload by 75%, and initial values by 80%, while one trial arm applied reversibility and diminishing returns. Fourteen interventions reported all FITT components; however, none reported adherence to each component. Including the principles of training and reporting FITT components will contribute to better understanding of the efficacy of exercise for persons with lung cancer and inform evidence-based exercise prescriptions.
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Zhou W, Woo S, Larson JL. Effects of perioperative exercise interventions on lung cancer patients: An overview of systematic reviews. J Clin Nurs 2020; 29:4482-4504. [DOI: 10.1111/jocn.15511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Weijiao Zhou
- School of Nursing University of Michigan Ann Arbor MI USA
| | - Seoyoon Woo
- School of Nursing University of Michigan Ann Arbor MI USA
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Lu T, Denehy L, Cao Y, Cong Q, Wu E, Granger CL, Ni J, Edbrooke L. A 12-Week Multi-Modal Exercise Program: Feasibility of Combined Exercise and Simplified 8-Style Tai Chi Following Lung Cancer Surgery. Integr Cancer Ther 2020; 19:1534735420952887. [PMID: 32851871 PMCID: PMC7457649 DOI: 10.1177/1534735420952887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To assess the feasibility, safety, and preliminary effect of a 12-week
multi-modal rehabilitation program targeted at improving health-related
quality of life and physical activity levels of patients with lung cancer
following treatment. Methods: Patients with stage I to IIIA non-small cell lung cancer were included 6 to
12 weeks following completion of treatment. The intervention comprised of
aerobic exercise (brisk walking), resistance training and 8-style Tai Chi.
The 12-week program included 2 supervised center-based sessions per week of
90 minutes duration and home-based exercise. The primary outcomes were the
feasibility and safety of the intervention. Secondary outcomes (assessed pre
and post program) were physical and patient-reported outcomes. Results: Seventy-eight patients were approached during the 6-month recruitment period
and 17 (22%) consented to the study. Eight participants (47%) met the
definition of adherence to the program (attending at least 70% of supervised
sessions). No serious adverse events occurred. A significant reduction in
anxiety and depression was observed post-program. In addition, improvements
in respiratory function, sleep quality, and some health-related quality of
life domains were observed post-program. There were no significant
differences in functional capacity or physical activity levels. Conclusion: This multi-modal exercise training program was safe, although the feasibility
of the program in its current state is not supported given the low consent
rate and low adherence to the intervention.
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Affiliation(s)
- Ting Lu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Linda Denehy
- The University of Melbourne, Parkville, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Yuejiao Cao
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Qirui Cong
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - En Wu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Catherine L Granger
- The University of Melbourne, Parkville, Victoria, Australia.,Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jun Ni
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Lara Edbrooke
- The University of Melbourne, Parkville, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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15
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Oikawa M, Hanada M, Nagura H, Tsuchiya T, Matsumoto K, Miyazaki T, Sawai T, Yamasaki N, Nagayasu T, Kozu R. Factors Influencing Functional Exercise Capacity After Lung Resection for Non-Small Cell Lung Cancer. Integr Cancer Ther 2020; 19:1534735420923389. [PMID: 32493079 PMCID: PMC7273541 DOI: 10.1177/1534735420923389] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose: We investigated, in patients who underwent lung resection
for non–small cell lung cancer (NSCLC), the magnitude of early limitation in
functional exercise capacity and the associations with pre- and postoperative
factors. Methods: Consecutive patients with preoperative clinical
stage I to IIIA NSCLC who underwent lung resection were prospectively enrolled.
We measured functional exercise capacity (6-minute walk distance [6MWD]) and
skeletal muscle strength (handgrip [HF] and quadriceps force [QF]) within 2 days
prior to surgery and on day 7 postoperatively. Results: Two hundred
eighteen participants were recruited (median age 69 years) of whom 49 developed
postoperative complications (POCs). 6MWD was markedly decreased (514 m vs 469 m,
P < .001); HF and QF were slightly decreased following
surgery. Multiple linear regression showed that preoperative vital capacity
(P < .01), QF (P < .05), the
duration of chest tube drainage (P < .001), and presence of
POCs (P < .05) were significant predictors. However,
intraoperative factors were not significantly associated with the decline in
6MWD. Conclusions: These results suggest that patients with
preoperative impairments in pulmonary function and muscle strength, and those
who require prolonged chest tube drainage or develop POCs are likely to have
impaired exercise capacity. Therefore, individual assessment and follow-up of
patients with such factors is indicated.
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Affiliation(s)
- Masato Oikawa
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Masatoshi Hanada
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroki Nagura
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Takeshi Nagayasu
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
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16
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Exercise Training in Patients With Non-Small Cell Lung Cancer During In-Hospital Chemotherapy Treatment: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev 2020; 39:127-133. [PMID: 30801436 PMCID: PMC6407827 DOI: 10.1097/hcr.0000000000000410] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aimed to assess the impact of exercise training in patients with lung cancer on several outcomes compared to a control group. Results suggest that exercise programs in patients with lung cancer are a practical and beneficial intervention for enhancing mobility and physical fitness. Purpose: The aim of this study was to perform a randomized trial to assess the impact of exercise training in patients with non–small cell lung cancer during chemotherapy on several outcomes in comparison to a control group (CG). Methods: The exercise training group (ETG) consisted of 20 patients and the CG consisted of 10 patients. In the ETG, a 4-wk in-hospital exercise training program was performed in 2-wk cycles interspersed with consecutive rounds of chemotherapy with cytostatic drugs. The exercise training program was individualized and included warm-up, respiratory muscle exercise, training on a cycle ergometer or treadmill, and Nordic walking. CG participants were assessed before and after 6 wk of chemotherapy alone. Results: Comparing pre- and post-intervention values, the ETG demonstrated an increase in 6-min walk distance (486 ± 92 vs 531 ± 103 m, P = .01). In a battery of physical performance tests: Up and Go Test (6.3 ± 1.0 vs 6.0 ± 1.1 sec, P = .01); chair stand (13.3 ± 2.8 vs 14.3 ± 3.4 repetitions, P = .001); and arm curl (18.4 ± 3.1 vs 20.4 ± 3.5 repetitions, P = .001) all improved significantly. Spirometry values also improved: FEV1 % predicted (76 ± 16 vs 84 ± 15, P = .01), FVC % predicted (87 ± 14 vs 95 ± 13, P = .01), and FEV1/FVC (73 ± 13% vs 76 ± 12%, P = .04). The exercise training was well tolerated, without any adverse events due to exercise. There were no significant improvements in the CG. Conclusions: This study suggests that planned, individualized, and supervised exercise programs in patients with advanced lung cancer during chemotherapy are a practical and beneficial intervention for enhancing mobility and physical fitness.
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17
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Schoenau MN, Hansen M, Ulvestad S, Sommer MS, Pedersen JH, Missel M. The Lived Experiences, Perceptions, and Considerations of Patients After Operable Lung Cancer Concerning Nonparticipation in a Randomized Clinical Rehabilitation Trial. QUALITATIVE HEALTH RESEARCH 2020; 30:760-771. [PMID: 31729930 DOI: 10.1177/1049732319886564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to explore the lived experiences, perceptions, and considerations of individuals who declined participation in a randomized clinical trial involving exercise rehabilitation after surgery for lung cancer. An interpretive phenomenological approach was applied comprising interviews with 15 individuals who did not wish to participate in the trial. The findings shed light on a discrepancy between their freedom to act and make decisions and the limitations of having to act in a certain way. The participants found themselves in a gray area between a healthy life and a good life, as influenced by societal norms and taking responsibility for one's own health and rehabilitation. When including patients in rehabilitation after lung cancer, having insight into the underlying narrative on values and the good life, priorities in daily life, social context and the norms embedded in people's self-understanding is crucial.
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Affiliation(s)
- Mai Nanna Schoenau
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Roskilde University, Roskilde, Denmark
| | | | | | | | - Jesper Holst Pedersen
- University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Malene Missel
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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18
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Ninot G, Flori N, Huteau ME, Stoebner-Delbarre A, Senesse P. Activités physiques et cancers : des bénéfices prouvés pendant et après les traitements. Bull Cancer 2020; 107:474-489. [DOI: 10.1016/j.bulcan.2019.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 09/18/2019] [Accepted: 11/29/2019] [Indexed: 01/15/2023]
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Abstract
PURPOSE Dyspnea is highly prevalent in lung cancer survivors following curative-intent therapy. We aimed to identify clinical predictors or determinants of dyspnea and characterize its relationship with functional exercise capacity (EC). METHODS In an analysis of data from a cross-sectional study of lung cancer survivors at the VA San Diego Healthcare System who completed curative-intent therapy for stage I-IIIA disease ≥1 mo previously, we tested a thorough list of comorbidities, lung function, and lung cancer characteristics. We assessed dyspnea using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Lung Cancer Module 13 (LC13) and functional EC using the 6-minute walk. We replicated results with the University of California San Diego Shortness of Breath Questionnaire. RESULTS In 75 participants at a median of 12 mo since treatment completion, the mean ± SD LC13-Dyspnea score was 35.3 ± 26.2; 60% had abnormally high dyspnea. In multivariable linear regression analyses, significant clinical predictors or determinants of dyspnea were (β [95% CI]) psychiatric illness (-20.8 [-32.4 to -9.09]), heart failure with reduced ejection fraction (-15.5 [-28.0 to -2.97]), and forced expiratory volume in the first second of expiration (-0.28 [-0.49 to -0.06]). Dyspnea was an independent predictor of functional EC (-1.54 [-2.43 to -0.64]). These results were similar with the University of California San Diego Shortness of Breath Questionnaire. CONCLUSION We identified clinical predictors or determinants of dyspnea that have pathophysiological bases. Dyspnea was independently associated with functional EC. These results have implications in efforts to reduce dyspnea and improve exercise behavior and functional EC in lung cancer survivors following curative-intent therapy.
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Affiliation(s)
- Duc Ha
- Institute for Health Research, Kaiser Permanente Colorado, Aurora (Dr Ha); and Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla (Dr Ries)
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20
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A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors After Curative-Intent Treatment. Am J Phys Med Rehabil 2020; 99:233-240. [PMID: 31361623 PMCID: PMC6982544 DOI: 10.1097/phm.0000000000001281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors. DESIGN We used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders exercise intervention compared with usual care for stage I-IIIA lung cancer survivors after curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios of less than US $100,000/quality-adjusted life-year as cost-effective and assessed model uncertainty using sensitivity analyses. RESULTS The base-case model showed that the Lifestyle Interventions and Independence for Elders exercise program would increase overall cost by US $4740 and effectiveness by 0.06 quality-adjusted life-years compared with usual care and have an incremental cost-effectiveness ratio of US $79,504/quality-adjusted life-year. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of US $100,000/quality-adjusted life-year, Lifestyle Interventions and Independence for Elders had a 71% probability of being cost-effective compared with 27% for usual care. When we included opportunity costs, Lifestyle Interventions and Independence for Elders had an incremental cost-effectiveness ratio of US $179,774/quality-adjusted life-year, exceeding the cost-effectiveness threshold. CONCLUSIONS A simulation of the Lifestyle Interventions and Independence for Elders exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective.
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21
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Bayly J, Fettes L, Douglas E, Teixiera MJ, Peat N, Tunnard I, Patel V, Gao W, Wilcock A, Higginson IJ, Maddocks M. Short-term integrated rehabilitation for people with newly diagnosed thoracic cancer: a multi-centre randomized controlled feasibility trial. Clin Rehabil 2019; 34:205-219. [PMID: 31786963 DOI: 10.1177/0269215519888794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The main objective of this study is to determine the feasibility of recruiting and retaining patients recently diagnosed with thoracic cancer to a trial of short-term integrated rehabilitation; evaluate uptake of theoretically informed components targeting physical function, symptom self-management and participation; estimate sample size requirements for an efficacy trial. DESIGN Parallel group randomized controlled feasibility trial. SETTING Three U.K. hospitals. PARTICIPANTS Patients ⩽eight weeks of thoracic cancer diagnosis, Eastern Cooperative Oncology Group Performance Status 0-3, any cancer stage and treatment plan. INTERVENTIONS Participants randomly allocated (1:1) to short-term integrated rehabilitation and standard care or standard care alone over 30 days. MAIN MEASURES Primary: participant recruitment and retention, targeting ⩾30% of eligible patients enrolling and ⩾50% of participants reporting outcomes at 30 days. Secondary: intervention fidelity; missing data and performance of outcome measures for self-efficacy, symptoms, physical activity and health-related quality of life. RESULTS Of 159 eligible patients approached, 54 (34%) were recruited. A total of 44 (82%) and 39 (72%) participants reported outcomes at 30 and 60 days, respectively. Intervention fidelity was high. Rehabilitation was delivered across 3 (1-3) sessions over 32 (22-45) days (median (range)). Changes in clinical outcomes were modest but most apparent at 60 days for health-related quality of life: Functional Assessment of Cancer Therapy Lung Cancer score median (interquartile range) change 9.7 (-12.0 to 16.0) rehabilitation versus 2.3 (-15.0 to 14.5) standard care. CONCLUSION A trial to examine efficacy of short-term integrated rehabilitation for people newly diagnosed with thoracic cancer is feasible. A sample of 336 participants could detect a meaningful effect on health-related quality of life as the primary outcome.
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Affiliation(s)
| | | | | | | | - Nicola Peat
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Wei Gao
- King's College London, London, UK
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22
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Jonsson M, Hurtig-Wennlöf A, Ahlsson A, Vidlund M, Cao Y, Westerdahl E. In-hospital physiotherapy improves physical activity level after lung cancer surgery: a randomized controlled trial. Physiotherapy 2019; 105:434-441. [DOI: 10.1016/j.physio.2018.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/04/2018] [Indexed: 02/07/2023]
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23
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The usefulness of preoperative exercise therapy in patients scheduled for lung cancer surgery; a survey among Dutch pulmonologists and cardiothoracic surgeons. Support Care Cancer 2019; 28:1983-1989. [DOI: 10.1007/s00520-019-05014-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022]
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24
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Chronic Obstructive Pulmonary Disease and Lung Cancer: Underlying Pathophysiology and New Therapeutic Modalities. Drugs 2019; 78:1717-1740. [PMID: 30392114 DOI: 10.1007/s40265-018-1001-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer are major lung diseases affecting millions worldwide. Both diseases have links to cigarette smoking and exert a considerable societal burden. People suffering from COPD are at higher risk of developing lung cancer than those without, and are more susceptible to poor outcomes after diagnosis and treatment. Lung cancer and COPD are closely associated, possibly sharing common traits such as an underlying genetic predisposition, epithelial and endothelial cell plasticity, dysfunctional inflammatory mechanisms including the deposition of excessive extracellular matrix, angiogenesis, susceptibility to DNA damage and cellular mutagenesis. In fact, COPD could be the driving factor for lung cancer, providing a conducive environment that propagates its evolution. In the early stages of smoking, body defences provide a combative immune/oxidative response and DNA repair mechanisms are likely to subdue these changes to a certain extent; however, in patients with COPD with lung cancer the consequences could be devastating, potentially contributing to slower postoperative recovery after lung resection and increased resistance to radiotherapy and chemotherapy. Vital to the development of new-targeted therapies is an in-depth understanding of various molecular mechanisms that are associated with both pathologies. In this comprehensive review, we provide a detailed overview of possible underlying factors that link COPD and lung cancer, and current therapeutic advances from both human and preclinical animal models that can effectively mitigate this unholy relationship.
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25
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Missel M, Borregaard B, Schoenau MN, Sommer MS. A sense of understanding and belonging when life is at stake—Operable lung cancer patients' lived experiences of participation in exercise. Eur J Cancer Care (Engl) 2019; 28:e13126. [DOI: 10.1111/ecc.13126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/28/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Malene Missel
- Department of Cardiothoracic Surgery Copenhagen University Hospital Copenhagen Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery Odense University Hospital Odense C Denmark
| | - Mai Nanna Schoenau
- Department of Cardiothoracic Surgery Copenhagen University Hospital Copenhagen Denmark
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26
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Topal B, Smelt HJ, Van Helden EV, Celik A, Verseveld M, Smeenk F, Pouwels S. Utility of preoperative exercise therapy in reducing postoperative morbidity after surgery; a clinical overview of current evidence. Expert Rev Cardiovasc Ther 2019; 17:395-412. [DOI: 10.1080/14779072.2019.1625771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Esmee V. Van Helden
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Alper Celik
- Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli, Istanbul, Turkey
| | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Frank Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
- SHE School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Sjaak Pouwels
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
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27
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Peddle‐McIntyre CJ, Singh F, Thomas R, Newton RU, Galvão DA, Cavalheri V. Exercise training for advanced lung cancer. Cochrane Database Syst Rev 2019; 2:CD012685. [PMID: 30741408 PMCID: PMC6371641 DOI: 10.1002/14651858.cd012685.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with advanced lung cancer have a high symptom burden, which is often complicated by coexisting conditions. These issues, combined with the indirect effects of cancer treatment, can cumulatively lead patients to continued deconditioning and low exercise capacity. This is a concern as exercise capacity is considered a measure of whole body health, and is critical in a patient's ability to participate in life activities and tolerate difficult treatments. There is evidence that exercise training improves exercise capacity and other outcomes, such as muscle force and health-related quality of life (HRQoL), in cancer survivors. However, the effectiveness of exercise training on these outcomes in people with advanced lung cancer is currently unclear. OBJECTIVES The primary aim of this review was to investigate the effects of exercise training on exercise capacity in adults with advanced lung cancer. Exercise capacity was defined as the six-minute walk distance (6MWD; in meters) measured during a six-minute walk test (6MWT; i.e. how far an individual can walk in six minutes on a flat course), or the peak oxygen uptake (i.e. VO₂peak) measured during a maximal incremental cardiopulmonary exercise test (CPET).The secondary aims were to determine the effects of exercise training on the force-generating capacity of peripheral muscles, disease-specific global HRQoL, physical functioning component of HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, lung function, level of physical activity, adverse events, performance status, body weight and overall survival in adults with advanced lung cancer. SEARCH METHODS We searched CENTRAL, MEDLINE (via PubMed), Embase (via Ovid), CINAHL, SPORTDiscus, PEDro, and SciELO on 7 July 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared exercise training versus no exercise training in adults with advanced lung cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies and selected those for inclusion. We performed meta-analyses for the following outcomes: exercise capacity, disease-specific global HRQoL, physical functioning HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, and lung function (forced expiratory volume in one second (FEV1)). Two studies reported force-generating capacity of peripheral muscles, and we presented the results narratively. Limited data were available for level of physical activity, adverse events, performance status, body weight and overall survival. MAIN RESULTS We identified six RCTs, involving 221 participants. The mean age of participants ranged from 59 to 70 years; the sample size ranged from 20 to 111 participants. Overall, we found that the risk of bias in the included studies was high, and the quality of evidence for all outcomes was low.Pooled data from four studies demonstrated that, on completion of the intervention period, exercise capacity (6MWD) was significantly higher in the intervention group than the control group (mean difference (MD) 63.33 m; 95% confidence interval (CI) 3.70 to 122.96). On completion of the intervention period, disease-specific global HRQoL was significantly better in the intervention group compared to the control group (standardised mean difference (SMD) 0.51; 95% CI 0.08 to 0.93). There was no significant difference between the intervention and control groups in physical functioning HRQoL (SMD 0.11; 95% CI -0.36 to 0.58), dyspnoea (SMD -0.27; 95% CI -0.64 to 0.10), fatigue (SMD 0.03; 95% CI -0.51 to 0.58), feelings of anxiety (MD -1.21 units on Hospital Anxiety and Depression Scale; 95% CI -5.88 to 3.45) and depression (SMD -1.26; 95% CI -4.68 to 2.17), and FEV1 (SMD 0.43; 95% CI -0.11 to 0.97). AUTHORS' CONCLUSIONS Exercise training may improve or avoid the decline in exercise capacity and disease-specific global HRQoL for adults with advanced lung cancer. We found no significant effects of exercise training on dyspnoea, fatigue, feelings of anxiety and depression, or lung function. The findings of this review should be viewed with caution because of the heterogeneity between studies, the small sample sizes, and the high risk of bias of included studies. Larger, high-quality RCTs are needed to confirm and expand knowledge on the effects of exercise training in this population.
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Affiliation(s)
- Carolyn J Peddle‐McIntyre
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
| | - Favil Singh
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
| | - Rajesh Thomas
- University of Western AustraliaSchool of Medicine and PharmacologyHospital AvenuePerthAustralia
- Institute for Respiratory Health, Sir Charles Gairdner HospitalPerthAustralia
| | - Robert U Newton
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
- The University of QueenslandSchool of Human Movement and Nutrition SciencesBrisbaneAustralia
| | - Daniel A Galvão
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
| | - Vinicius Cavalheri
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
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Messaggi-Sartor M, Marco E, Martínez-Téllez E, Rodriguez-Fuster A, Palomares C, Chiarella S, Muniesa JM, Orozco-Levi M, Barreiro E, Güell MR. Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial. Eur J Phys Rehabil Med 2019; 55:113-122. [DOI: 10.23736/s1973-9087.18.05156-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Association between Pulmonary Function and Stair-Climbing Test Results after Lung Resection: A Pilot Study. Can Respir J 2018; 2018:1925028. [PMID: 30271508 PMCID: PMC6151193 DOI: 10.1155/2018/1925028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background The stair-climbing test was used to assess the exercise capacity before lung resection in subjects with lung cancer. However, few studies have systematically evaluated the role of this exercise methodology as a postoperative test. The aim of the present study was to assess whether the stair-climbing test findings reflect the postoperative decrease in pulmonary function. Methods Twenty subjects with non-small-cell lung cancer who underwent lung resection were enrolled in the study. Perioperative functional evaluation comprised the pulmonary function test, stair-climbing test, and 6-min walk distance test (6MWD). A correlation analysis was performed between the postoperative percentages of pulmonary function with respect to preoperative values and the exercise capacity. Results No correlation was noted between the percentage changes in pulmonary function and those in 6MWD. However, there was a significant correlation between the percentage changes in forced expiratory volume in 1 s and those in the altitude reached in the stair-climbing test (r=0.46, p < 0.05) and between the percentage changes in carbon monoxide lung diffusion capacity and those in the altitude (r=0.54, p < 0.05). Conclusions The stair-climbing test findings might be effective at detecting changes in exercise capacity induced by postoperative decrease in pulmonary function.
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Mikkelsen MK, Lund CM, Vinther A, Tolver A, Ragle AM, Johansen JS, Chen I, Engell-Noerregaard L, Larsen FO, Zerahn B, Nielsen DL, Jarden M. Engaging the older cancer patient; Patient Activation through Counseling, Exercise and Mobilization - Pancreatic, Biliary tract and Lung cancer (PACE-Mobil-PBL) - study protocol of a randomized controlled trial. BMC Cancer 2018; 18:934. [PMID: 30261853 PMCID: PMC6161425 DOI: 10.1186/s12885-018-4835-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/18/2018] [Indexed: 01/06/2023] Open
Abstract
Background Several intervention studies have demonstrated that exercise training has beneficial effects among cancer patients. However, older cancer patients are underrepresented in clinical trials, and only few exercise-based studies have focused specifically on older patients with cancer. In particular, research investigating the effects of exercise training among older patients with advanced cancer is lacking. The purpose of the current study is to investigate the effect of a 12-week multimodal and exercise-based intervention among older patients (≥65 years) with advanced pancreatic, biliary tract or lung cancer, who are treated with first-line palliative chemotherapy, immunotherapy or targeted therapy. Methods PACE-Mobil-PBL is a two-armed randomized controlled trial. Participants will be randomized 1:1 to an intervention group (N = 50) or a control group (N = 50). Participants in the intervention group will receive standard oncological treatment and a 12-week multimodal intervention, comprised of: (I) supervised exercise training, twice weekly in the hospital setting, (II) home-based walking with step counts and goal-setting, (III) supportive and motivational nurse-led counseling, and (IV) protein supplement after each supervised training session. Participants in the control group will receive standard oncological treatment. The primary outcome is physical function measured by the 30-s chair stand test. Secondary outcomes include measures of feasibility, activity level, physical capacity and strength, symptom burden, quality of life, toxicity to treatment, dose reductions, inflammatory biomarkers, body weight and composition, hospitalizations and survival. Assessments will be conducted at baseline, and after 6, 12 and 16 weeks. Discussion The current study is one of the first to investigate the effect of an exercise-based intervention specifically targeting older patients with advanced cancer. PACE-Mobil-PBL supports the development of health promoting guidelines for older patients with cancer, and the study results will provide new and valuable knowledge in this understudied field. Trial registration The study was prospectively registered at ClinicalTrials.gov on January 26, 2018 (ID: NCT03411200). Electronic supplementary material The online version of this article (10.1186/s12885-018-4835-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marta Kramer Mikkelsen
- Department of Oncology and Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Cecilia Margareta Lund
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark
| | - Anders Vinther
- Department of Rehabilitation, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,QD-Research Unit, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Anders Tolver
- Data Science Laboratory, Department of Mathematical Sciences, University of Copenhagen, 2100 Copenhagen Ø, Denmark
| | - Anne-Mette Ragle
- Department of Rehabilitation, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Julia Sidenius Johansen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark.,Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark
| | - Inna Chen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Lotte Engell-Noerregaard
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Finn Ole Larsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Dorte Lisbet Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Mary Jarden
- Department of Oncology and Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1014 Copenhagen K, Denmark
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Associations of objectively assessed physical activity and sedentary time with health-related quality of life among lung cancer survivors: A quantile regression approach. Lung Cancer 2018; 119:78-84. [PMID: 29656757 DOI: 10.1016/j.lungcan.2018.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/05/2018] [Accepted: 03/09/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES No studies have examined objectively assessed physical activity, sedentary time, and patient-reported outcomes among lung cancer survivors. The objective of this study was to determine associations of objectively assessed moderate-to-vigorous intensity physical activity (MVPA) and sedentary time with health-related quality of life (HRQoL) and fatigue among lung cancer survivors. MATERIALS AND METHOD Lung cancer survivors in Southern Alberta (N = 540) were invited to complete a mailed survey that assessed HRQoL [Functional Assessment of Cancer Therapy-Lung (FACT-L)], physical and functional well-being [Trial Outcome Index (TOI)], and fatigue [Fatigue Scale (FS)]. Physical activity and sedentary time data was collected using an Actigraph® GT3X+ accelerometer that was worn on the hip for seven consecutive days. Quantile regression was used to examine associations of HRQoL and fatigue with physical activity and sedentary time at the 25th, 50th, and 75th HRQoL and fatigue percentiles. RESULTS A total of 127 lung cancer survivors participated for a 24% response rate (Mean age = 71 years; Mean time since diagnosis = 75 months). Total MVPA minutes was positively associated with fewer fatigue symptoms at the 25th percentile (β = 0.16, p = 0.046). Total sedentary time was inversely associated with HRQoL at the 75th percentile (β = -0.07, p = 0.014) and inversely associated with fatigue symptoms at the 50th percentile (β = -0.04, p = 0.009). Total sedentary time was also inversely associated with physical and functional well-being scores at the 25th (β = -0.07, p = 0.045), 50th (β = -0.07, p = 0.004) and 75th (β = -0.04, p = 0.035) percentiles. CONCLUSION Across the HRQoL, fatigue, and physical and functional well-being distributions, sedentary time was inversely associated with HRQoL, fatigue, and physical and functional well-being in lung cancer survivors. Small associations were observed between MVPA and fatigue, but no associations emerged with HRQoL or physical and functional well-being.
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32
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Timmerman JGJ, Dekker-van Weering MGHM, Wouters MWJMM, Stuiver MMM, de Kanter WW, Vollenbroek-Hutten MMRM. Physical behavior and associations with health outcomes in operable NSCLC patients: A prospective study. Lung Cancer 2018; 119:91-98. [PMID: 29656759 DOI: 10.1016/j.lungcan.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/29/2018] [Accepted: 03/08/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Our objectives were to 1) characterize daily physical behavior of operable non-small cell lung cancer (NSCLC) patients, from preoperative to six months postoperative using accelerometry, and explore if physical behavior preoperative or one month postoperative is associated with better health outcomes at six months postoperative. METHODS A prospective study with 23 patients (13 female) diagnosed with primary NSCLC and scheduled for curative lung resection was performed. Outcome measures were assessed two weeks preoperative, and one, three and six months postoperative, and included accelerometer-derived physical behavior measures and the following health outcomes: six minute walking distance (6MWD), questionnaires concerning health-related quality of life (HRQOL), fatigue and distress. RESULTS On group average, physical behavior showed significant changes over time. Physical behavior worsened following surgery, but improved between one and six months postoperative, almost reaching preoperative levels. However, physical behavior showed high variability between patients in both amount as well as change over time. More time in moderate-to-vigorous physical activity in bouts of 10 min or longer in the first month postoperative was significantly associated with better 6MWD, HRQOL, distress, and fatigue at six months postoperative. CONCLUSION As expected, curative lung resection impacts physical behavior. Patients who were more active in the first month following surgery reported better health outcome six months postoperative. The large variability in activity patterns over time observed between patients, suggests that physical behavior 'profiling' through detailed monitoring of physical behavior could facilitate tailored goal setting in interventions that target change in physical behavior.
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Affiliation(s)
- J G Josien Timmerman
- Roessingh Research and Development, Telemedicine group, Roessinghsbleekweg 33b, 7522 AH Enschede, The Netherlands; Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, University of Twente, Postbox 217, 7500 AE Enschede, The Netherlands; ZGT Academy, Ziekenhuis Groep Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands.
| | | | - M W J M Michel Wouters
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - M M Martijn Stuiver
- Department of Physical Therapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; ACHIEVE, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands.
| | - W Wanda de Kanter
- Department of Pulmonology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - M M R Miriam Vollenbroek-Hutten
- Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, University of Twente, Postbox 217, 7500 AE Enschede, The Netherlands; ZGT Academy, Ziekenhuis Groep Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands.
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Abstract
PURPOSE OF REVIEW Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. RECENT FINDINGS Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. SUMMARY We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.
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Yan T, Liang XQ, Wang T, Li WO, Li HJ, Zhu SN, Wang DX. Prophylactic penehyclidine inhalation for prevention of postoperative pulmonary complications in high-risk patients: study protocol of a randomized controlled trial. Trials 2017; 18:571. [PMID: 29183393 PMCID: PMC5706155 DOI: 10.1186/s13063-017-2315-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 11/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) are major causes of morbidity, mortality, and prolonged hospital stay in patients after surgery. Using effective strategies to prevent its occurrence is essential to improve outcome. However, despite various efforts, the incidence of PPCs remains elevated in high-risk patients. Anticholinergic inhalation is used to reduce high airway resistance and improve pulmonary function; it may be helpful to decrease the risk of PPCs. Penehyclidine is a long-acting anticholinergic agent which selectively blocks M1 and M3 receptors. We hypothesize that, in high-risk patients, prophylactic penehyclidine inhalation may decrease the incidence of PPCs. Methods This is a randomized, double-blind, placebo-controlled trial with two parallel arms. A total of 864 patients at high risk of PPCs will be enrolled and randomized to receive prophylactic inhalation of either penehyclidine or placebo (water for injection). Study drug inhalation will be administered from the night (7 pm) before surgery until the second day after surgery, in an interval of every 12 hours. The primary outcome is the incidence of PPCs within 30 days after surgery. Secondary outcomes include the time to onset of PPCs (from end of surgery to first diagnosis of PPCs), the number of PPCs (indicates the number of diagnosed individual PPCs), the incidence of postoperative extrapulmonary complications, the length of stay in hospital after surgery, and the 30-day all-cause mortality. Discussion Results of the present study will provide evidence to guide clinical practice in using prophylactic inhalation of an anticholinergic to prevent PPCs in high-risk patients. Trial registration The study was registered prospectively in Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR-IPC-15006603) on 14 May 2015 and retrospectively in ClinicalTrials.gov (NCT02644876) on 30 December 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2315-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ting Yan
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xin-Quan Liang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Tong Wang
- Department of Anesthesiology, Aerospace Central Hospital, No.15 Yuquan Street, Haidian District, Beijing, 100049, China
| | - Wei-Ou Li
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hui-Juan Li
- Peking University Clinical Research Institute, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Sai-Nan Zhu
- Department of Biostatistics, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Schwellnus L, Roos R, Naidoo V. Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:344. [PMID: 30135901 PMCID: PMC6093126 DOI: 10.4102/sajp.v73i1.344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 05/30/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Physiotherapy is included in the management of patients undergoing thoracic surgery. The aim of this study was to describe physiotherapy practice in the management of patients who undergo an open thoracotomy. METHODS A cross-sectional study using convenience sampling was undertaken. An electronic self-administered questionnaire was distributed via SurveyMonkey to 1389 physiotherapists registered with the South African Society of Physiotherapy in Gauteng. The data collection period was August and September 2014 and data were analysed descriptively. RESULTS A total of 323 physiotherapists (23.3%) responded to the survey and 141 (10.2%) indicated that they treated patients with open thoracotomies. Preoperative treatment was done by 65 (41.6%) and consisted of teaching supported coughing (92.3%; n = 60), sustained maximal inspiration (70.8%; n = 46) and the active cycle of breathing technique (69.2%; n = 45). One hundred and sixteen (82.3%) respondents treated patients during their hospital stay. Deep breathing exercises (97.6%; n = 83), coughing (95.3%; n = 81), early mobilisation (95.3%; n = 81), upper limb mobility exercises (91.8%; n = 78), chest wall vibrations (88.2%; n = 75) and trunk mobility exercises (85.9%; n = 73) were done frequently. Pain management modalities were less common, for example transcutaneous electrical nerve stimulation (12.9%; n = 11). Post hospital physiotherapy management was uncommon (32.6%; n = 46). CONCLUSION Physiotherapy related to early mobilisation in hospital is in line with evidence-based practice, but further education is needed regarding the need for physiotherapy post hospital discharge and pain management.
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Affiliation(s)
- Liezel Schwellnus
- Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ronel Roos
- Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Vaneshveri Naidoo
- Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Li J, Guo NN, Jin HR, Yu H, Wang P, Xu GG. Effects of exercise training on patients with lung cancer who underwent lung resection: a meta-analysis. World J Surg Oncol 2017; 15:158. [PMID: 28835249 PMCID: PMC5569526 DOI: 10.1186/s12957-017-1233-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/13/2017] [Indexed: 01/29/2023] Open
Abstract
Background The efficacy of exercise training in patients with lung cancer after lung resection has not been well established yet. Therefore, we performed a meta-analysis to investigate the efficiency of exercise training in patients with lung cancer after lung resection. Methods Several databases were searched for eligible randomised controlled trials (RCTs). The primary outcome was quality of life, and the secondary outcomes included 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1) and postoperative complications (POCs). Weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated by random-effects model. Results Six RCTs involving 438 patients were enrolled in this meta-analysis. The pooled WMDs of the scores were 2.41 (95% CI = −5.20 to 10.02; P = 0.54) and −0.46 (95% CI = −20.52 to 19.61; P = 0.96) for the physical and mental components of the 36-item short-form scale, respectively. The pooled WMDs were 23.50 m (95% CI = −22.04 to 69.03; P = 0.31) for 6MWD and 0.03 L (95% CI = −0.19 to 0.26; P = 0.76) for FEV1. Finally, the pooled RRs were 0.79 (95% CI = 0.41 to 1.53; P = 0.49) for POCs. Conclusions Insufficient evidence is available to support the efficacy of exercise training in patients with lung cancer after lung resection. Further studies must confirm our findings and investigate the long-term effects of exercise training on patients with lung cancer following lung resection. Electronic supplementary material The online version of this article (doi:10.1186/s12957-017-1233-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Li
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Nan-Nan Guo
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hai-Rong Jin
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hua Yu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Wang
- Nanlou Medical Oncology Department, Chinese PLA General Hospital, Beijing, 100853, China
| | - Guo-Gang Xu
- Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Hoffman AJ, Brintnall RA, Given BA, von Eye A, Jones LW, Brown JK. Using Perceived Self-efficacy to Improve Fatigue and Fatigability In Postsurgical Lung Cancer Patients: A Pilot Randomized Controlled Trial. Cancer Nurs 2017; 40:1-12. [PMID: 27135752 PMCID: PMC5086324 DOI: 10.1097/ncc.0000000000000378] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatigue remains a prevalent and debilitating symptom in persons with non-small cell lung cancer (NSCLC). Exercise has been shown to be effective in reducing fatigue, yet interventions are limited for postsurgical NSCLC patients. To date, while surgery is offered as a standard curative treatment for NSCLC, no formal guidelines exist for postsurgical rehabilitation. OBJECTIVE This study focuses on the design and testing of a postsurgical intervention for NSCLC patients to promote perceived self-efficacy for fatigue self-management targeting cancer-related fatigue (CRF) severity and its associated fatigability through exercise. METHODS A 2-arm randomized controlled trial was used to examine the impact of a 6-week rehabilitative CRF self-management exercise intervention on 37 NSCLC participants compared with 35 control group participants receiving usual care from diagnosis to 6 weeks' postsurgical hospital discharge. RESULTS We exceeded goals for recruitment (66%), retention (97%), adherence (93%), and acceptability. Our 6-week exercise intervention demonstrated preliminary efficacy in significantly reducing CRF severity and fatigability as compared with usual care, with mean CRF levels restored to levels lower than presurgery. Likewise, the exercise group's functional performance (physical and mental health scores) exceeded usual care. Furthermore, no adverse events were reported; participants had a mean age of 67 years and a mean of 8 comorbid conditions. CONCLUSIONS An exercise intervention for postsurgical NSCLC patients is feasible, safe, and highly acceptable showing positive changes in CRF self-management. IMPLICATIONS FOR PRACTICE To advance practice, testing of the effectiveness of this health-promoting self-management exercise intervention in a larger-scale randomized controlled trial is needed.
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Affiliation(s)
- Amy J Hoffman
- Author Affiliations: College of Nursing, Michigan State University, East Lansing (Drs Hoffman and Given); Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan (Dr Brintnall); and Psychology Department, Michigan State University, East Lansing (Dr von Eye); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (Dr Jones); and School of Nursing, University at Buffalo, the State University of New York (Dr Brown)
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Kubori Y, Matsuki R, Hotta A, Morisawa T, Tamaki A. Comparison between stair-climbing test and six-minute walk test after lung resection using video-assisted thoracoscopic surgery lobectomy. J Phys Ther Sci 2017; 29:902-904. [PMID: 28603368 PMCID: PMC5462695 DOI: 10.1589/jpts.29.902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/16/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Currently, the six-minute walk distance (6MWD) is used to evaluate exercise
capacity in people following lung resection for non-small cell lung cancer. However, it is
unclear whether the 6MWD can detect changes in cardiorespiratory fitness induced by
exercise training or lung resection. Conversely, the stair-climbing test is used
frequently for the preoperative evaluation of lung resection candidates. It is considered
a sensitive method for detecting changes associated with training, but is not used to
evaluate exercise capacity after lung resection. The purpose of this study was to compare
the stair-climbing test and the six-minute walk test (6MWT) after lung resection.
[Subjects and Methods] Fourteen patients undergoing lung resection completed the
stair-climbing test and the 6MWT preoperatively, and one month postoperatively. The
postoperative values and the percentage change in the stair-climbing test and the 6MWT
were evaluated. [Results] The stair-climbing test results showed a significant
deterioration at one month after lung resection; however, a significant change in the 6MWD
was not observed. [Conclusion] When compared with the 6MWT, the stair-climbing test was
more sensitive in detecting lung resection-induced changes in cardiorespiratory
fitness.
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Affiliation(s)
- Yohei Kubori
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Ryosuke Matsuki
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Akira Hotta
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Japan
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Japan
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Peddle-McIntyre CJ, Baker MK, Lee YCG, Galvão DA, Cormie P, Graham V, Newton RU. The feasibility of a pragmatic distance-based intervention to increase physical activity in lung cancer survivors. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28597947 DOI: 10.1111/ecc.12722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 01/09/2023]
Abstract
The purpose of this study was to investigate the feasibility and preliminary efficacy of a pragmatic distance-based intervention designed to increase physical activity (PA) participation in lung cancer survivors. Fourteen lung cancer survivors were recruited via invitation from the State Cancer Registry to join a 12-week PA intervention of print materials paired with brief telephone follow-up. Outcome measures of feasibility, PA participation and quality of life (QoL) were assessed at baseline, post-intervention and follow-up via telephone interview. Eligibility, recruitment and attrition rates were 16%, 58% and 29% respectively. No adverse events were reported; however, pain scores worsened following the intervention (median change -3.6, IQR -8.0, 0.0). Average intervention adherence was 91% with low median ratings of participation burden (i.e., all items 1/7) and high trial evaluation (i.e., all items 7/7). Post-intervention, median change in self-reported moderate and vigorous PA was 84 min (IQR -22, 188), and several domains of QoL improved. However, for both of these outcomes, improvements were not maintained at follow-up. Our findings suggest that this pragmatic distance-based intervention was safe, had good adherence rates, and indicate potential for improving short-term PA and QoL in lung cancer survivors. Additional strategies are needed to improve other indicators of feasibility, particularly recruitment, retention and long-term maintenance of improvements. Australian New Zealand Clinical Trials Registration: ACTRN12612000085875.
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Affiliation(s)
- C J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - M K Baker
- School of Exercise Science, Australian Catholic University, Strathfield, NSW, Australia
| | - Y C G Lee
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - D A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - P Cormie
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Institute for Health and Aging, Australian Catholic University, Melbourne, Vic., Australia
| | - V Graham
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia
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40
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Abstract
BACKGROUND Surgical resection for early stage non-small cell lung cancer (NSCLC) offers the best chance of cure, but is associated with a risk of postoperative pulmonary complications (i.e. pneumonia (new infiltrate coupled with either fever (> 38º C) and purulent secretions, or fever and white cell count > 11,000), bronchopleural fistula, severe atelectasis that requires chest physiotherapy or bronchoscopy, and prolonged mechanical ventilation (> 48 hours)). It is currently unclear if preoperative exercise training, and the potential resultant improvement in exercise capacity, may also improve postoperative outcomes, such as the risk of developing postoperative pulmonary complications, the length of postoperative intercostal drainage, or the length of hospital stay. OBJECTIVES The primary aims of this study were to determine the effect of preoperative exercise training on postoperative outcomes, such as risk of developing a postoperative pulmonary complication, and postoperative duration of intercostal catheter use in adults scheduled to undergo lung resection for NSCLC. The secondary aims of this study were to determine the effect of preoperative exercise training on length of hospital stay, fatigue, dyspnoea, exercise capacity, lung function, and postoperative mortality. SEARCH METHODS We searched CENTRAL, MEDLINE (PubMed), Embase Ovid, PEDro, and SciELO on the 28th of November 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which study participants who were scheduled to undergo lung resection for NSCLC were allocated to receive either preoperative exercise training or no exercise training. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies and selected those for inclusion. We performed meta-analyses for the outcomes: risk of developing a postoperative pulmonary complication; postoperative duration of intercostal catheter; length of hospital stay; post-intervention exercise capacity (6-minute walk distance), and post-intervention forced vital capacity (FVC). Although three studies reported post-intervention forced expiratory volume in 1 second (FEV1), we did not perform meta-analysis on this outcome due to significant statistical heterogeneity (I² = 93%) across the studies. Data were not available for fatigue or dyspnoea. One study reported no in-hospital postoperative mortality in either the exercise or the non-exercise groups. MAIN RESULTS We identified five RCTs involving 167 participants (mean age ranged from 54 to 72.5 years; sample size ranged from 19 to 60 participants). Overall, we found that the risk of bias in the included studies was high, and the quality of evidence for all outcomes was low. Pooled data from four studies demonstrated that preoperative exercise training reduced the risk of developing a postoperative pulmonary complication by 67% (risk ratio (RR) 0.33, 95% CI 0.17 to 0.61). The number of days patients in the exercise group needed an intercostal catheter was lower than in the non-exercise group (mean difference (MD) -3.33 days, 95% CI -5.35 to -1.30 days; two studies); postoperative length of hospital stay was also lower in the exercise group (MD -4.24 days, 95% CI -5.43 to -3.06 days; four studies). Pooled data from two studies demonstrated that compared to the non-exercise group, post-intervention 6-minute walk distance (MD 18.23 m, 95% CI 8.50 to 27.96 m), and post-intervention FVC (MD 2.97% predicted, 95% CI 1.78 to 4.16% predicted) were higher in the exercise group. AUTHORS' CONCLUSIONS Preoperative exercise training may reduce the risk of developing a postoperative pulmonary complication, the duration of intercostal catheter use, postoperative length of hospital stay, and improve both exercise capacity and FVC in people undergoing lung resection for NSCLC. The findings of this review should be interpreted with caution due to disparities between the studies, risk of bias, and small sample sizes. This review emphasises the need for larger RCTs.
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Affiliation(s)
- Vinicius Cavalheri
- Curtin UniversitySchool of Physiotherapy and Exercise ScienceKent StreetPerthWestern AustraliaAustralia6102
- Institute for Respiratory HealthPerthAustralia
| | - Catherine Granger
- The University of MelbourneDepartment of PhysiotherapyLevel 7, Alan Gilbert Building161 Barry StreetParkvilleVictoriaAustralia3010
- Royal Melbourne HospitalPhysiotherapyGrattan StreetParkvilleVICAustralia3010
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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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Ambulant monitoring and web-accessible home-based exercise program during outpatient follow-up for resected lung cancer survivors: actual use and feasibility in clinical practice. J Cancer Surviv 2017; 11:720-731. [PMID: 28396993 PMCID: PMC5671546 DOI: 10.1007/s11764-017-0611-6] [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: 08/22/2016] [Accepted: 02/24/2017] [Indexed: 01/05/2023]
Abstract
Purpose The aim of this study is to evaluate the feasibility of a telehealthcare application for operable lung cancer (OLC) patients, consisting of ambulant symptom and physical activity monitoring (S&PAM) and a web-accessible home-based exercise program (WEP), and identify possible barriers for successful adoption and implementation. Methods A two-stage mixed methods design was used, in which 22 OLC patients and their treating healthcare professionals (HCPs) participated from pre-surgery to three (stage 1; n = 10) or six (stage 2; n = 12) months post-surgery. Actual use and acceptability (usability, usefulness, and satisfaction) were evaluated. Results Seventeen OLC patients (age (SD): 59 (8) years; 8 female) actively used the modules. S&PAM use varied from 1 to 11 monitoring days prior to outpatient consultations. Patients used WEP most frequently during the first 5 weeks, with an average of four logins a week. Fifty-eight percent used WEP beyond 7 weeks. No adverse situations occurred, and patients felt confident using the applications. Perceived added value included active lifestyle promotion, decreased anxiety, and accessibility to specialized HCPs. Physiotherapists used WEP as intended. Contrarily, physicians scarcely used information from S&PAM. To promote future adoption, strategies should focus on high-level patient tailoring of the technology, and formalization of including the applications in the clinical workflow. Conclusions Ambulant monitoring and web-accessible home exercise is clinically feasible for OLC patients. However, low level of adoption by referring physicians may hamper successful implementation. Implications for cancer survivors Patients perceived both ambulant monitoring and web-accessible exercise as an added value to regular care and feasible to use in the period before and after lung resection. Electronic supplementary material The online version of this article (doi:10.1007/s11764-017-0611-6) contains supplementary material, which is available to authorized users.
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Cavalheri V, Jenkins S, Cecins N, Gain K, Phillips MJ, Sanders LH, Hill K. Exercise training for people following curative intent treatment for non-small cell lung cancer: a randomized controlled trial. Braz J Phys Ther 2017; 21:58-68. [PMID: 28442076 PMCID: PMC5537441 DOI: 10.1016/j.bjpt.2016.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 12/23/2022] Open
Abstract
Lung resection for lung cancer is associated with marked reductions in exercise capacity. Exercise training increased exercise capacity in people with non-small cell lung cancer. Exercise training did not improve other outcomes.
Objective In people following curative intent treatment for non-small cell lung cancer, to investigate the effects of supervised exercise training on exercise capacity, physical activity and sedentary behavior, peripheral muscle force, health-related quality of life, fatigue, feelings of anxiety and depression, and lung function. Method This pilot randomized controlled trial included participants 6–10 weeks after lobectomy for non-small cell lung cancer or, for those who required adjuvant chemotherapy, 4–8 weeks after their last cycle. Participants were randomized to either 8 weeks of supervised exercise training (exercise group) or 8 weeks of usual care (control group). Prior to and following the intervention period, both groups completed measurements of exercise capacity, physical activity and sedentary behavior, quadriceps and handgrip force, HRQoL, fatigue, feelings of anxiety and depression, and lung function. Intention-to-treat analysis was undertaken. Results Seventeen participants (mean age 67, SD = 9 years; 12 females) were included. Nine and eight participants were randomized to the exercise and control groups, respectively. Four participants (44%) adhered to exercise training. Compared with any change seen in the control group, those in the exercise group demonstrated greater gains in the peak rate of oxygen consumption (mean difference, 95% confidence interval for between-group difference: 0.19 [0.04–0.33] L min−1) and 6-minute walk distance (52 [12–93] m). No other between-group differences were demonstrated. Conclusions In people following curative intent treatment for non-small cell lung cancer, 8 weeks of supervised exercise training improved exercise capacity, measured by both laboratory- and field-based exercise tests. These results suggest that this clinical population may benefit from attending exercise training programs.
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Affiliation(s)
- Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, WA, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Nola Cecins
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, WA, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, WA, Australia; Community Physiotherapy Services, Perth, WA, Australia
| | - Kevin Gain
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Martin J Phillips
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Lucas H Sanders
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, WA, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, WA 6001, Australia
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Hoffman AJ, Brintnall RA. A Home-based Exercise Intervention for Non-Small Cell Lung Cancer Patients Post-Thoracotomy. Semin Oncol Nurs 2017; 33:106-117. [PMID: 28062324 DOI: 10.1016/j.soncn.2016.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are no evidenced-based rehabilitative guidelines for postsurgical non-small cell lung cancer (NSCLC) patients. This qualitative study provides evidence on the acceptability of an effective postsurgical exercise intervention targeting the self-management of cancer-related fatigue to fill this gap. DATA SOURCES Qualitative perspective of 37 individuals randomized to a 6-week exercise program following hospital discharge post-thoracotomy for NSCLC. CONCLUSION Postsurgical NSCLC participants found this rehabilitative exercise intervention highly acceptable because it removed traditional barriers to exercise. IMPLICATION FOR NURSING PRACTICE A highly acceptable and effective solution for meeting the unmet rehabilitative support needs of NSCLC patients has broader implications for extension to other vulnerable, aging, deconditioned populations.
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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.
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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
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Activité physique et cancer : mise au point et revue de la littérature. Rev Med Interne 2016; 37:399-405. [DOI: 10.1016/j.revmed.2015.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/04/2015] [Accepted: 12/24/2015] [Indexed: 12/29/2022]
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Ni HJ, Pudasaini B, Yuan XT, Li HF, Shi L, Yuan P. Exercise Training for Patients Pre- and Postsurgically Treated for Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis. Integr Cancer Ther 2016; 16:63-73. [PMID: 27151583 PMCID: PMC5736064 DOI: 10.1177/1534735416645180] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This meta-analysis examined the effects of exercise training on length of hospital stay, postoperative complications, exercise capacity, 6-minute walking distance (6MWD), and health-related quality of life (HRQoL) in patients following resection of non-small cell lung cancer (NSCLC). METHODS This review searched PubMed, EMBASE, and the Cochrane Collaboration data base up to August 16, 2015. It includes 15 studies comparing exercise endurance and quality of life before versus after exercise training in patients undergoing lung resection for NSCLC. RESULTS This review identified 15 studies, 8 of which are randomized controlled trials including 350 patients. Preoperative exercise training shortened length of hospital stay; mean difference (MD): -4.98 days (95% CI = -6.22 to -3.74, P < .00001) and also decreased postoperative complications for which the odds ratio was 0.33 (95% CI = 0.15 to 0.74, P = .007). Four weeks of preoperative exercise training improved exercise capacity; 6MWD was increased to 39.95 m (95% CI = 5.31 to 74.6, P = .02) .While postoperative exercise training can also effectively improve exercise capacity, it required a longer training period; 6MWD was increased to 62.83 m (95% CI = 57.94 to 67.72) after 12 weeks of training ( P < .00001). For HRQoL, on the EORTC-QLQ-30, there were no differences in patients' global health after exercise, but dyspnea score was decreased -14.31 points (95% CI = -20.03 to -8.58, P < .00001). On the SF-36 score, physical health was better after exercise training (MD = 3 points, 95% CI = 0.81 to 5.2, P = .007) while there was no difference with regard to mental health. The I2 statistics of all statistically pooled data were lower than 30%. There was a low amount of heterogeneity among these studies. CONCLUSIONS Evidence from this review suggests that preoperative exercise training may shorten length of hospital stay, decrease postoperative complications and increase 6MWD. Postoperative exercise training can also effectively improve both the 6MWD and quality of life in surgical patients with NSCLC, but requiring a longer training period.
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Affiliation(s)
- Hui-Juan Ni
- 1 Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bigyan Pudasaini
- 1 Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xun-Tao Yuan
- 2 Weifang Traditional Chinese Hospital, Shandong, China
| | - He-Fang Li
- 3 Laian Maternal and Child Health Care and Family Plaining Service Center, Chuzhou, Anhui, China
| | - Lei Shi
- 4 Zhejiang Cancer Hospital, Hangzhou City, Zhejiang, China
| | - Ping Yuan
- 1 Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Cavalheri V, Jenkins S, Cecins N, Gain K, Hill K. Comparison of the six-minute walk test with a cycle-based cardiopulmonary exercise test in people following curative intent treatment for non-small cell lung cancer. Chron Respir Dis 2016; 13:118-27. [PMID: 26869579 PMCID: PMC5734602 DOI: 10.1177/1479972316631137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study is aimed to (i) compare both the magnitude of impairment in exercise capacity and exercise responses measured during the six-minute walk test (6MWT) and the cardiopulmonary exercise test (CPET) and (ii) investigate the effect of test repetition on six-minute walk distance (6MWD) in people following curative intent treatment for non-small cell lung cancer (NSCLC). Twenty participants (67 ± 10 years; 14 females), 6-10 weeks following lobectomy, underwent a CPET and two 6MWTs. Peak exercise responses, dyspnoea and leg fatigue, as well as heart rate (HR) and oxygen saturation (SpO2) during the 6MWT, were compared to those during the CPET. Compared with exercise capacity when expressed as peak rate of oxygen consumption (%pred) measured during the CPET, exercise capacity when expressed as 6MWD (%pred) was less impaired (81 ± 10 vs. 63 ± 15 %pred; p < 0.001). Compared with the CPET, the 6MWT elicited lower peak HR (119 ± 15 vs. 128 ± 18 beats minute(-1); p = 0.02), lower SpO2 (93 ± 2 vs. 95 ± 3%; p < 0.05), less dyspnoea (3.1 ± 1.6 vs. 6.9 ± 2.6; p < 0.01) and less leg fatigue (2.0 ± 1.9 vs. 6.8 ± 2.4; p < 0.01). The 6MWD increased 19 ± 19 metre (4 ± 4%) with test repetition (p < 0.001). In people following curative intent treatment for NSCLC, the 6MWT appears to elicit sub-maximal exercise responses when compared with the CPET. There is a significant effect of test repetition on 6MWD.
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Affiliation(s)
- Vinicius Cavalheri
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sue Jenkins
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Physiotherapy Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
| | - Nola Cecins
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Physiotherapy Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia Community Physiotherapy Services, Perth, Western Australia, Australia
| | - Kevin Gain
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Kylie Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia
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Hoffman AJ, Brintnall RA, Cooper J. Merging technology and clinical research for optimized post-surgical rehabilitation of lung cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:28. [PMID: 26889481 DOI: 10.3978/j.issn.2305-5839.2016.01.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The 21(st) century has ushered in an age of wireless communication and technological breakthroughs providing researchers with opportunities and challenges as they incorporate this technology into their research. This paper presents the challenges our team encountered introducing new technologies and how they were overcome for an intervention for post-thoracotomy non-small cell lung cancer (NSCLC) patients. METHODS Our intervention incorporated the Nintendo Wii Fit Plus virtual-reality walking and balance exercise into a home-based rehabilitation program. The intervention is novel and innovative in that the intervention provides light-intensity exercise post-thoracotomy for NSCLC patients immediately after return to home from the hospital. The intervention overcomes the barriers of conventional exercise programs that require travel, conventional exercise equipment, and begin months after surgery. RESULTS When translating new technology to research, researchers need to consider a number of factors that need to be addressed. Institutional Review Boards may need further explanation as to why the technology is safe, potential participants may need to have unfounded concerns explained before enrolling, and the research team needs a plan for introducing the technology to participants with a vast range of skill sets and environments in which they will be using technology. In our study, we addressed each of these factors using varying approaches as we translated how the Wii would be used in a home-based exercise intervention by a highly vulnerable, post-thoracotomy NSCLC population. CONCLUSIONS While technology brings with it multiple barriers for successful implementation, our team showed that with proper planning and teamwork, researchers can navigate these issues bringing the full benefit of technology to even the most vulnerable of patient populations.
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Affiliation(s)
- Amy J Hoffman
- 1 College of Nursing, Michigan State University, East Lansing, Michigan 48824-1315, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan 49503, USA
| | - Ruth Ann Brintnall
- 1 College of Nursing, Michigan State University, East Lansing, Michigan 48824-1315, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan 49503, USA
| | - Julie Cooper
- 1 College of Nursing, Michigan State University, East Lansing, Michigan 48824-1315, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan 49503, USA
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Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd012020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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