Changes in Health-Related Quality of Life During Rehabilitation in Patients With Operable Lung Cancer: A Feasibility Study (PROLUCA)

Evaluating the Effectiveness of Geriatric-Specific Cancer Rehabilitation Programs on Patient Health Outcomes

OBJECTIVE

This study evaluated a specialized rehabilitation program's impact on senior cancer patients' quality of life.

METHODS

one hundred and thirty patients aged ≥65 years with various cancer types undergoing/recovering from treatment were enrolled in oncology clinics in Al-Ahsa, Saudi Arabia. The intervention arm (n=65) participated in a tailored geriatric cancer rehabilitation program. The control group (n=65) received standard oncology care. The Functional Assessment of Cancer Therapy-General (FACT-G) tool assessed the quality of life across physical, social, emotional, and functional domains. T-tests and multivariate regression analyses compared outcomes.

RESULT

Total FACT-G scores showed a significantly higher quality of life for the geriatric cancer rehabilitation group versus standard care. Rehabilitation patients also demonstrated meaningful improvements across physical, social, and functional subscales. Rehabilitation involvement was the most predictive factor for optimized outcomes.

CONCLUSION

Specialized geriatric cancer rehabilitation meaningfully improved several quality of life domains in older patients over standard care. Despite persistent barriers, rehabilitation programming optimized older cancer patients' physical and psychosocial health. Oncology and geriatrics must collaborate to ensure evidence-based rehabilitation access meets older cohorts' unique needs.

Physical activity in patients with non-small cell lung cancer after lung resection

BACKGROUND

Lung resection is the standard of care for patients with clinical stage I/II non-small cell lung cancer. This surgery reduces both the duration and quality of patients' daily ambulatory activities 1 month after surgery. However, little is known about physical activity after lung resection in patients with lung cancer. To evaluate the recovery process of physical activity with pulmonary rehabilitation in patients after lung resection and examine whether physical activity is affected by age.

METHODS

In this prospective, observational study, we measured and analysed participants' postoperative physical activity using a uniaxial accelerometer daily from postoperative day 1 to 30.

FINDINGS

We analysed 99 patients who underwent thoracic surgery. The number of walking steps significantly increased until day 4 and then reached a plateau thereafter. The duration of exercise at <3 metabolic equivalents significantly increased until day 3, and no significant difference was observed thereafter. Exercise at >3 metabolic equivalents significantly increased until day 4 and reached a plateau thereafter. A significant correlation was observed between age and number of steps after day 4. Compared with video-assisted thoracoscopic surgery, thoracotomy significantly decreased the number of steps from day 3 to 4.

INTERPRETATION

We found that the level of physical activity varied by index in patients with non-small cell lung cancer who underwent lung resection. Age and surgical procedure affect different periods with the increase in post-operative walking steps.

Safety and efficacy evaluation of personalized exercise prescription during chemotherapy for lung cancer patients

BACKGROUND

To explore the safety and effectiveness of personalized exercise intervention during chemotherapy for lung cancer patients who were relatively weak and with compromised cardiopulmonary function.

METHODS

Thirty-eight lung cancer patients treated with chemotherapy at Peking University Third Hospital were enrolled in this prospective study. The exercise group (N = 21) received individualized exercise guidance based on personal test results and exercised regularly, while the control group (N = 17) only received exercise education and planed exercise methods according to their own preferences. Both groups underwent three fitness tests and clinical indicator assessments at 0, 6, and 12 weeks after starting the exercise, and the differences in trends of various indicators between the two groups were compared.

RESULTS

No exercise-related adverse events occurred during the 12-week exercise period. After 12 weeks of exercise training, in terms of fitness, the exercise group showed significant improvements in 6-min walk test (6MWT) (p < 0.001), peak oxygen consumption (VO2peak) (p = 0.005), muscle content (p < 0.001), muscle percentage (p < 0.001), and grip strength (p = 0.008) compared to the control group. In terms of clinical indicators, the exercise group showed significant improvements in vital capacity (p = 0.018), D-dimer (p = 0.031), and C-reactive protein (CRP) (p = 0.01), uric acid (p = 0.003), triglycerides (p < 0.001), functional average score (p < 0.001), and main symptom average score (p = 0.004) compared to the control group in trends over time.

CONCLUSION

Rehabilitation exercises using individualized exercise prescriptions tailored by exercise prescription specialists during chemotherapy are safe for lung cancer patients. Adhering to exercise can achieve comprehensive improvements in physical fitness and quality of life at 12 weeks.

A Retrospective Analysis Comparing VATS Cost Discrepancies and Outcomes in Primary Lung Cancer vs. Second Primary Lung Cancer Patients

This study aimed to compare the outcomes and cost differences between primary lung cancer (PLC) and second primary lung cancer (SPLC) patients who underwent video-assisted thoracoscopic surgery (VATS). This was a retrospective analysis of 124 patients with lung cancer stages I, II, and III who underwent VATS between January 2018 and January 2023. The patients were divided into two groups based on their cancer status that was matched by age and gender: the PLC group (n = 62) and the SPLC group (n = 62). The results showed that there was no significant difference in the clinical characteristics between the 2 groups, except for the Charlson Comorbidity Index (CCI), with a score above 3 in 62.9% of PLC patients and 80.6% among SPLC patients (p = 0.028). Regarding the surgical outcomes, the operative time for the VATS intervention was significantly higher in the SPLC group, with a median of 300 min, compared with 260 min in the PLC group (p = 0.001), varying by the cancer staging as well. The average duration of hospitalization was significantly longer before and after surgery among patients with SPLC (6.1 days after surgery), compared with 4.2 days after surgery in the PLC group (0.006). Regarding the cost analysis, the total hospitalization cost was significantly higher in the SPLC group (15,400 RON vs. 12,800 RON; p = 0.007). Lastly, there was a significant difference in the survival probability between the two patient groups (log-rank p-value = 0.038). The 2-year survival was 41.9% among PLC patients and only 24.2% among those with SPLC. At the 5-year follow-up, there were only 1.6% survivors in the SPLC group, compared with 11.3% in the PLC group (p-value = 0.028). In conclusion, this study found that VATS is a safe and effective surgical approach for both PLC and SPLC patients. However, SPLC patients have a higher VATS operating time and require more healthcare resources than PLC patients, resulting in higher hospitalization costs. These findings suggest that careful pre-operative evaluation and individualized surgical planning are necessary to optimize the outcomes and cost-effectiveness of VATS for lung cancer patients. Nevertheless, the 5-year survival remains very low and concerning.

Reminiscence therapy involved care programs as an option to improve psychological disorders and patient satisfaction in elderly lung cancer patients: A randomized, controlled study

Objective

Reminiscence therapy (RT) is frequently used with elderly patients to improve their psychological status, but a few studies have examined its application in lung cancer patients. This study explored whether a reminiscence therapy-involved care program (RTICP) could improve cognitive functions, anxiety, depression, patient satisfaction, and survival in elderly lung cancer patients.

Materials and Methods

This randomized, controlled study enrolled 138 elderly post-operative lung cancer patients into two groups, an RTICP group (n = 69) and a usual care program (UCP) group (n = 69), for a 12-month intervention period and a follow-up period. During the 12-month intervention, the Mini-Mental State Examination (MMSE) score, the Hospital Anxiety and Depression Scale for anxiety (HADS-A) and depression (HADS-D), patient satisfaction, disease-free survival (DFS), and overall survival (OS) were evaluated.

Results

MMSE and patient satisfaction were elevated in the RTICP group compared to the UCP group at month (M) 12. Additionally, RTICP reduced HADS-A at M6, M9, and M12 and the anxiety rate at M9, HADS-D at M9, and M12 compared to UCP, whereas the depression rate was no different between the two groups at any time (all P > 0.050). Moreover, DFS and OS were no different between the two groups (all P > 0.050).

Conclusion

RTICP, considered as an optional psychological intervention, enhances cognitive functions, alleviates anxiety and depression feelings, and elevates satisfaction among elderly lung cancer patients.

Dynamic Changes and Influencing Factors for the Quality of Life in Nursing Care after Lung Cancer Resection

To investigate the dynamic changes and influencing factors for the quality of life in nursing care in patients with lung cancer after resection. Totally, 136 patients undergoing lung cancer resection in our hospital from January 2019 to January 2022 were prospectively enrolled as subjects. The quality of life was measured before and 1 and 2 weeks and 1, 3, 6, and 12 months after the operation to analyze the dynamic changes in the quality of life in nursing care. Clinical data of patients were collected at the time of discharge. The patients were divided into high-quality and low-quality groups according to the median level of quality of life in nursing care at the final follow-up. The logistic regression equation was applied to analyze the influencing factors for the quality of life in nursing care after lung cancer resection. Of 136 patients receiving lung cancer resection, 32 were lost to follow-up until the final follow-up, so 104 patients were finally included. According to the median level of quality of life in nursing care at the final follow-up, the patients were divided into high-quality and low-quality groups (n = 52 per group). The quality of life in nursing care first decreased, then increased, and then stabilized after lung cancer resection. The comparison of clinical data between the two groups exhibited that albumin level was higher in the high-quality group than that in the control group. The age, proportion of living alone, S-AI score, and FoP-Q-SF score were lower in the high-quality group than those in the low-quality group ( $P<0.05$ ). Univariate logistic regression analysis demonstrated that high albumin (OR = 0.884) was a protective factor for the quality of life in nursing care after lung cancer resection ( $P<0.05$ ). Living alone (OR = 1.333), high S-AI score (OR = 1.211), high FoP-Q-SF score (OR = 1.221), and advanced age (OR = 1.209) were the risk factors for the quality of life in nursing care after lung cancer resection ( $P<0.05$ ). Multivariate logistic regression analysis demonstrated that high albumin (OR = 0.861) was a protective factor for the quality of life in nursing care after lung cancer resection ( $P<0.05$ ). Living alone (OR = 1.144), high S-AI score (OR = 1.170), high FoP-Q-SF score (OR = 1.161), and advanced age (OR = 1.181) were the risk factors for the quality of life after lung cancer resection ( $P<0.05$ ). The quality of life in nursing care first decreased, then increased, and then stabilized after lung cancer resection. Albumin, age, living alone, and S-AI and FoP-Q-SF scores were the influencing factors for the quality of life in nursing care after lung cancer resection. In the nursing care process after lung cancer resection, we should focus on elderly patients living alone who are affected by anxiety and fear of recurrence to improve the quality of life of these patients.

The Importance of Social Support, Optimism and Resilience on the Quality of Life of Cancer Patients

Introduction

The aim of the present study is to carry out a multidimensional analysis on the relation between satisfaction with social support received, resilience and optimism in cancer patients and their quality of life.

Materials and Methods

Data were gathered through questionnaires fulfilled by 142 cancer patients. Data relate to sociodemographic, health, quality of life, social support, resilience and optimism.

Results

Satisfaction with the sources and types of support, resilience and optimism relates positively with quality of life. Predictive models show that informational support from friends is the variable that most increases patients' general health, while emotional support from the partner is the one that best improves how patients cope with the disease. In the same line, emotional support from the partner, together with informational support from family are the ones that most contribute to reduce patients' symptoms. Resilience improves general health and functioning, and reduces symptoms. Patients' optimism and resilience also reduce symptoms. Gender differences were found, with females showing lower quality of life than males, mainly in how they cope with cancer. Patients in the stage of treatment showed lower quality of life and higher symptoms. Such increase was observed in patients who received hormonotherapy or chemotherapy.

Discussion

Important practical implications can be drawn from results, which could help improve cancer patients' quality of life through intervention strategies aimed at increasing their resilience, optimism and the social support provided by their closer sources.

The Perspectives and Lived Experience of Postoperative Patients with Lung Cancer Participating in a Home-Based Exercise Intervention

OBJECTIVES

Postoperative patients with lung cancer experience a cluster of symptoms and reduced quality of life. This study aimed to collect the pre- and postexercise intervention opinions of postoperative patients with lung cancer and to identify their perceptions of barriers, facilitators, and benefits of a home-based exercise intervention and its impact on their future exercise.

DATA SOURCES

Fourteen participants (aged 53 to 78) were purposively recruited from a tertiary hospital to participate in a 4-week home-based walking exercise intervention after discharge. Semi-structured, one-on-one interviews were conducted to collect data. The interviews were transcribed verbatim, and the data were analyzed using a thematic analysis approach. Details regarding the exercise duration and intensity for each participant were collected using a sports watch app, and participants exercise diaries.

CONCLUSION

Three main themes emerged: (1) participants' differing opinions preintervention, (2) barriers and facilitators encountered during the exercise period, and (3) the positive impact on participants' future exercise. Other results showed that 12 of the 14 participants reached the goal of exercise duration and intensity. Postoperative patients with lung cancer need an exercise intervention to motivate and guide them to perform exercise after discharge. This study showed that a home-based walking exercise intervention was feasible and acceptable; patients perceived benefits and became more active and confident about their future exercise plans.

IMPLICATIONS FOR NURSING PRACTICE

Against the backdrop of inadequate staffing, insufficient funding, and lack of supervised exercise programs for this rapidly increasing population, this study of a nurse-led home-based exercise program provides a feasible and realistic approach and qualitative evidence to address these issues.

Reminiscence therapy-based care program relieves anxiety, depression, and improves quality of life in post-operational non-small cell lung cancer patients

OBJECTIVES

The study aimed to explore the effect of reminiscence therapy-based care program (RTCP) on anxiety, depression, quality of life (QoL), and survival profiles in post-operational non-small cell lung cancer (NSCLC) patients.

METHODS

In this randomized, controlled study, a total of 192 newly diagnosed post-operational NSCLC patients were randomly assigned to control care program (CCP) group (N = 96) or RTCP group (N = 96), and both groups experienced 12-month intervention and 36-month follow-up without intervention. Hospital Anxiety and Depression Scale (HADS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) were evaluated at baseline (M0), month (M)3, M6, and M12.

RESULTS

Reduced HADS-anxiety score at M6 and M12, anxiety rate at M12, and anxiety severity at M6 and M12 were observed in RTCP group compared with CCP group. Additionally, HADS-depression score was decreased at M6 and M12, while both depression rate and severity were of no difference at each time point between two groups. Furthermore, QLQ-C30 global health status score at M6 and M12, QLQ-C30 functions score at M12 were increased, while QLQ-C30 symptoms score was of no difference at each time point in RTCP group compared with CCP group. Regarding survival profiles, Kaplan-Meier curves indicated that disease-free survival and overall survival were of no difference between two groups, further multivariate Cox's proportional hazard regression analysis also observed the same trends.

CONCLUSION

RTCP effectively relieves anxiety and depression, improves QoL, but did not prolong survival, suggesting its value as a non-pharmacological approach for post-operational NSCLC management.

Pre-treatment optimization with pulmonary rehabilitation in lung cancer: Making the inoperable patients operable

BACKGROUND

Anatomical lung resection offers the best prospect of long-term survival in patients with non-small cell lung cancer (NSCLC). However, some patients with significant dyspnoea, impaired performance status (PS), borderline or poor pulmonary function are considered inoperable and instead referred for radiotherapy, chemotherapy or palliative care. The aims of the study were to determine whether pre-operative pulmonary physiotherapy (Prehab), by improving clinical parameters, (i) makes patients suitable for surgery who were considered inoperable on subjective criteria of dyspnoea >3 and PS >2, and objective criteria of diffusing capacity for carbon monoxide (DLCO) <50%; and (ii) thereby allows them to safely receive curative surgery with reduced morbidity and mortality.

METHODS

From January 2017 to December 2018 a total of 306 patients were prospectively and sequentially assessed for Prehab and 216 patients with lung cancer studied. Their mean age (95% CI) was 71.7 ± 1.1 years, 50.5% (n = 109) were men and they received Prehab over 39.0 ± 7.0 days averaging 3.1 ± 0.6 sessions. Their dyspnoea scores, PS, level of activity, six minute walk test (6MWT) and frailty index prior to and following Prehab were determined. Following surgery the post-operative length of hospital stay (LOHS), complications and mortality at 30 days, 90 days and 1 year determined. Similar outcomes were determined for (i) high-risk patients with dyspnoea scores >3 and PS >2, and compared with low-risk patients having dyspnoea scores <2 and PS <2 (subjective criteria); and (ii) high-risk patients with DLCO <50% and compared with low-risk patients with DLCO >80% (objective criteria).

FINDINGS

In the total cohort following Prehab, there was significant improvement in the dyspnoea scores <2 / ≥2 (40%/60% prior to Prehab vs. 65%/35% following Prehab, p = 0.00002), PS <2 / ≥2 (45%/55% prior to vs. 62%/38% following Prehab, p = 0.003), frailty index ≤3 / >3 (49%/51% vs 70%/30%, p = 0.0006), and 6MWT (306.6 ± 6.8 m vs 354.8 ± 52.7 m, p = 0.04). Post-operative major complication rates were 8.7%; median LOHS was 7 (IQR 6) days; hospital mortality at 30 days 1.3%, 90 days 4.7% and 1 year 16%. Using subjective criteria of dyspnoea scores >3 and PS >2, 100% of high-risk patients were considered inoperable. Following optimization with Prehab 84.2% of the high-risk patients were ready to proceed with radical treatment and 52.6% with surgery, and subsequently 42.8% of patients underwent surgery. Likewise, 78.8% of patients with DLCO <50% were considered inoperable. Following Prehab 86.5% of high-risk patients were ready to proceed with radical treatment and 59.1% with surgery, and 54.6% of high-risk patients underwent surgery. In each category there were no significant differences in complications, LOHS or mortality rates between the high-risk and low-risk patients.

INTERPRETATION

Our prospective study showed that with Prehab there was clinical and statistically significant improvement in the dyspnoea scores, PS, level of activity and frailty, particularly in the high-risk group of patients. Importantly, Prehab made previously inoperable patients operable, allowing them to safely undergo curative lung resection. This strategy helps improve resection rates and may contribute to the long term survival of lung cancer patients.

FUNDING

This is a Welsh Health Specialised Services Committee (WHSSC) commissioned service.

The Association of Sources of Support, Types of Support and Satisfaction with Support Received on Perceived Stress and Quality of Life of Cancer Patients

INTRODUCTION

The aim of the present study is to carry out a multidimensional analysis of the relationship of social support with quality of life and the stress perceived by cancer patients.

METHODS

The participants were 200 patients with cancer. Data was gathered on sociodemographic characteristics, health, quality of life, social support and perceived stress.

RESULTS

Frequency of and satisfaction with different sources and types of support are related positively with improvement of quality of life and negatively with perceived stress. The emotional support from the partner and the emotional and informational support from the family are significant predictors of quality of life. Emotional support from the family reduces patients' perceived stress. Satisfaction with emotional support from the partner and with the informational support from friends and family increases quality of life. Satisfaction with emotional support from the family and with informational support from friends decreases patients' perceived stress. Instrumental support and support provided by health professionals are not good predictors of quality of life and perceived stress. Satisfaction with the support received is more significantly related with quality of life and stress than the frequency with which the sources provide support.

CONCLUSIONS

These results have important practical implications to improve cancer patients' quality of life and reduce their perceived stress through social support. Designing intervention strategies to improve satisfaction with the support provided to patients by their closest networks results in a global benefit for the patient's quality of life.

Effects of progressive Orff vocal therapy on BODE index and quality of life in patients with low lung function after non-small cell lung cancer surgery

Objective: To explore the effect of Orff vocal therapy on BODE index and quality of life of patients with low lung function after non-small cell lung cancer surgery.

Methods: From March 2014 to March 2019, 231 patients with NSCLC postoperative (their pulmonary functions FEV1 [Formula: see text] of the expected value) in the Huashan Hospital, Fudan University were selected and randomly divided into observation groups and control group. On the basis of conventional treatment of NSCLC, the control group used lung rehabilitation training, and the observation group used the Orff music therapy. They carry out vocal and breath training step by step, using a combination of online and offline methods, 1[Formula: see text]h per day online interactive training, 2[Formula: see text]h of offline group vocal therapy once a week, continuous intervention for 12 months. The patient’s BODE index and FACT-L scores were monthly follow-up.

Results: Compared with the control group, the BODE index and FACT-L scores improved more significantly in the vocal therapy group ([Formula: see text]). Especially in the FEV1pred, family/society module and functional status module, the improvement was most significant, compared with the control group ([Formula: see text]). And the loss of follow-up rate in the vocal therapy group was lower than that in the lung rehabilitation group ([Formula: see text]).

Conclusion: Orff vocal therapy can improve the BODE index and quality of life of patients with low lung function after non-small cell lung cancer surgery, and its compliance and intervention effects are better than ordinary lung rehabilitation training.

Early initiated postoperative rehabilitation enhances quality of life in patients with operable lung cancer: Secondary outcomes from a randomized trial

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.

The Lived Experiences, Perceptions, and Considerations of Patients After Operable Lung Cancer Concerning Nonparticipation in a Randomized Clinical Rehabilitation Trial

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.

Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled?

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.

Chronic Obstructive Pulmonary Disease: Clinical Implications for Patients With Lung Cancer

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is the most common smoking-related illness. COPD often is underemphasized as a comorbidity except when considering issues surrounding surgical treatment options.

OBJECTIVES

This article aims to provide nurses with an overview of the pharmacologic and nonpharmacologic treatment implications of COPD.

METHODS

Definitions, differentials, and treatment considerations are provided, and clinical implications and resources are described.

FINDINGS

The added burden of dyspnea, fatigue, and psychological distress related to COPD may affect the overall outcome and quality of life (QOL) of patients with lung cancer. Attention to the prevention, assessment, and treatment of lung cancer and COPD and related symptomatology will help maximize patients' QOL.

Physical Activity Behavior After a Diagnosis of Lung Cancer Differs Between Countries: An Observational Cohort Study

INTRODUCTION

Physical activity (PA) is important in lung cancer.

OBJECTIVES

To investigate PA levels and health-related quality of life (HRQoL) of patients with lung cancer in China and compare this to a similar cohort in Australia.

METHODS

Prospective cohort study. 71 patients from China (group CH) and 90 patients from Australia (group AU) with newly diagnosed lung cancer. Questionnaires assessed self-reported PA levels and HRQoL at baseline (diagnosis) and 8 weeks.

RESULTS

At baseline, group CH were engaged in less overall PA than group AU (Physical Activity Scale for the Elderly [PASE] total score: median [IQR] group CH, 56 [32-59]; group AU, 66 [38-116]; P < .005), and less occupational and household activity ( P < .005). However, at baseline, group CH reported significantly more walking time than group AU (median [IQR]: group CH, 210 [150-315] min/wk; group AU, 55[0-210] min/wk; P < .0005). Global HRQoL scores were similar between groups (P = .038). Over 8 weeks, group CH increased their overall PA levels ( P < .005) and walking time ( P = .008), and HRQoL remained unchanged. The comparison group AU experienced a reduction in PA levels ( P = .02) and HRQoL ( P < .005).

CONCLUSIONS

A diagnosis, patients in China were less physically active than those in Australia. Following diagnosis, patients in China increased their PA levels, whereas those in Australia reduced their PA levels. Research is required to explore potential reasons behind differences, and this may inform research/clinical services to facilitate patients with lung cancer to be more active.