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Zhang L, Luo Y, Mao D, Zhu B, Yang Z, Miao J, Zhang L. Nonpharmacological Interventions for the Fatigue-Pain-Sleep Disturbance Symptom Cluster in Lung Cancer Patients: Best Evidence Summary. Semin Oncol Nurs 2024:151727. [PMID: 39191622 DOI: 10.1016/j.soncn.2024.151727] [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: 03/21/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES This study aimed to summarize the most effective evidence on nonpharmacological interventions for the fatigue-pain-sleep disturbance symptom cluster in lung cancer patients and to provide evidence-based management methods for clinical team and lung cancer patients. METHODS Guided by the "6S" pyramid model, we retrieved evidence on fatigue, pain, and sleep disturbance management from relevant websites and databases, and unpublished gray literature was also searched. The time frame of the search ranged from database establishment to September 30, 2023. Two researchers independently evaluated the literature quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) for guidelines, and the Assessment of Multiple Systematic Reviews II (AMSTAR II) for systematic reviews. Two people independently extracted and summarized the evidence according to the first principle of high-quality evidence and newly published evidence. The included evidence was graded by the JBI Evidence Pre-Grading System. RESULTS A total of 52,238 articles were retrieved, of which 60 articles, including 18 guidelines, 18 JBI best practice recommendations, one Up To Date clinical practice, and 23 systematic reviews, were included. Overall, 49 pieces of evidence from six dimensions-screening, assessment, management, education, referral, and follow-up-were summarized. Forty-three pieces of evidence were level 1, three pieces of evidence were level 4, and three pieces of evidence were level 5. CONCLUSIONS The best 49 pieces of evidence on nonpharmacological interventions for the fatigue-pain-sleep disturbance symptom cluster in lung cancer patients were summarized in this study, and these nonpharmacological interventions are scientific and comprehensive. IMPLICATIONS FOR NURSING PRACTICE This study can provide guidance for clinical team to improve the fatigue-pain-sleep disturbance symptom cluster management. These evidence items can be implemented by clinical team to reduce the symptom burden and improve the self-management ability of symptoms in lung cancer patients.
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Affiliation(s)
- Le Zhang
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuanyuan Luo
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Dongmei Mao
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Benxiang Zhu
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhihui Yang
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Jingxia Miao
- Department of Medical Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lili Zhang
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China.
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Toohey K, Mizrahi D, Hart NH, Singh B, Lopez P, Hunter M, Newton RU, Schmitz KH, Adams D, Edbrooke L, Hayes S. Exercise in cancer care for people with lung cancer: A narrative synthesis. J Sci Med Sport 2024:S1440-2440(24)00263-9. [PMID: 39155211 DOI: 10.1016/j.jsams.2024.08.002] [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: 01/13/2024] [Revised: 05/24/2024] [Accepted: 08/02/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES Lung cancer is the second most common cancer diagnosed worldwide, resulting in significant physical and psychological consequences. In this narrative review, we explore the role of exercise as an adjunct therapy to counteract health issues experienced by people before, during and after treatment for lung cancer, and offer recommendations for exercise prescription and future research. DESIGN Narrative cornerstone review. METHODS A narrative review was conducted to explore the role of exercise in cancer care for people diagnosed with lung cancer. RESULTS Improvements in fitness, strength and quality of life have been demonstrated in people with lung cancer following participation in exercise programmes before, during and post treatment. Whilst combined aerobic (50-100 % heart rate maximum) and resistance (50-85 % of 1 repetition maximum) training, 2-5 times per week across the cancer continuum is typically prescribed, few people with lung cancer currently access exercise services. 'Optimal' exercise prescription is unclear, although is likely individual-specific. The immediate priority is to identify a tolerable starting exercise dosage, with the side effects of lung cancer and its treatment on the respiratory system, particularly shortness of breath (dyspnoea), likely driving the initial maximum threshold for session mode, duration and intensity. To date, exercise safety for people with lung cancer has been poorly evaluated and reported - few trials report it, but those that do report small numbers of serious adverse events. CONCLUSIONS Recommendations for health professionals prescribing exercise therapy to people with lung cancer are provided, with consideration of the strengths and limitations of the current evidence base.
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Affiliation(s)
- Kellie Toohey
- Physical Activity, Sport, and Exercise Research Theme, Faculty of Health, Southern Cross University, Australia; Faculty of Health, University of Canberra, Australia.
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia; Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Australia; Institute for Health Research, The University of Notre Dame Australia, Australia
| | - Ben Singh
- Allied Health & Human Performance, University of South Australia, Australia
| | - Pedro Lopez
- Grupo de Pesquisa em Exercício para Populações Clínicas (GPCLIN), Universidade de Caxias do Sul, Brazil; Pleural Medicine Unit, Institute for Respiratory Health, Australia; Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Australia
| | | | - Robert U Newton
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
| | - Kathryn H Schmitz
- Division of Hematology and Oncology, Hillman Cancer Center, University of Pittsburgh, USA
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Australia; Viertel Cancer Research Centre, Cancer Council Queensland, Australia
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Bower JE, Lacchetti C, Alici Y, Barton DL, Bruner D, Canin BE, Escalante CP, Ganz PA, Garland SN, Gupta S, Jim H, Ligibel JA, Loh KP, Peppone L, Tripathy D, Yennu S, Zick S, Mustian K. Management of Fatigue in Adult Survivors of Cancer: ASCO-Society for Integrative Oncology Guideline Update. J Clin Oncol 2024; 42:2456-2487. [PMID: 38754041 DOI: 10.1200/jco.24.00541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To update the ASCO guideline on the management of cancer-related fatigue (CRF) in adult survivors of cancer. METHODS A multidisciplinary panel of medical oncology, geriatric oncology, internal medicine, psychology, psychiatry, exercise oncology, integrative medicine, behavioral oncology, nursing, and advocacy experts was convened. Guideline development involved a systematic literature review of randomized controlled trials (RCTs) published in 2013-2023. RESULTS The evidence base consisted of 113 RCTs. Exercise, cognitive behavioral therapy (CBT), and mindfulness-based programs led to improvements in CRF both during and after the completion of cancer treatment. Tai chi, qigong, and American ginseng showed benefits during treatment, whereas yoga, acupressure, and moxibustion helped to manage CRF after completion of treatment. Use of other dietary supplements did not improve CRF during or after cancer treatment. In patients at the end of life, CBT and corticosteroids showed benefits. Certainty and quality of evidence were low to moderate for CRF management interventions. RECOMMENDATIONS Clinicians should recommend exercise, CBT, mindfulness-based programs, and tai chi or qigong to reduce the severity of fatigue during cancer treatment. Psychoeducation and American ginseng may be recommended in adults undergoing cancer treatment. For survivors after completion of treatment, clinicians should recommend exercise, CBT, and mindfulness-based programs; in particular, CBT and mindfulness-based programs have shown efficacy for managing moderate to severe fatigue after treatment. Yoga, acupressure, and moxibustion may also be recommended. Patients at the end of life may be offered CBT and corticosteroids. Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage symptoms of CRF. There is insufficient evidence to make recommendations for or against other psychosocial, integrative, or pharmacological interventions for the management of fatigue.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | - Yesne Alici
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra L Barton
- University of Tennessee, College of Nursing, Knoxville, TN
| | | | | | | | | | | | | | | | | | - Kah Poh Loh
- University of Rochester Medical Center, Rochester, NY
| | - Luke Peppone
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | | | | | - Karen Mustian
- University of Rochester Medical Center, Rochester, NY
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Jiao M, Liang H, Zhang M. Effect of exercise on postoperative recovery of patients with non-small cell lung cancer: a systematic review and meta-analysis. Discov Oncol 2024; 15:230. [PMID: 38884823 PMCID: PMC11183035 DOI: 10.1007/s12672-024-01079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024] Open
Abstract
Patients with non-small cell lung cancer (NSCLC) in the postoperative recovery period often experience reduced exercise capacity and impaired lung function, which affects their overall quality of life. This paper investigated the effect of exercise interventions on exercise capacity, lung function, quality of life, and symptoms in these patients. METHODS We performed a literature search across Cochrane, Embase, PubMed, Web of Science, and EBSCO databases were comprehensively searched for randomized controlled trials (RCTs) from inception to September 2023, all English RCTs were eligible if they assessed the effects of exercise interventions on postoperative NSCLC patients. RESULTS Twelve articles met our inclusion criteria, evidencing that exercise interventions could significantly improve the functional capacity of NSCLC patients in postoperative recovery. Notably, Forced Expiratory Volume in 1 s (FEV1) was improved, indicating enhanced lung function. Furthermore, exercise improved the physical and mental health scores of SF-36, along with increased quadriceps strength and relieved dyspnea. However, fatigue levels were not significantly changed. CONCLUSIONS Exercise interventions of NSCLC patients in the postoperative recovery are associated with improved functional capacity, lung function, quality of life, and quadriceps strength, as well as alleviated symptoms of dyspnea. These findings underscore the potential benefits of incorporating exercise into postoperative care for NSCLC patients. Nonetheless, further large-scale RCTs are required to solidify the evidence base on the clinical outcomes of exercise following pneumonectomy.
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Affiliation(s)
- Mingyue Jiao
- School of Teacher Education, Hezhou University, Hezhou, 542899, Guangxi, China.
- West Campus, Hezhou University, 3261 Xiaohe Avenue, Babu District, Hezhou City, Guangxi, China.
| | - Hanping Liang
- School of Tourism and Sports Health, Hezhou University, Hezhou, 542899, Guangxi, China
| | - Mengge Zhang
- School of Teacher Education, Hezhou University, Hezhou, 542899, Guangxi, China
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Yu Z, Xie G, Qin C, He H, Wei Q. Effect of postoperative exercise training on physical function and quality of life of lung cancer patients with chronic obstructive pulmonary disease: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37285. [PMID: 38457572 PMCID: PMC10919482 DOI: 10.1097/md.0000000000037285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Postoperative rehabilitation programs consisting of exercise training are considered effective for unselected lung cancer patients. However, whether postoperative exercise is beneficial to lung cancer patients comorbid with chronic obstructive pulmonary disease remains unknown. METHODS Eighty-four patients diagnosed with both lung cancer and chronic obstructive pulmonary disease were randomized into the exercise group and control group. Both groups were given standard postoperative rehabilitation for 1 week. After that, oxygen therapy (if needed) and nebulization were given to the control group, while patients in the exercise group started to participate in exercise programs on the basis of receiving oxygen therapy and nebulization as in the control group. The exercise programs consisted of 24 training sessions. RESULTS In both groups, the functional status and the results of the pulmonary function test decreased from baseline to the endpoint. However, after surgery and the intervention program, both the maximal oxygen consumption in the cardiopulmonary exercise test and walking distance in the 6-minute walk test in the exercise group were significantly better than those in the control group [15.5 (±1.4) mL/kg/min vs 13.1 (±1.3) mL/kg/min, P = 0.016; 437.4 (±48.6) m vs 381.7 (±40.5) m, P = 0.040]. Force vital capacity and forced expiratory volume in the first second in the exercise group were better than those in the control group, but the differences were not statistically significant [1798.1 (±298.9) mL vs 1664.0 (±329.7) mL, P = 0.254; 1155.7 (±174.3) mL vs 967.4 (±219.4) mL, P = 0.497]. The decline in the standard score of the QLQ-C30 (V3.0) was smaller in the exercise group, but the difference did not meet a statistically significant level [61.7 (±5.7) vs 58.4 (±9.3), P = 0.318]. CONCLUSION This study demonstrates that a short-term postoperative exercise training program can facilitate the recovery of functional capacity in lung cancer patients with comorbidities of chronic obstructive pulmonary disease.
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Affiliation(s)
- Zhonghua Yu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Guosheng Xie
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Changlong Qin
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Hongchen He
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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Ichimura H, Kobayashi K, Gosho M, Sekine Y, Sugai K, Kawamura T, Saeki Y, Suzuki H, Kobayashi N, Goto Y, Sato Y. Relationship between changes in pulmonary function and patient-reported outcomes of lung cancer surgery. Surg Today 2024; 54:195-204. [PMID: 37306743 DOI: 10.1007/s00595-023-02716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To investigate the relationship between changes in pulmonary function (PF) and patient-reported outcomes (PROs) of lung cancer surgery. METHODS We recruited 262 patients who underwent lung resection for lung cancer, to evaluate the PROs, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 and the Lung Cancer 13-question supplement (LC13). The patients underwent PF tests and PRO assessments preoperatively (Pre) and 1 year after surgery (Y1). Changes were calculated by subtracting the value at Pre from the value at Y1. We set two cohorts: patients under the ongoing protocol (Cohort 1) and patients who were eligible for lobectomy with clinical stage I lung cancer (Cohort 2). RESULTS Cohorts 1 and 2 comprised 206 and 149 patients, respectively. In addition to dyspnea, changes in PF were also correlated with scores for global health status, physical and role function scores, fatigue, nausea and vomiting, pain, and financial difficulties. Absolute correlation coefficient values ranged from 0.149 to 0.311. Improvement of emotional and social function scores was independent of PF. Sublobar resection preserved PF more than lobectomy did. Wedge resection mitigated dyspnea in both cohorts. CONCLUSION The correlation between PF and PROs was found to be weak; therefore, further studies are needed to improve the patient's postoperative experience.
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Affiliation(s)
- Hideo Ichimura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan.
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Keisuke Kobayashi
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuharu Sekine
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Kazuto Sugai
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Yusuke Saeki
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Hisashi Suzuki
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Xu J, Li X, Zeng J, Zhou Y, Li Q, Bai Z, Zhang Y, Xiao J. Effect of Baduanjin qigong on postoperative pulmonary rehabilitation in patients with non-small cell lung cancer: a randomized controlled trial. Support Care Cancer 2023; 32:73. [PMID: 38158422 DOI: 10.1007/s00520-023-08194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to explore the effect of Baduanjin qigong on improving lung function and postoperative quality of life of patients with non-small cell lung cancer (NSCLC) and to find an effective home-based pulmonary rehabilitation method. METHODS A randomised controlled trial was carried out from July 2019 to October 2021, which included 216 NSCLC postoperative participants from Beijing China-Japan Friendship Hospital and Cancer Hospital of Chinese Academy of Medical Science. Participants were randomly divided into two groups, including the observation (n = 108) group and the control group (n = 108). The control group was given routine lung rehabilitation training, while the observation group was given Baduanjin qigong. Both groups were trained for 12 weeks.The patient's age, sex, smoking history, lung cancer stage, pathological type were recorded. Related indicators of lung function, 6-min walk distance(6MWD), Piper fatigue Scale, and Borg dyspnea score before and after intervention were recorded. RESULTS Compared with these indicators before indicators, lung function, 6MWD, Piper fatigue Scale score and Borg score were significantly better in the two groups after intervention (P < 0.05). There were no significant differences in FVC%, 6MWD and Borg score between the two groups (P > 0.05), whereas FEV1% and Piper fatigue Scale scores in the observation group were better than that in the control group (P < 0.05). CONCLUSION Both Baduanjin qigong and traditional pulmonary rehabilitation methods can improve the postoperative lung function and quality of life of patients with NSCLC; and compared with traditional pulmonary rehabilitation training, Baduanjin Qigong may have certain advantages in relieving cancer-related fatigue and FEV1%, and may be another new method of home-based pulmonary rehabilitation for patients with NSCLC. TRIAL REGISTRATION Clinical Trial No.: ChiCTR1900025121.
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Affiliation(s)
- Jilai Xu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xia Li
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Jing Zeng
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Yanfen Zhou
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Qiyan Li
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Zhenmin Bai
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yuxuan Zhang
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China.
| | - Jun Xiao
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China.
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Maheta BJ, Singh NK, Lorenz KA, Fereydooni S, Dy SM, Wong HN, Bergman J, Leppert JT, Giannitrapani KF. Interdisciplinary interventions that improve patient-reported outcomes in perioperative cancer care: A systematic review of randomized control trials. PLoS One 2023; 18:e0294599. [PMID: 37983229 PMCID: PMC10659207 DOI: 10.1371/journal.pone.0294599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Interdisciplinary teams are often leveraged to improve quality of cancer care in the perioperative period. We aimed to identify the team structures and processes in interdisciplinary interventions that improve perioperative patient-reported outcomes for patients with cancer. METHODS We searched PubMed, EMBASE, and CINAHL for randomized control trials published at any time and screened 7,195 articles. To be included in our review, studies needed to report patient-reported outcomes, have interventions that occur in the perioperative period, include surgical cancer treatment, and include at least one non physician intervention clinical team member: advanced practice providers, including nurse practitioners and physician assistants, clinical nurse specialists, and registered nurses. We narratively synthesized intervention components, specifically roles assumed by intervention clinical team members and interdisciplinary team processes, to compare interventions that improved patient-reported outcomes, based on minimal clinically important difference and statistical significance. RESULTS We included 34 studies with a total of 4,722 participants, of which 31 reported a clinically meaningful improvement in at least one patient-reported outcome. No included studies had an overall high risk of bias. The common clinical team member roles featured patient education regarding diagnosis, treatment, coping, and pain/symptom management as well as postoperative follow up regarding problems after surgery, resource dissemination, and care planning. Other intervention components included six or more months of continuous clinical team member contact with the patient and involvement of the patient's caregiver. CONCLUSIONS Future interventions might prioritize supporting clinical team members roles to include patient education, caregiver engagement, and clinical follow-up.
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Affiliation(s)
- Bhagvat J. Maheta
- VA Center for Innovation to Implementation, Menlo Park, CA, United States of America
- California Northstate University College of Medicine, Elk Grove, CA, United States of America
| | - Nainwant K. Singh
- VA Center for Innovation to Implementation, Menlo Park, CA, United States of America
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Karl A. Lorenz
- VA Center for Innovation to Implementation, Menlo Park, CA, United States of America
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | | | - Sydney M. Dy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Hong-nei Wong
- Lane Medical Library, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jonathan Bergman
- VA Los Angeles Healthcare System, Los Angeles, CA, United States of America
- Olive View UCLA Medical Center, Los Angeles, CA, United States of America
| | - John T. Leppert
- VA Center for Innovation to Implementation, Menlo Park, CA, United States of America
- Department of Urology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Karleen F. Giannitrapani
- VA Center for Innovation to Implementation, Menlo Park, CA, United States of America
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
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Zhang Q, Tang L, Chen H, Chen S, Luo M, He Y, Liu M. Psychological outcomes of the systematic interventions based on the stress-induced situation, affective, bodily, and cognitive reactions framework for patients with lung cancer: A randomized clinical trial. Int J Nurs Stud 2023; 146:104566. [PMID: 37544148 DOI: 10.1016/j.ijnurstu.2023.104566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Psychological distress is a multi-factorial unpleasant experience of a psychological, social, spiritual, and/or physical nature that may interfere with one's ability to cope effectively with cancer, physical symptoms and treatment. Psychological distress is common and affects the prognosis of cancer patients. Lung cancer accounted for 11.4 % of all new cancer cases and 18 % of all cancer mortality for 36 cancers in 185 countries. The prevalence of distress among Chinese lung cancer patients ranged from 10.1 % to 61.29 %. However, the existing intervention studies on the psychological distress in lung cancer patients are limited and intervention results may be different. OBJECTIVES To explore the psychological outcomes of a nurse-led systematic intervention program based on the stress-induced situation, affective, bodily, and cognitive reactions framework for patients with lung cancer undergoing operation at anxiety and depression. DESIGN A randomized clinical trial. SETTING Thoracic surgery ward in a tertiary hospital in China. PARTICIPANTS Lung cancer patients undergoing surgery. METHODS This is a 12-month longitudinal randomized controlled study in a tertiary hospital in China. A total of 240 lung cancer patients were randomly divided into either the control group or the intervention group. The nurse-led systematic intervention contents include psychological education, intervention measures based on the stress-induced situation, affective, bodily, and cognitive reactions framework, issuance of daily lifestyle cards, and regular follow-ups. The Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-Fatigue Scale, and Satisfaction with Life Scale were used for the baseline assessment within 48 h upon admission. The same assessment was performed respectively at 1, 3, 6 and 12 months after the intervention started. The effects of the systematic interventions on depression, anxiety, fatigue, and life satisfaction were tested by a linear mixed effects model. RESULTS Overall time-by-group interaction effects were significantly different with regard to anxiety, depression, and fatigue after controlling for the covariates, while a significant time-by-group interaction effect was not found for life satisfaction. Changes for anxiety and depression scores at 6 and 12 months after initiation of the intervention were significantly greater in the intervention group compared with those in the control group (t = 3.046, p = 0.002, t = 3.190, p = 0.001; t = 3.735, p = 0.000, t = 2.979, p = 0.002), whereas scores for fatigue were significantly higher in the intervention group at 6 and 12 months (t = -3.096, p = 0.002, t = -2.784, p = 0.005). CONCLUSION The systematic intervention program based on the stress-induced situation, affective, bodily, and cognitive reactions framework may effectively relieve anxiety, depression, and fatigue in lung cancer patients undergoing surgery. REGISTRATION This study was registered on December 22, 2019 with the registration number ChiCTR1900028487, and the date of first recruitment was Jan 5, 2020.
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Affiliation(s)
- Qingling Zhang
- Department of Medical Psychology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Lili Tang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Hui Chen
- Digestive Department, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Shuanghong Chen
- Department of Medical Psychology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Maoyu Luo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Yuexia He
- Department of Thoracic Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Minghua Liu
- Emergency Department, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China.
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Toohey K, Chapman M, Rushby AM, Urban K, Ingham G, Singh B. The effects of physical exercise in the palliative care phase for people with advanced cancer: a systematic review with meta-analysis. J Cancer Surviv 2023; 17:399-415. [PMID: 35040076 DOI: 10.1007/s11764-021-01153-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this systematic review with meta-analysis was to evaluate the safety, feasibility and effectiveness of exercise in the palliative care phase for people with advanced cancer. METHODS Electronic databases were searched for exercise randomised controlled trials involving individuals with incurable cancer that were published prior to April 14, 2021. Meta-analyses were performed to evaluate the effects of exercise on health outcomes. Subgroup effects for exercise mode, supervision, intervention duration and cancer diagnosis were assessed. RESULTS Twenty-two trials involving interventions ranging between 2 weeks and 6 months were included. Interventions comprised of aerobic (n = 3), resistance (n = 4), mixed-mode (n = 14) and other exercise (n = 1) modalities. Cancer types consisted of lung (n = 6), breast (n = 3), prostate (n = 2), multiple myeloma (n = 1) and mixed cancer types (n = 10). Meta-analysis of 20 RCTs involving 1840 participants showed no difference in the risk of a grade 2-4 adverse event between exercise and usual care (n = 110 adverse events (exercise: n = 66 events; usual care: n = 44 events), RD = - 0.01 (91% CI = - 0.01, 0.02); p = 0.24). Overall median recruitment, retention and adherence rates were 56%, 80% and 69%, respectively. Meta-analysis of health outcomes showed effects in favour of exercise for quality of life, fatigue, aerobic fitness and lower-body strength (SMD range = 0.27-0.48, all p < 0.05). CONCLUSIONS Participants who engaged in exercise experienced an increase in quality of life, fitness and strength and a decrease in fatigue. IMPLICATIONS FOR CANCER SURVIVORS Physical activity programs were found to be safe and feasible for people with advanced cancer in the palliative care phase.
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Affiliation(s)
- Kellie Toohey
- Faculty of HealthCanberra Specialist Medical CentreACT, University of Canberra, Level C Office 3, Bruce, 2617, Australia.
- Exercise and Survivorship (PACES) Research Group, University of Canberra, ActivityBruce ACT, Cancer, Australia.
| | - Michael Chapman
- Palliative Care, Canberra Hospital, ACT Health Services, Canberra ACT, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | - Anne-Marie Rushby
- Faculty of HealthCanberra Specialist Medical CentreACT, University of Canberra, Level C Office 3, Bruce, 2617, Australia
- University of South Australia, Adelaide, SA, Australia
- Australian Institute of Health and Welfare, Canberra, Australia
| | - Kat Urban
- Palliative Care, Lismore Base Hospital, Lismore, NSW, Australia
| | - Gemma Ingham
- Palliative Care, Prince of Wales Hospital, Randwick, NSW, Australia
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Bade BC, Faiz SA, Ha DM, Tan M, Barton-Burke M, Cheville AL, Escalante CP, Gozal D, Granger CL, Presley CJ, Smith SM, Chamberlaine DM, Long JM, Malone DJ, Pirl WF, Robinson HL, Yasufuku K, Rivera MP. Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e6-e28. [PMID: 36856560 PMCID: PMC10870898 DOI: 10.1164/rccm.202210-1963st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.
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Hou W, Zhai L, Yang Y, Gu S, Li C, Yang Y, Zhu Y. Is physical activity effective against cancer-related fatigue in lung cancer patients? An umbrella review of systematic reviews and meta-analyses. Support Care Cancer 2023; 31:161. [PMID: 36781549 DOI: 10.1007/s00520-023-07627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To discuss the effects of physical activity on cancer-related fatigue (CRF) in lung cancer patients, summarize the types of physical activity in the published reviews, assess the quality of the evidence, and provide suggestions for the clinical selection of exercise intervention. METHODS PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews were searched through 8 November 2021 to identify relevant systematic reviews and meta-analyses. We also performed a manual search of the reference lists of included articles as supplements. Two researchers independently performed literature screening, data extraction, and quality assessment. The umbrella review has been registered in the International Prospective Register of Systematic Review (PROSPERO) registry (CRD42021292548). RESULTS From the 13 systematic reviews or meta-analyses identified, 10 physical activity interventions were included. The most mentioned intervention was aerobic combined with resistance exercise; however, no reduction of the symptoms of CRF was observed in lung cancer patients by this exercise intervention. Most of the patients who performed aerobic exercises alone showed improvement in CRF after the intervention. In addition, Tai Chi and breathing exercises have been shown to improve fatigue, but more high-quality research is still needed to support its effectiveness. CONCLUSIONS Aerobic exercise, respiratory muscle training, aerobic combined with balance training, and other exercise interventions have been shown to improve CRF in lung cancer patients. But it should be noted that according to the different treatment methods and disease stages of patients, individualized rehabilitation programs should be developed for patients. Due to the low methodological quality and evidence quality of some systematic reviews and meta-analyses included in this study, more high-quality clinical studies and systematic reviews are still needed for validation in the future. This umbrella review helps to identify effective ways of exercise to improve fatigue in lung cancer patients before dedicated evidence-based medical guidelines are established.
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Affiliation(s)
- Weiqian Hou
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Liwen Zhai
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yujie Yang
- University of Health and Rehabilitation Sciences, Qingdao, 266000, Shandong, China
| | - Shanshan Gu
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Conghui Li
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yao Yang
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yi Zhu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China.
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13
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Do JH, Gelvosa MN, Choi KY, Kim H, Kim JY, Stout NL, Cho YK, Kim HR, Kim YH, Kim SA, Jeon JY. Effects of Multimodal Inpatient Rehabilitation vs Conventional Pulmonary Rehabilitation on Physical Recovery After Esophageal Cancer Surgery. Arch Phys Med Rehabil 2022; 103:2391-2397. [PMID: 35760108 DOI: 10.1016/j.apmr.2022.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the effects of multimodal rehabilitation initiated immediately after esophageal cancer surgery on physical recovery compared with conventional pulmonary rehabilitation. DESIGN Retrospective study. SETTING Private quaternary care hospital. PARTICIPANTS Fifty-nine inpatients (N=59) who participated in either conventional pulmonary rehabilitation (n=30) or in multimodal rehabilitation (n=29) after esophageal cancer surgery were included. INTERVENTIONS Both groups performed pulmonary exercises, including deep breathing, chest expansion, inspiratory muscle training, coughing, and manual vibration. In the conventional pulmonary rehabilitation group, light-intensity mat exercise, stretching, and walking were performed. The multimodal rehabilitation group performed resistance exercises and moderate- to high-intensity aerobic interval exercises using a bicycle. MAIN OUTCOME MEASURES The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30), pain, 6-minute walk test (6MWT), 30-second chair stand test, and grip strengths were assessed before and after the rehabilitation programs. RESULTS Symptom scales of pain, dyspnea, and insomnia in the EORTC QLQ-C30 as well as 6MWT improved significantly after each program (P<.05). 6MWT (73.1±52.6 vs 28.4±14.3, P<.001, d=1.15), 30-second chair stand test (3.5±3.9 vs 0.35±2.0, P<.001, d=1.06), and left grip strength (1.2±1.3 vs 0.0±1.5, P=.002, d=0.42) improved significantly in the multimodal rehabilitation group compared with the pulmonary rehabilitation group. While right grip strength also showed more improvement for those undergoing the multimodal program, the mean strength difference was not clinically meaningful. CONCLUSIONS A multimodal inpatient rehabilitation program instituted early after esophageal cancer surgery improved endurance for walking more than conventional pulmonary rehabilitation as measured by the 6MWT and the 30-second chair stand test.
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Affiliation(s)
- Jung Hwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ma Nessa Gelvosa
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Yong Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hwal Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ja Young Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Nicole L Stout
- West Virginia University School of Public Health, West Virginia University Cancer Institute, Morgantown, West Virginia, United States
| | - Young Ki Cho
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Ah Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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14
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Factors related to quality of life after video-assisted thoracoscopic surgery in patients with stage I adenocarcinoma lung cancer: A longitudinal study. Eur J Oncol Nurs 2022; 61:102225. [DOI: 10.1016/j.ejon.2022.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/09/2022] [Indexed: 11/22/2022]
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15
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Missel M, Beck M, Donsel PO, Petersen RH, Benner P. Do enhanced recovery after lung cancer surgery programs risk putting primacy of caring at stake? A qualitative focus group study on nurses' perspectives. J Clin Nurs 2022. [DOI: 10.1111/jocn.16555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Malene Missel
- Department of Cardiothoracic Surgery Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Malene Beck
- Department of Physiotherapy and Occupational Therapy Slagelse Hospital Slagelse Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Pernille Orloff Donsel
- Department of Cardiothoracic Surgery Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Patricia Benner
- University of Nevada, Las Vegas School of Nursing Las Vegas Nevada USA
- University of California School of Nursing Los Angeles California USA
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16
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Seo KS. Recent Trends in Rehabilitation for Cancer Patients. Ann Rehabil Med 2022; 46:111-113. [PMID: 35793899 PMCID: PMC9263325 DOI: 10.5535/arm.22072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kwan-Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
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17
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:208-241. [PMID: 35585017 DOI: 10.1016/j.redare.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, Spain
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - G Sanchez-Pedrosa
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, Spain
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de la Ribera, Alzira, Valencia, Spain
| | - P Piñeiro
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Cruz
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F de la Gala
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, Spain
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario A Coruña, La Coruña, Spain
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, Spain
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Huang L, Kehlet H, Petersen RH. Functional recovery after discharge in enhanced recovery video-assisted thoracoscopic lobectomy: a pilot prospective cohort study. Anaesthesia 2022; 77:555-561. [PMID: 35261025 DOI: 10.1111/anae.15682] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
Little is known about functional recovery following patient discharge in an established enhanced recovery programme after video-assisted thoracoscopic lobectomy. We conducted a single-centre pilot prospective observational cohort study. We hypothesised that patients achieved early functional recovery after discharge. A total of 32 patients aged ≥ 18 years were enrolled. A digital device was used for objective activity measurements, and patient-reported outcomes were collected as subjective measurements. Primary outcomes were the difference in physical activity; sleep duration; pain; fatigue; and average quality of life scores between pre-operative baseline and 7 days following discharge. The secondary outcome was the reason for reduced daily activity during the first 7 days after discharge. Median (IQR [range]) length of stay was 3 (2-5 [1-13]) days. Up to post-discharge day 7, total, lower intensity and moderate-to-vigorous activities were lower than pre-operative activity (p < 0.001; p = 0.005 and p = 0.027, respectively). Numerical rating scale (0-10) pain scores increased postoperatively at rest (mean difference 1.2, p < 0.001) and during walking (mean difference 1.4, p < 0.001). Fatigue assessed by the Christensen Fatigue Scale (1-10) was also increased postoperatively (mean difference 1.7, p = 0.001). There was a reduction in quality of life scores, while sedentary activity and sleep duration were unchanged postoperatively. Dominant reasons for not recovering daily activity included fatigue in 43% and pain in 33% of patients. Despite compliance with an enhanced recovery programme with a median length of hospital stay of 3 days after video-assisted thoracoscopic lobectomy, functional recovery was not achieved within 7 days after hospital discharge. Reduction in postoperative pain and fatigue are important factors to enhance functional recovery.
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Affiliation(s)
- L Huang
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - H Kehlet
- Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - R H Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Romero-Ruíz L, Da Cuña-Carrera I, Alonso-Calvete A, González-González Y. Effects of therapeutic exercises in patients with lung cancer. A scoping review. J Bodyw Mov Ther 2022; 31:22-29. [DOI: 10.1016/j.jbmt.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/05/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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20
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[Study on the Benefit of Postoperative Exercise Rehabilitation in Patients with
Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:14-20. [PMID: 35078280 PMCID: PMC8796134 DOI: 10.3779/j.issn.1009-3419.2021.102.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary diseases (COPD) affects 45%-63% of lung cancer patients worldwide. Lung cancer patients complicated with COPD have decreased cardiopulmonary function and increased perioperative risk, and their postoperative exercise endurance and lung function are significantly lower than those with conventional lung cancer. Previous studies have shown that postoperative exercise training can improve the exercise endurance of unselected lung cancer patients, but it is unclear whether lung cancer patients with COPD can also benefit from postoperative exercise training. This study intends to explore the effects of postoperative exercise training on exercise endurance, daily activity and lung function of lung cancer patients with COPD. METHODS Seventy-four patients with non-small cell lung cancer (NSCLC) complicated with COPD who underwent pneumonectomy in the lung cancer center of West China Hospital of Sichuan University from August 5, 2020 to August 25, 2021 were prospectively analyzed. They were randomly divided into exercise group and control group; The patients in the two groups received routine postoperative rehabilitation in the first week after operation, and the control group was given routine nursing from the second week. On this basis, the exercise group received postoperative exercise rehabilitation training for two weeks. Baseline evaluation was performed 3 days before operation and endpoint evaluation was performed 3 weeks after operation. RESULTS The exercise endurance, daily activity and pulmonary function test results of the two groups decreased from baseline to the end point. However, after the operation and intervention program, the maximum oxygen consumption of Cardiopulmonary Exercise Test and the walking distance of 6-Minute Walking Test in the exercise group were significantly better than those in the control group [(13.09±1.46) mL/kg/min vs (11.89±1.38) mL/kg/min, P=0.033; (297±46) m vs (243±43) m, P=0.041]. The average number of we-chat steps in the exercise group was also significantly better than that in the control group (4,381±397 vs 3,478±342, P=0.035). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in the exercise group were better than those in the control group, but the difference did not reach a statistically significant level [(1.76±0.19) L vs (1.60±0.28) L, P=0.084; (1.01±0.17) L vs (0.96±0.21) L, P=0.467]. CONCLUSIONS Postoperative exercise rehabilitation training can improve exercise endurance and daily activity ability of patients with lung cancer complicated with COPD and promote postoperative rehabilitation.
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21
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Wang J, Dong Y, Su J, Wang Y, Yu P, Che G. Postoperative exercise training improves the quality of life in patients receiving pulmonary resection: A systematic review and meta-analysis based on randomized controlled trials. Respir Med 2021; 192:106721. [PMID: 34979345 DOI: 10.1016/j.rmed.2021.106721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate whether postoperative exercise training is effective in improving clinical outcomes such as the quality of life (QoL), exercise capacity and respiratory function of patients receiving pulmonary resection. DATA SOURCES The PubMed, EMBASE, Web of Science and PEDro electronic databases were comprehensively searched to identify eligible randomized controlled trials (RCTs). METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The primary outcome was postoperative QoL and secondary outcomes were exercise capacity and respiratory function. RESULTS A total of eight studies involving 691 participants were enrolled in this systematic review and meta-analysis. For the postoperative QoL measured by 36-Item Short Form Health Survey (SF-36), the pooled results demonstrated that postoperative exercise training could significantly improve the SF-36 physical domain score [weighted mean difference (WMD) = 5.87, 95% confidence interval (CI): 3.96 to 7.78, P<0.001] and SF-36 mental domain score (WMD = 8.15, 95% CI: 0.13 to 16.16, P = 0.05). The results of further analysis for the eight dimensions of SF-36 were similar to the overall results. However, for secondary outcomes, no significant effects of postoperative exercise training on exercise capacity and respiratory function were observed. CONCLUSION Postoperative exercise training could significantly improve the QoL of patients undergoing lung surgery. However, more RCTs with large samples are still needed to verify the effects of postoperative exercise rehabilitation on clinical outcomes of patients who receive pulmonary resection.
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Affiliation(s)
- Jiao Wang
- Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jianhua Su
- Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Pengming Yu
- Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Attention to principles of exercise training: an updated systematic review of randomized controlled trials in cancers other than breast and prostate. BMC Cancer 2021; 21:1179. [PMID: 34740332 PMCID: PMC8569988 DOI: 10.1186/s12885-021-08701-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The primary objective of this systematic review was to update our previous review on randomized controlled trials (RCTs) of exercise in cancers other than breast or prostate, evaluating: 1) the application of principles of exercise training within the exercise prescription; 2) reporting of the exercise prescription components (i.e., frequency, intensity, time, and type (FITT)); and 3) reporting of participant adherence to FITT. A secondary objective was to examine whether reporting of these interventions had improved over time. METHODS MEDLINE, EMBASE, CINAHL and SPORTDiscus databases were searched from 2012 to 2020. Eligible studies were RCTs of at least 4 weeks of aerobic and/or resistance exercise that reported on physiological outcomes relating to exercise (e.g., aerobic capacity, muscular strength) in people with cancer other than breast or prostate. RESULTS Eighty-six new studies were identified in the updated search, for a total of 107 studies included in this review. The principle of specificity was applied by 91%, progression by 32%, overload by 46%, initial values by 72%, reversibility by 7% and diminishing returns by 5%. A significant increase in the percentage of studies that appropriately reported initial values (46 to 80%, p < 0.001) and progression (15 to 37%, p = 0.039) was found for studies published after 2011 compared to older studies. All four FITT prescription components were fully reported in the methods in 58% of all studies, which was higher than the proportion that fully reported adherence to the FITT prescription components in the results (7% of studies). Reporting of the FITT exercise prescription components and FITT adherence did not improve in studies published after 2011 compared to older studies. CONCLUSION Full reporting of exercise prescription and adherence still needs improvement within exercise oncology RCTs. Some aspects of exercise intervention reporting have improved since 2011, including the reporting of the principles of progression and initial values. Enhancing the reporting of exercise prescriptions, particularly FITT adherence, may provide better context for interpreting study results and improve research to practice translation.
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Machado P, Pimenta S, Oliveiros B, Ferreira JP, Martins RA, Cruz J. Effect of Exercise Training on Quality of Life after Colorectal and Lung Cancer Surgery: A Meta-Analysis. Cancers (Basel) 2021; 13:4975. [PMID: 34638459 PMCID: PMC8508091 DOI: 10.3390/cancers13194975] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023] Open
Abstract
Surgical treatment affects health-related quality of life (HRQoL) and increases fatigue symptoms in patients with lung cancer (LC) and colorectal cancer (CRC). We aimed to systematically review the effect of exercise training on HRQoL and fatigue after LC and CRC surgery. Randomized controlled trials published before 21 March 2021, were searched in PubMed, Scopus, Web of Science, SPORTDiscus and PEDro. Eligible trials compared the effect of exercise interventions initiated preoperatively or in the first 3 months after surgery versus usual care on postoperative HRQoL and fatigue. Standardized mean differences (SMD) were pooled using random-effects models. Twelve studies with a total of 777 patients were included. In LC patients (10 studies, n = 651), exercise training in general led to a moderate improvement in the physical domain of HRQoL (0.68: 95% CI: [0.47; 0.89]) and a small reduction in fatigue levels after surgery (SMD = 0.28: 95% CI: [0.02; 0.53]), while no effects were found in other HRQoL domains. In CRC (two studies, n = 126), exercise training showed no effects on HRQoL and fatigue after surgery. Exercise training is an effective intervention to improve physical function and fatigue after LC surgery. Further studies are necessary to clarify the effects of exercise on HRQoL and fatigue after CRC surgery.
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Affiliation(s)
- Pedro Machado
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria, 2411-901 Leiria, Portugal; (S.P.); (J.C.)
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal; (J.P.F.); (R.A.M.)
| | - Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria, 2411-901 Leiria, Portugal; (S.P.); (J.C.)
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3000-548 Coimbra, Portugal
- Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, 3000-548 Coimbra, Portugal
| | - José Pedro Ferreira
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal; (J.P.F.); (R.A.M.)
| | - Raul A. Martins
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal; (J.P.F.); (R.A.M.)
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria, 2411-901 Leiria, Portugal; (S.P.); (J.C.)
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00102-X. [PMID: 34294445 DOI: 10.1016/j.redar.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, España
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - G Sanchez-Pedrosa
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, España
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de La Ribera, Alzira, Valencia, España
| | - P Piñeiro
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Cruz
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F de la Gala
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, España
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario de A Coruña, La Coruña, España
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, España
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Mikami Y, Kouda K, Kawasaki S, Okada KI, Kawai M, Kitahata Y, Miyazawa M, Hirono S, Unno M, Tajima F, Yamaue H. Preoperative In-Hospital Rehabilitation Improves Physical Function in Patients with Pancreatic Cancer Scheduled for Surgery. TOHOKU J EXP MED 2021; 251:279-285. [PMID: 32759553 DOI: 10.1620/tjem.251.279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Low preoperative physical function in cancer patients is associated with postoperative complications; however, there have been no reports on the benefits of in-hospital preoperative rehabilitation on preoperative physical function in patients with pancreatic cancer. Therefore, the aim of this study was to quantitatively determine the effects of preoperative in-hospital rehabilitation provided under the supervision of a physiotherapist, on preoperative physical function in patients with pancreatic cancer. The study subjects were 26 patients (15 males, 11 females; age 71.2 ± 8.5 years, range: 51-87 years), including four patients with preoperative chemotherapy, scheduled for surgery for pancreatic cancer. Muscle strengthening exercises and aerobic exercises were conducted 11.9 ± 5.1 days prior to surgery. Cardiopulmonary exercise testing, 6-minute walk distance, and the Functional Independence Measure score were measured before and after the rehabilitation program. We also investigated the relation between the rehabilitation program and incidence of postoperative complications. All 26 study patients completed the preoperative rehabilitation program and no adverse events were noted. Peak oxygen uptake during cardiopulmonary exercise testing and 6-minute walk distance increased significantly after the rehabilitation program. The Functional Independence Measure score remained constant throughout the intervention. No wound infection, delirium, deep vein thrombosis, or respiratory complications were encountered postoperatively. In-hospital preoperative rehabilitation under the supervision of a physiotherapist significantly improved physical function and maintained physical activity in patients with pancreatic cancer. Such improvements may contribute toward preventing serious postoperative complications, resulting in better outcomes.
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Affiliation(s)
- Yukio Mikami
- Department of Rehabilitation Medicine, Wakayama Medical University
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University
| | - Shinji Kawasaki
- Department of Rehabilitation Medicine, Wakayama Medical University
| | - Ken-Ichi Okada
- Second Department of Surgery, Wakayama Medical University
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University
| | - Yuji Kitahata
- Second Department of Surgery, Wakayama Medical University
| | | | - Seiko Hirono
- Second Department of Surgery, Wakayama Medical University
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University
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Zhou L, Chen Q, Zhang J. Effect of Exercise on Fatigue in Patients with Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Trials. J Palliat Med 2021; 24:932-943. [PMID: 33835877 DOI: 10.1089/jpm.2020.0504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background: Fatigue is a frequent debilitating symptom among patients with lung cancer. The effect of exercise on fatigue remains to be quantified. Objective: This review aimed to examine the effect of exercise on fatigue by synthesizing findings from randomized controlled trials (RCTs). Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted in five electronic databases from inception to March 2020. Only RCT was included. The primary outcome was fatigue and the secondary outcomes included depression, anxiety, quality of life, and functional capacity. Pooled weighted or standardized mean difference (WMD or SMD) with 95% confidence interval (CI) was calculated. Results: Eight RCTs were included. The exercise intervention was delivered in the supervised environment (n = 6) or free-living settings (n = 2). Exercise reduced the level of fatigue (SMD = -0.33; 95% CI = -0.54 to -0.13). Exercise also decreased depressive symptom (WMD = -1.57; 95% CI = -2.69 to -0.44) and anxiety (WMD = -1.39; 95% CI = -2.60 to -0.18). Exercise showed a moderate effect on the quality of life, with an SMD of 0.33 (95% CI = 0.08 to 0.58). Exercise intervention increased functional capacity as measured by the six-minute walk test by 20 meters (95% CI = 14.2 to 55.0), but the effect was not significant (p = 0.247). Conclusion: Exercise demonstrated a moderate effect on fatigue in patients with lung cancer. Exercise also improved depressive symptoms, anxiety, and quality of life; however, its impact on functional capacity was not significant. More clinical trials are warranted to explore the mechanisms underlying the impact of exercise on fatigue. Strategies improving adherence to exercise prescription should be developed to help these patients overcome potential challenges.
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Affiliation(s)
- Liang Zhou
- Second Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qijiu Chen
- Second Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jianyong Zhang
- Second Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Dennett AM, Sarkies M, Shields N, Peiris CL, Williams C, Taylor NF. Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review. J Physiother 2021; 67:12-26. [PMID: 33358544 DOI: 10.1016/j.jphys.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 02/01/2023] Open
Abstract
QUESTION What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function? DESIGN Systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS Adults diagnosed with cancer. INTERVENTION Multidisciplinary, group-based rehabilitation that includes exercise for cancer survivors. OUTCOME MEASURES Primary outcomes related to health service delivery, including costs, hospitalisations and healthcare service utilisation. Secondary outcomes were patient-level measures, including: the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire, 30-second timed sit to stand and the Hospital Anxiety and Depression Scale. The evidence was evaluated using the PEDro Scale and the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. RESULTS Seventeen trials (1,962 participants) were included. There was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on healthcare service outcomes, as only one trial reported length of stay and reported wide confidence intervals (MD 2.4 days, 95% CI -3.1 to 7.8). Multidisciplinary, exercise-based rehabilitation improved muscle strength (1RM chest press MD 3.6 kg, 95% CI 0.4 to 6.8; 1RM leg press MD 19.5 kg, 95% CI 12.3 to 26.8), functional strength (30-second sit to stand MD 6 repetitions, 95% CI 3 to 9) and reduced depression (MD -0.7 points, 95% CI -1.2 to -0.1) compared to usual care. There was uncertainty whether multidisciplinary rehabilitation programs are more effective when delivered early versus late or more effective than exercise alone. Adherence was typically high (mean weighted average 76% sessions attended) with no major and few minor adverse events reported. CONCLUSION Multidisciplinary, exercise-based oncology rehabilitation programs improve some patient-level outcomes compared with usual care. Further evidence from randomised trials to determine their effect at a healthcare service level are required if these programs are to become part of standard care. TRIAL REGISTRATION PROSPERO CRD42019130593.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia.
| | - Mitchell Sarkies
- School of Public Health, Curtin University, Perth, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Allied Health, Peninsula Health, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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Exercise for Individuals With Lung Cancer: A Systematic Review and Meta-Analysis of Adverse Events, Feasibility, and Effectiveness. Semin Oncol Nurs 2020; 36:151076. [PMID: 33008682 DOI: 10.1016/j.soncn.2020.151076] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to evaluate the safety (adverse events), feasibility (recruitment, retention, and adherence) and effectiveness of exercise among individuals with lung cancer. DATA SOURCES Electronic databases (CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, Science Direct, and SPORTDiscus) were searched for randomized, controlled, exercise trials involving individuals with lung cancer that were published prior to May 1, 2020. The PEDro scale was used to assess risk of bias, and the Common Terminology Criteria for Adverse Events was used to classify adverse event severity. Feasibility was assessed by computing median (range) recruitment, retention, and exercise attendance rates. Meta-analyses were performed to evaluate adverse event risk between exercise and usual care, and effects on health outcomes. Subgroup effects for exercise mode, supervision, intervention duration, diagnosis or treatment-related factors, and trial quality were assessed. RESULTS Thirty-two trials (n=2109) involving interventions ranging between 1 and 20 weeks were included. Interventions comprised of aerobic (n=13, 41%), resistance (n=1, 3%), combined aerobic and resistance (n=16, 50%) and other exercise (n=2, 6%). There was no difference in the risk of an adverse event between exercise and usual care groups (exercise: n=64 events; usual care: n=61 events]; risk difference: -0.01 [91% CI = -0.02, 0.01]; P = .31). Median recruitment rate was 59% (9%-97%), retention rate was 86% (50%-100%), and adherence rate was 80% (44%-100%). Significant effects of exercise compared to usual care were observed for quality of life, aerobic fitness, upper-body strength, lower-body strength, anxiety, depression, forced expiratory volume, and sleep (standardized mean difference range=0.20-0.59). Subgroup analyses showed that safety, feasibility, and effect was similar irrespective of exercise characteristics, stage at diagnosis, treatment (surgery and chemotherapy), and trial quality. CONCLUSION For individuals with lung cancer (stages I-IV), the risk of an adverse event with exercise is low. Exercise can be feasibly undertaken post-diagnosis and leads to improvements in health-related outcomes. Together, these findings add weight behind the importance of integrating exercise into standard cancer care, including for this specific cancer type. IMPLICATIONS FOR NURSING PRACTICE Exercise should be considered as part of the treatment for all patients with lung cancer at any stage. Exercise has been shown to be low risk and can be feasibly undertaken by patients. The ideal mode, intensity, frequency, or duration of exercise for all patients with lung cancer is not known. Nonetheless, these findings support endorsement of cancer-specific physical activity guidelines, as well as referral to an exercise professional, such as an exercise physiologist or physiotherapist, for those diagnosed with lung cancer.
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Sommer MS, Vibe-Petersen J, Stærkind MB, Langer SW, Larsen KR, Trier K, Christensen M, Clementsen PF, Missel M, Christensen KB, Lillelund C, Langberg H, Pedersen JH, Quist M. Early initiated postoperative rehabilitation enhances quality of life in patients with operable lung cancer: Secondary outcomes from a randomized trial. Lung Cancer 2020; 146:285-289. [PMID: 32593918 DOI: 10.1016/j.lungcan.2020.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/06/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with lung cancer report a lower degree of Health Related Quality of Life (HRQoL) compared with other cancer patients. HRQoL reflects how patients experience the impact of their disease and its treatment on their quality of daily living. A widely used questionnaire in lung cancer patients is the Functional Assessment of Cancer Therapy - Lung (FACT-L) questionnaire. Here we report the secondary outcomes on FACT-L data from the Postoperative Rehabilitation in Operation for Lung CAncer (PROLUCA) study, which describes the effect of early (14 days) versus late initiated (14 weeks) postoperative rehabilitation. MATERIALS AND METHODS The PROLUCA study was designed as a two-armed randomized controlled trial with an early rehabilitation group (14 days after surgery (ERG)) or a control arm with a late rehabilitation group (14 weeks after surgery (LRG)). The results for seven domain scores obtained using the FACT-L at the following time-points: baseline, 14 weeks, 26 weeks and 52 weeks after surgery are presented here. RESULTS 119 patients were randomized to the ERG and 116 to the LRG. In the ERG, HRQoL measured by both FACT-L and FACT-G (general core instrument) showed a continuous improvement up to 26 weeks after which HRQoL decreased after further 26 weeks without structured intervention. In the LRG a non-significant deterioration was detected over the first 14 weeks after surgery. After participation in the 12 weeks rehabilitation program, an increase in HRQoL was seen, without reaching the same level as the early group. CONCLUSION Analyses of the seven domain scores obtained using FACT-L and FACT-G reflect the importance of starting exercise early after surgery since the ERG avoid a temporary decrease in HRQoL. It is therefore recommended to start up a structured rehabilitation program 14 days after surgery, containing high intensity interval training and strength exercise twice a week for 12 weeks.
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Affiliation(s)
| | | | - Maja Bohlbro Stærkind
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
| | - Seppo W Langer
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Karen Trier
- Copenhagen Centre for Cancer and Health, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Paul F Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark; Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Christian Lillelund
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
| | - Henning Langberg
- Department of Public Health, Faculty of Health, University of Copenhagen, Denmark
| | - Jesper H Pedersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten Quist
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
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30
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Codima A, das Neves Silva W, de Souza Borges AP, de Castro G. Exercise prescription for symptoms and quality of life improvements in lung cancer patients: a systematic review. Support Care Cancer 2020; 29:445-457. [PMID: 32388616 DOI: 10.1007/s00520-020-05499-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/24/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to conduct a systematic review to assess the effect of exercise on symptoms and quality of life in lung cancer patients. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Embase, Scopus, Web of Science, and SciELO were searched for studies published from January 1998 to January 2019. The review included all randomized controlled trials that evaluated the effect of exercise on symptoms and quality of life of lung cancer patients. Two reviewers independently assessed the quality of all the included studies using the Physiotherapy Evidence Database scale. RESULTS In total, ten studies (835 participants) met all inclusion criteria. Three studies investigated the effect of exercise after lung resection, whereas four studies investigated it as a pre-surgery intervention. Two studies investigated the effect of exercise in patients under systemic treatment only, and one study included patients on diverse treatment plans. Exercise protocols consisted of different combinations of strength, aerobic, and inspiratory muscle training. Two trials, including 101 participants, found significant difference in quality of life between groups, favoring the intervention group; and five trials, including 549 participants, found significant inter-group differences in isolated symptoms, also favoring the intervention group. CONCLUSIONS Exercise can lead to improvements of symptoms and of quality of life in lung cancer survivors. Providing resistance training combined with high-intensity interval aerobic exercise after lung resection seems to be particularly effective. Further studies are warranted to investigate exercise for patients with poor performance status.
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Affiliation(s)
- Alberto Codima
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil
| | - Willian das Neves Silva
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil.,Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da FMUSP, Av Dr. Arnaldo, 251, 5th floor, São Paulo, SP, 01246-000, Brazil
| | - Ana Paula de Souza Borges
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil.,Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da FMUSP, Av Dr. Arnaldo, 251, 5th floor, São Paulo, SP, 01246-000, Brazil
| | - Gilberto de Castro
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil. .,Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da FMUSP, Av Dr. Arnaldo, 251, 5th floor, São Paulo, SP, 01246-000, Brazil.
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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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32
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Gao S, Barello S, Chen L, Chen C, Che G, Cai K, Crisci R, D'Andrilli A, Droghetti A, Fu X, Ferrari PA, Fernando HC, Ge D, Graffigna G, Huang Y, Hu J, Jiao W, Jiang G, Li X, Li H, Li S, Liu L, Ma H, Ma D, Martinez G, Maurizi G, Phan K, Qiao K, Refai M, Rendina EA, Shao G, Shen J, Tian H, Voltolini L, Vannucci J, Vanni C, Wu Q, Xu S, Yu F, Zhao S, Zhang P, Zhang L, Zhi X, Zhu C, Ng C, Sihoe ADL, Ho AMH. Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery. Transl Lung Cancer Res 2019; 8:1174-1187. [PMID: 32010595 DOI: 10.21037/tlcr.2019.12.25] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shugeng Gao
- Department of Thoracic Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 211166, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350122, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Roberto Crisci
- Division of Thoracic Surgery, University of L'Aquila, Mazzini Hospital, Teramo, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Droghetti
- Division of Thoracic Surgery, Carlo Poma Hospital, Mantova, Italy
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery, A. Businco Cancer Center, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Hiran C Fernando
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Guendalina Graffigna
- Department of Psychology, EngageMinds Hub Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Yunchao Huang
- Department of Thoracic Surgery, Cancer Research Institute of Yunnan Province, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming 650106, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | - Wenjie Jiao
- Division of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266555, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100032, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Haitao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow 215006, China
| | - Dongchun Ma
- Department of Cardiothoracic Surgery, Anhui Chest Hospital, Hefei 230022, China
| | - Guillermo Martinez
- Department of Anesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Kevin Phan
- Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kun Qiao
- Department of Thoracic Surgery, The Third People's Hospital of Shenzhen, Shenzhen 518034, China
| | - Majed Refai
- Division of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Guoguang Shao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun 130021, China
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
| | - Hui Tian
- Department of Thoracic Surgery, The Qilu Hospital of Shandong University, Jinan 250012, China
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Qingchen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Song Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Peng Zhang
- Department of Cardiothoracic Surgery, Tianjing General Hospital of Tianjing Medical University, Tianjing 300052, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
| | - Calvin Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Anthony M H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University Kingston, Ontario, Canada
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33
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Avancini A, Sartori G, Gkountakos A, Casali M, Trestini I, Tregnago D, Bria E, Jones LW, Milella M, Lanza M, Pilotto S. Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled? Oncologist 2019; 25:e555-e569. [PMID: 32162811 PMCID: PMC7066706 DOI: 10.1634/theoncologist.2019-0463] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022] Open
Abstract
Lung cancer remains the leading cause of cancer‐related death worldwide. Affected patients frequently experience debilitating disease‐related symptoms, including dyspnea, cough, fatigue, anxiety, depression, insomnia, and pain, despite the progresses achieved in term of treatment efficacy. Physical activity and exercise are nonpharmacological interventions that have been shown to improve fatigue, quality of life, cardiorespiratory fitness, pulmonary function, muscle mass and strength, and psychological status in patients with lung cancer. Moreover, physical fitness levels, especially cardiorespiratory endurance and muscular strength, are demonstrated to be independent predictors of survival. Nevertheless, patients with lung cancer frequently present insufficient levels of physical activity and exercise, and these may contribute to quality of life impairment, reduction in functional capacity with skeletal muscle atrophy or weakness, and worsening of symptoms, particularly dyspnea. The molecular bases underlying the potential impact of exercise on the fitness and treatment outcome of patients with lung cancer are still elusive. Counteracting specific cancer cells’ acquired capabilities (hallmarks of cancer), together with preventing treatment‐induced adverse events, represent main candidate mechanisms. To date, the potential impact of physical activity and exercise in lung cancer remains to be fully appreciated, and no specific exercise guidelines for patients with lung cancer are available. In this article, we perform an in‐depth review of the evidence supporting physical activity and exercise in lung cancer and suggest that integrating this kind of intervention within the framework of a global, multidimensional approach, taking into account also nutritional and psychological aspects, might be the most effective strategy. Implications for Practice Although growing evidence supports the safety and efficacy of exercise in lung cancer, both after surgery and during and after medical treatments, most patients are insufficiently active or sedentary. Engaging in exercise programs is particularly arduous for patients with lung cancer, mainly because of a series of physical and psychosocial disease‐related barriers (including the smoking stigma). A continuous collaboration among oncologists and cancer exercise specialists is urgently needed in order to develop tailored programs based on patients’ needs, preferences, and physical and psychological status. In this regard, benefit of exercise appears to be potentially enhanced when administered as a multidimensional, comprehensive approach to patients’ well‐being. The potential effect of physical activity in lung cancer is not fully understood, and no specific exercise guidelines for lung cancer patients are available. This article reviews the evidence supporting physical activity and exercise in lung cancer and suggests that this type of intervention, along with considerations for the nutritional and psychological aspects of such an intervention, might be the most effective strategy.
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Affiliation(s)
- Alice Avancini
- Section of Clinical and Experimental Biomedical Science, Department of Medicine, University of VeronaItaly
| | - Giulia Sartori
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Anastasios Gkountakos
- Department of Diagnostics and Public Health, University and Hospital Trust of VeronaVeronaItaly
| | - Miriam Casali
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Ilaria Trestini
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Daniela Tregnago
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Emilio Bria
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)RomeItaly
- Università Cattolica Del Sacro CuoreRomeItaly
| | - Lee W. Jones
- Department of Medicine, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Michele Milella
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of VeronaItaly
| | - Sara Pilotto
- Section of Medical Oncology, Department of Medicine, University of VeronaItaly
- Azienda Ospedaliera Universitaria IntegrataVeronaItaly
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