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Tang WR, Su W, Lien JJJ, Chang CC, Yen YT, Tseng YL. Development of a real-time RGB-D visual feedback-assisted pulmonary rehabilitation system. Heliyon 2024; 10:e23704. [PMID: 38261861 PMCID: PMC10796957 DOI: 10.1016/j.heliyon.2023.e23704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Background Following surgery, perioperative pulmonary rehabilitation (PR) is important for patients with early-stage lung cancer. However, current inpatient programs are often limited in time and space, and outpatient settings have access barriers. Therefore, we aimed to develop a background-free, zero-contact thoracoabdominal movement-tracking model that is easily set up and incorporated into a pre-existing PR program or extended to home-based rehabilitation and remote monitoring. We validated its effectiveness in providing preclinical real-time RGB-D (colour-depth camera) visual feedback. Methods Twelve healthy volunteers performed deep breathing exercises following audio instruction for three cycles, followed by audio instruction and real-time visual feedback for another three cycles. In the visual feedback system, we used a RealSense™ D415 camera to capture RGB and depth images for human pose-estimation with Google MediaPipe. Target-tracking regions were defined based on the relative position of detected joints. The processed depth information of the tracking regions was visualised on a screen as a motion bar to provide real-time visual feedback of breathing intensity. Pulmonary function was simultaneously recorded using spirometric measurements, and changes in pulmonary volume were derived from respiratory airflow signals. Results Our movement-tracking model showed a very strong correlation (r = 0.90 ± 0.05) between thoracic motion signals and spirometric volume, and a strong correlation (r = 0.73 ± 0.22) between abdominal signals and spirometric volume. Displacement of the chest wall was enhanced by RGB-D visual feedback (23 vs 20 mm, P = 0.034), and accompanied by an increased lung volume (2.58 vs 2.30 L, P = 0.003). Conclusion We developed an easily implemented thoracoabdominal movement-tracking model and reported the positive impact of real-time RGB-D visual feedback on self-promoted external chest wall expansion, accompanied by increased internal lung volumes. This system can be extended to home-based PR.
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Affiliation(s)
- Wen-Ruei Tang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei Su
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Jenn-Jier James Lien
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
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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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Sharma VS, Yadav V. Effect of Prehabilitation in Lung Cancer Patients Undergoing Lobectomy: A Review. Cureus 2023; 15:e49940. [PMID: 38179388 PMCID: PMC10765220 DOI: 10.7759/cureus.49940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Deaths from lung cancer are mostly caused by smoking. Cough, dyspnea, fatigue, weight loss, and Horner's syndrome are among the symptoms. Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are the two categories into which lung cancer may be divided. Because of its effectiveness and lower death rates, lobectomy is the primary line of therapy for benign and early-stage lung illnesses. Pulmonary rehabilitation is a routine treatment for thoracic surgery individuals who are at a high risk to improve functional ability, avoid postoperative deterioration, avoid postoperative deterioration, and reduce complications and even hospital stays. Pulmonary rehabilitation is a multifaceted continuum of services intended to help individuals with pulmonary disease and their families reach and sustain their highest possible degree of independence and community functioning, typically provided by an interdisciplinary team of specialists. The objective of this research was to gather preliminary information and assess the effects of pre-rehabilitation on those suffering from lung cancer and having lobectomy. The pre-rehabilitation program's outcomes include increased lung functional capacity, enhanced quality of life, patient independence in daily living activities, and a shorter hospital stay. Gradually increasing walking distance over time can build endurance, requiring consistency, pacing, proper hydration, nutrition, and regular breaks. This review analyzed the effect of pre-rehabilitation in lung cancer patients undergoing lobectomy. Pre-rehabilitation program for individuals with lung cancer improves both preoperative and postoperative health through various exercises. Pulmonary rehabilitation is a multidisciplinary approach that encourages physical activity, learning about disease, treatment options, and coping mechanisms. Instead of curing the illness, its goal is to lessen its symptoms and limitations. Patients with pulmonary diseases or undergoing thoracic surgery prefer pre-rehabilitation programs due to their non-traumatic nature and fewer resources required. Elastic resistance band exercises are beneficial for lung cancer patients' pre-rehabilitation by strengthening and stretching muscle groups, improving exercise capacity, and supporting white blood cell counts. These exercises can be customized to individual needs, making them a safe and effective addition to a patient's exercise routine. They have to be carried out at least three days a week. Pulmonary exercise, including the use of a tri-ball pulmonary exerciser or three-ball spirometer, can improve lung function, respiratory muscle strength, and exercise capacity in lung cancer patients. It involves breathing techniques, cough exercises, and inflating a balloon. Pulmonary rehabilitation has a positive impact on patient health. Improved lung vital capacity, shorter hospital stays, and fewer problems following surgery are all achieved with pulmonary rehabilitation. The pre-rehabilitation plan allows the patient to resume their daily routines.
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Affiliation(s)
- Vaishnavi S Sharma
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, Maharashtra, IND
| | - Vaishnavi Yadav
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, Maharashtra, IND
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Xu Q, Shen ZQ, Feng KP, Xu C, Ding C, Li C, Ju S, Chen J, Pan S, Zhao J. The efficacy of three-ball breathing apparatus exercise based on the concept of pulmonary rehabilitation in patients after lung cancer surgery. J Cardiothorac Surg 2023; 18:218. [PMID: 37415230 DOI: 10.1186/s13019-023-02307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Postoperative patients with lung cancer mostly experience different degrees of dyspnea and decreased activity tolerance, and these symptoms all significantly affect postoperative quality of life. The concept of pulmonary rehabilitation applicable to patients with chronic respiratory diseases is also applicable to patients with postoperative lung cancer. The current application of postoperative pulmonary rehabilitation for lung cancer is inconsistent, and reliable guidelines are lacking. The purpose of this study was to further verify the efficacy and feasibility of postoperative pulmonary rehabilitation for lung cancer patients, and to find a suitable local pulmonary rehabilitation program for postoperative patients with lung cancer that is clinically promoted in our department through this study. METHODS We collected the clinical data of patients undergoing video-assisted thoracoscopic surgery (VATS) wedge resection or lobectomy. The patients were divided into rehabilitation group (using three-ball breathing apparatus after discharge) and control group (routine follow-up after discharge) according to whether the patients were trained with three-ball breathing apparatus after operation. The detailed method using three-ball apparatus is as follows. To begin with, patients are required to put themselves in a comfortable position. Then, after the three-ball breathing apparatus put on the same plane of their eyes, patients hold the tube in their mouth closely and control their breath slowly. When patients inhale to their largest extent, the balls will rise up accordingly. Then they exhale. The evaluation results of pulmonary function, activity tolerance, anxiety scores and others were collected. All data was gathered at the First Affiliated Hospital of Soochow University. The effects of pulmonary rehabilitation training on wedge resection and lobectomy were compared. RESULTS A total of 210 patients were included in this study, including 126 patients with VATS wedge resection and 84 patients with VATS lobectomies. No discrepancy was noticed when FEV1 loss between two groups were compared in the wedge resection patients, and the same results were also shown in patients undergoing lobectomy (12.8% ± 2.0% vs. 12.7% ± 1.9%, P = 0.84, wedge resection; 12.6% ± 2.9% vs. 12.1% ± 1.8%, P = 0.37, lobectomy). The loss of FVC in the control group was greater than that in the rehabilitation group for patients undergoing lobectomy (11.7% ± 5.2%, vs. 17.1% ± 5.6%, P < 0.001, lobectomy). No difference was found in the wedge resection patients between the control and rehabilitation groups (6.6% ± 2.8%, vs. 6.4% ± 3.2%, P = 0.76, lobectomy). Moreover, all patients showed no significant difference in 6MWD regardless of surgical procedure and with or without breathing exercises at T3 (392.6 ± 50.6 m, rehabilitation group vs. 394.0 ± 46.6 m, control group. P = 0.87, wedge resection; 381.3 ± 38.9 m, rehabilitation group vs. 369.1 ± 49.3 m, control group. P = 0.21, lobectomy). CONCLUSIONS For patients after thoracoscopic pulmonary wedge resection, the use of three-ball apparatus did not significantly improve postoperative pulmonary function and activity tolerance, dyspnea, and anxiety symptoms. In patients after thoracoscopic lobectomy, respiratory trainers were able to improve postoperative lung function but were unable to significantly improve dyspnea and anxiety symptoms. There was a significant benefit for the use of three-ball apparatus in patients after thoracoscopic lobectomy, whereas there was no significant benefit for the use of respiratory trainers after wedge resection. Registry: Medical Ethics Committee of the First Affiliated Hospital of Soochow University. REGISTRATION NUMBER no. 2022455.
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Affiliation(s)
- Qiang Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zi-Qing Shen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kun-Peng Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Ju
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shu Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Lai X, Li C, Yang Y, Niu M, Yang Y, Gu S, Hou W, Chen L, Zhu Y. Global estimates of rehabilitation needs and disease burden in tracheal, bronchus, and lung cancer from 1990 to 2019 and projections to 2045 based on the global burden of disease study 2019. Front Oncol 2023; 13:1152209. [PMID: 37456232 PMCID: PMC10344363 DOI: 10.3389/fonc.2023.1152209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Background The global cancer burden is substantial and spiraling. Although rehabilitation specialists could offer assistance, oncologic rehabilitation is still underutilized and not a routine part of clinical oncology guidelines worldwide. Global investigations of disease prevalence and years lived with disability (YLDs) for tracheal, bronchus, and lung (TBL) cancer are valuable for facilitating clinical practice improvement and health resource management. The objective of this study is to report the global estimates of rehabilitation needs and disease burden of TBL cancers from 1990 to 2019 and provide predictions for 2045. Methods To estimate the need for rehabilitation, the data used from the Global Burden of Disease Study 2019 to calculate the prevalence, YLDs, and the attributable risk factors of TBL cancer. The Bayesian age-period-cohort model and Auto-Regressive Integrated Moving Average model were established to forecast the future health burden. All analyses were done at the global level and then some in the aggregation with the seven World Bank regions. All the data were analyzed by R software (x64 version 4.2.1) and Microsoft Excel (version 2019). Results Globally in 2019, 3,212,307 cases of TBL cancer (95% UI 2,937,037-3,488,346) could have benefitted from rehabilitation, contributing to 544,215 (95% UI 396,134-700,099) YLDs. Over the past 30 years, the age-standardized rate (ASR) of prevalence (EAPC = 0.51) and YLDs (EAPC = 0.03) increased. Throughout this period, the global prevalence and YLDs counts were greater in males than females. The ASR of prevalence and YLDs are projected to show a slight downward trend by 2045 on the global scale, the overall prevalence and YLDs due to TBL cancer are likely to increase further, but all indicators show a growing trend in females. Conclusion TBL cancer remains one of the major public health issues globally. According to the forecasted results, the burden of YLDs due to TBL cancer will continue to rise, and the increment is higher in females than males. A rising number of patients worldwide will benefit from rehabilitation services in the future to achieve precise control and management throughout the TBL cancer patient lifecycle.
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Affiliation(s)
- Xigui Lai
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Conghui Li
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Yao Yang
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Mingyuan Niu
- Department of Computer Science, University of Waikato, Hamilton, New Zealand
| | - Yujie Yang
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Shanshan Gu
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Weiqian Hou
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Lili Chen
- Department of Rehabilitation Medicine, Hainan Cancer Hospital, Haikou, Hainan, China
| | - Yi Zhu
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Effectiveness of Outpatient Pulmonary Rehabilitation in Patients with Surgically Resected Lung Cancer: A Retrospective Real-World Analysis. Cancers (Basel) 2022; 14:cancers14143479. [PMID: 35884540 PMCID: PMC9322504 DOI: 10.3390/cancers14143479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 01/27/2023] Open
Abstract
Patients with lung cancer frequently suffer from physical deconditioning, low exercise capacity, and reduced quality of life. There is little evidence on the effects of a structured outpatient pulmonary rehabilitation program (OPR) on exercise capacity and symptom load in these patients. We performed a retrospective, single-center analysis of surgically resected lung cancer patients, who underwent a multiprofessional 6-week OPR. The primary endpoint was a change in the six-minute walk test distance (6 MWT). Secondary endpoints included changes in maximal workload and constant work-rate test results during cycle-ergometry, upper and lower extremity strength, and inspiratory muscle strength. The COPD Assessment Test (CAT) was used to assess symptom burden. Fifty-seven patients were included. Of those, fifty-two (91.2%) completed the full 6 weeks of OPR. The mean age was 56.4 (SD 9.2) years, and 58% were female. At completion of OPR, there was a statistically significant mean of a 50 m (95% CI, 29.6−70.7; p < 0.001) increase in 6 MWT. Significant improvements were also seen in all other exercise and strength tests (p < 0.001), accompanied by a significant reduction in the CAT score (mean difference −3.1, p = 0.001). No adverse effects were reported. OPR for surgically resected lung cancer patients was safe and effective and showed high adherence in the current study.
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Fuzhi Y, Dongfang T, Wentao F, Jing W, Yingting W, Nianping M, Wen G, Xiaoyong S. Rapid Recovery of Postoperative Pulmonary Function in Patients With Lung Cancer and Influencing Factors. Front Oncol 2022; 12:927108. [PMID: 35898890 PMCID: PMC9309725 DOI: 10.3389/fonc.2022.927108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
Among malignant tumors, lung cancer has the highest morbidity and mortality worldwide. Surgery is the first-line treatment for early-stage lung cancers, and has gradually advanced from conventional open-chest surgery to video-assisted thoracic surgery (VATS). Additionally, increasingly smaller surgical incisions and less surgical trauma have resulted in reduced pulmonary function damage. Previous studies have found that the level of pulmonary function loss and recovery is significantly correlated with postoperative complications and the quality of life. Thus, an accurate assessment of the preoperative pulmonary function and effective rehabilitation of postoperative pulmonary function are highly important for patients undergoing lung surgery. In addition, pulmonary function assessment after pulmonary rehabilitation serves as an objective indicator of the postoperative pulmonary rehabilitation status and is crucial to facilitating pulmonary function recovery. Furthermore, a complete preoperative assessment and effective rehabilitation are especially critical in elderly patients with pulmonary tumors, poor basic physiological functions, comorbid lung diseases, and other underlying diseases. In this review, we summarize the clinical significance of pulmonary function assessment in patients undergoing lung cancer surgery, postoperative changes in pulmonary function, effective pulmonary function rehabilitation, and the influencing factors of pulmonary function rehabilitation.
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Rabe BJ, Stafford JW, Hassinger AD, Swartzwelder HS, Shofer SL. Implementation and Effectiveness of a Veterans Affairs-Based Comprehensive Lung Cancer Survivorship Program. J Cardiopulm Rehabil Prev 2022; 42:196-201. [PMID: 34840244 DOI: 10.1097/hcr.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Few programs exist to address persistent impairment in functional status, quality of life, and mental health in lung cancer survivors. We aimed to determine whether a 12-wk multimodal survivorship program imparts clinical benefit. METHODS Any patient at the Durham Veterans Affairs Medical Center with lung cancer and a Karnofsky score of ≥60 could participate. Chronic obstructive pulmonary disease medications were optimized at the enrollment visit. Participants with a Hospital Anxiety and Depression Scale (HADS) score of >8 were offered pharmacotherapy and mental health referral. Participants did home-based exercise with a goal of 1 hr/d, 5 d/wk. They were called weekly to assess exercise progress and review depression/anxiety symptoms. Participants were offered pharmacotherapy for smoking cessation. RESULTS Twenty-three (50%) of the first 46 enrollees completed the full 12-wk program. Paired changes from enrollment to completion (mean ± SD) were observed in 6-min walk test (73.6 ± 96.9 m, P = .002), BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise) index (-1.45 ± 1.64 points, P < .001), Duke Activity Status Index (3.84 ± 7.12 points, P = .02), Fried Frailty Index (-0.588 ± 0.939 points, P = .02), modified Medical Research Council dyspnea scale (-0.619 ± 1.284 points, P = .04), Functional Assessment of Cancer Therapy-Lung Emotional subscale score (1.52 ± 2.96 points, P = .03), HADS total score (-2.63 ± 4.34 points, P = .02), and HADS Anxiety subscale score (-1.47 ± 2.29 points, P = .01). CONCLUSIONS A comprehensive Lung Cancer Survivorship Program provides clinically meaningful improvements in functional status, quality of life, and mental health.
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Affiliation(s)
- Brian J Rabe
- Durham Veterans Affairs Medical Center, Durham, North Carolina (Drs Rabe and Shofer, Mr Stafford, and Ms Hassinger); Department of Medicine (Dr Rabe), Department of Psychiatry (Dr Swartzwelder), and Division of Pulmonary, Allergy, and Critical Care (Dr Shofer), Duke University Medical Center, Durham, North Carolina
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Şahin H, Naz İ, Aksel N, Güldaval F, Gayaf M, Yazgan S, Ceylan KC. Outcomes of pulmonary rehabilitation after lung resection in patients with lung cancer. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2022; 30:227-234. [PMID: 36168581 PMCID: PMC9473605 DOI: 10.5606/tgkdc.dergisi.2022.21595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/27/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND In this study, we aimed to examine the effectiveness of pulmonary rehabilitation applied after resection in patients with lung cancer. METHODS Between October 2017 and December 2019, a total of 66 patients (53 males, 13 females; median age: 65 years; range, 58 to 70 years) who underwent lung resection for non-small cell lung cancer and who were not administered any chemotherapy or radiotherapy regimen were included in the study. An eight-week comprehensive outpatient pulmonary rehabilitation program was applied to half of the patients, while the other half received respiratory exercise training. After the intervention, the results of both groups were compared. RESULTS In the pulmonary rehabilitation group, forced vital capacity value (p=0.011), six-minute walking distance (p<0.001), and Short Form-36 physical function, mental health, vitality scores increased significantly, while all scores of St. George's Respiratory Questionnaire, dyspnea (p<0.001) and anxiety score (p=0.041) significantly decreased. In the group given breathing exercise training, only dyspnea (p=0.046) and St. George's Respiratory Questionnaire symptom scores (p=0.038) were decreased. When the changes in the groups after pulmonary rehabilitation were compared, the decrease in dyspnea perception was significantly higher in the pulmonary rehabilitation group (p<0.001). CONCLUSION Pulmonary rehabilitation program applied after lung resection in patients with non-small cell lung cancer reduces dyspnea and psychological symptoms, increases exercise capacity, and improves quality of life. It should be ensured that patients with lung cancer who have undergone lung resection are directed to the pulmonary rehabilitation program and benefit from this program.
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Affiliation(s)
- Hülya Şahin
- Department of Chest Diseases, University of Health Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Türkiye
| | - İlknur Naz
- Physiotherapy and Rehabilitation Unit, Katip Çelebi University, Faculty of Health Sciences, Izmir, Türkiye
| | - Nimet Aksel
- Department of Chest Diseases, University of Health Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Türkiye
| | - Filiz Güldaval
- Department of Chest Diseases, University of Health Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Türkiye
| | - Mine Gayaf
- Department of Chest Diseases, University of Health Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Türkiye
| | - Serkan Yazgan
- Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases And Chest Surgery Training and Research Hospital, Izmir, Türkiye
| | - Kenan Can Ceylan
- Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases And Chest Surgery Training and Research Hospital, Izmir, Türkiye
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Home-Based Pulmonary Rehabilitation in Aged Individuals With Lung Tumor After Thoracoscopic Surgery. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zou H, Qin Y, Gong F, Liu J, Zhang J, Zhang L. ABCDEF pulmonary rehabilitation program can improve the mid-term lung function of lung cancer patients after thoracoscopic surgery: A randomized controlled study. Geriatr Nurs 2022; 44:76-83. [DOI: 10.1016/j.gerinurse.2021.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
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Zhou T, Sun C. Effect of physical manipulation pulmonary rehabilitation on lung cancer patients after thoracoscopic lobectomy. Thorac Cancer 2021; 13:308-315. [PMID: 34882313 PMCID: PMC8807280 DOI: 10.1111/1759-7714.14225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022] Open
Abstract
Background To introduce a new postoperative pulmonary rehabilitation program named physical manipulation pulmonary rehabilitation (PMPR) and to explore the effect of perioperative management, including PMPR, on patients with non‐small cell lung cancer (NSCLC) after thoracoscopic lobectomy. Methods A randomized controlled trial was conducted between April and June 2021 at the Department of Thoracic Surgery, Beijing Hospital. Adult patients with NSCLC who had undergone thoracoscopic lobectomy were allocated to the treatment and control groups using a random number table. The treatment group received both conventional pulmonary rehabilitation (CVPR) and 14 days of PMPR after surgery; the control group patients received CVPR only. PMPR included relaxing and exercising the intercostal muscles, thoracic costal joint and abdominal breathing muscles. Pulmonary function tests and the 6‐min walk test were conducted preoperatively and 7, 14, 21 and 28 days postoperatively. The postoperative length of hospital stay, chest tube retention time and postoperative pulmonary complications were recorded. The baseline data, pulmonary function parameters and prognosis were compared with t‐ and chi‐square tests between the two groups. Results A total of 86 patients were enrolled, and 44 patients were allocated to the treatment group. There were no significant differences in the baseline data for age, sex, body mass index, basic disease, surgical plan or preoperative pulmonary function between the two groups (all p > 0.05). The peak expiratory flow of patients in the treatment group was higher than that of those in the control group 21 days after surgery (316 ± 95 vs. 272 ± 103 l/min, respectively, p = 0.043), and forced expiratory volume in the first second on day 28 after surgery was greater than that in the control group (2.1 ± 0.2 vs. 1.9 ± 0.3 L, respectively, p < 0.001). There were no significant differences in forced vital capacity or 6‐min walk test scores (both p > 0.05). There were no significant differences in the incidences of pneumonia and atelectasis between the two groups (both p > 0.05). The postoperative length of hospital stay (3.3 ± 1.3 vs. 3.9 ± 1.5 days, p = 0.043) and chest tube retention time (66 ± 30 vs. 81 ± 35 h, p = 0.036) in the treatment group were shorter than those in the control group. Conclusions We determined that PMPR could improve early lung function in patients with NSCLC after thoracoscopic lobectomy, and that chest tube retention time and length of hospital stay were shortened.
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Affiliation(s)
- Ting Zhou
- Thoracic surgery Department, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Sun
- Nursing Department, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Mao X, Ni Y, Niu Y, Jiang L. The Clinical Value of Pulmonary Rehabilitation in Reducing Postoperative Complications and Mortality of Lung Cancer Resection: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:685485. [PMID: 34646857 PMCID: PMC8503917 DOI: 10.3389/fsurg.2021.685485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Pulmonary rehabilitation is one meaningful way of improving exercise tolerance and pulmonary function. Thus, it may reduce the postoperative complications and mortality of pulmonary resection. Hence, we refreshed the data and conducted this systemic analysis. Method: We searched Pubmed, Web of Science, and EMBASE using “lung OR pulmonary” AND “operation OR resection OR surgery” AND “rehabilitation or exercise.” The cut-off date was September 30, 2020. The publications were filtrated, and data were extracted from all selected studies by two reviewers. Review Manger 5.1 and the fixed or random regression model were used for calculating the pooled odds ratio (OR). Result: Finally, 13 publications were enrolled in this study. Among them, five publications reported mortality, nine reported postoperative complications, and seven reported postoperative pulmonary complications. The pooled OR of mortality was 1.32 [95% confidence interval (CI): 0.54–3.23] for the pulmonary rehabilitation group, the pooled OR of postoperative complications was 0.62 (95% CI: 0.49–0.79) for the pulmonary rehabilitation group, and the pooled OR of postoperative pulmonary complications was 0.39 (95% CI: 0.27–0.56) for the pulmonary rehabilitation group. Subgroup analysis revealed the perioperative pulmonary rehabilitation was the most important part. Conclusion: Pulmonary rehabilitation may not affect the mortality of pulmonary resection patients, however, it could decrease the number of postoperative complications, especially pulmonary complications. Perioperative pulmonary rehabilitation was the most important part of the program.
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Affiliation(s)
- Xiaowei Mao
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yiqian Ni
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yanjie Niu
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Liyan Jiang
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
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Harman N, Lazio M, Hayward R. Exercise training-induced adaptations in lung cancer patients who have undergone a lobectomy. Exp Gerontol 2021; 155:111587. [PMID: 34637950 DOI: 10.1016/j.exger.2021.111587] [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: 06/25/2021] [Revised: 09/16/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the safety and effectiveness of a prescribed, individualized, 12-week exercise intervention on cardiorespiratory function, muscular strength, and quality of life in lung cancer patients who have undergone a lobectomy. In addition, we sought to compare the exercise training response of lung cancer patients who have undergone a lobectomy to a population of cancer patients with all other cancers in order to examine the specific effects of a lobectomy when compared to cancer patients at large. METHODS Participants were referred by a physician, and upon entry, completed an exercise-based assessment and surveys to assess various quality of life measures. Participants were divided into two groups: lung cancer patients having undergone a lobectomy (LOB, n = 9) or those diagnosed with all other cancers (AOC, n = 201). Participants underwent 12 weeks of supervised exercise based on an individualized exercise prescription. Measures of cardiorespiratory function, muscular strength, and quality of life were collected prior to the intervention and after 12 weeks of exercise training. RESULTS Significant improvements to VO2peak (p < 0.05) were seen in both groups. Significant improvements to muscular strength (p < 0.05) were seen in both groups for all measures aside from shoulder press in the LOB group. Both groups showed significant improvements to aspects of fatigue and quality of life (p < 0.05), but only the AOC group significantly improved in measures of depression (p < 0.05). CONCLUSION Exercise-based rehabilitation is a safe and effective intervention for lung cancer survivors who have undergone a lobectomy. These individuals saw significant improvements in cardiorespiratory fitness, muscular strength, and quality of life. Although there were similarities in the pattern of these training-induced improvements for these groups, lung cancer patients undergoing a lobectomy consistently demonstrated lower absolute values when compared to patients with all other cancer diagnoses.
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Affiliation(s)
- Nicholas Harman
- School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO, USA; University of Northern Colorado Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, CO, USA
| | - Michael Lazio
- University of Northern Colorado Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, CO, USA
| | - Reid Hayward
- School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO, USA; University of Northern Colorado Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, CO, USA.
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15
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Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
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Gupta A, Sedhom R, Sharma R, Zhang A, Waldfogel JM, Feliciano JL, Day J, Gersten RA, Davidson PM, Bass EB, Dy SM. Nonpharmacological Interventions for Managing Breathlessness in Patients With Advanced Cancer: A Systematic Review. JAMA Oncol 2021; 7:290-298. [PMID: 33211072 DOI: 10.1001/jamaoncol.2020.5184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Breathlessness is a frequent and debilitating symptom in patients with advanced cancer. Often, in the context of breathlessness, aggressive cancer treatment is not beneficial, feasible, or aligned with goals of care. Targeted symptom-focused interventions may be helpful in this scenario. Objective To evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer. Evidence Review PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception through May 2020 for published randomized clinical trials (RCTs), nonrandomized controlled trials, and observational studies of the advantages and/or harms of nonpharmacological interventions on alleviating breathlessness in adults with advanced cancer. Only English-language studies were screened for eligibility, titles, abstracts, and full text. Risk of bias and strength of evidence (SOE) were independently assessed. The key outcomes reported in studies were breathlessness, anxiety, exercise capacity, health-related quality of life, and harms. Data were analyzed from October 1, 2019, to June 30, 2020. Findings A total of 29 RCTs (2423 participants) were included. These RCTs evaluated various types of interventions, such as respiratory (9 RCTs), activity and rehabilitation (7 RCTs), behavioral and psychoeducational (3 RCTs), integrative medicine (4 RCTs), and multicomponent (6 RCTs). Several nonpharmacological interventions were associated with improved breathlessness, including fan therapy (standardized mean difference [SMD], -2.09; 95% CI, -3.81 to -0.37; I2 = 94.3%; P for heterogeneity = .02; moderate SOE) and bilevel ventilation (estimated slope difference, -0.58; 95% CI, -0.92 to -0.23; low SOE), lasting for a few minutes to hours, in the inpatient setting. In the outpatient setting, nonpharmacological interventions associated with improved breathlessness were acupressure and reflexology (integrative medicine) (low SOE) and multicomponent interventions (combined activity and rehabilitation, behavioral and psychoeducational, and integrative medicine) (low SOE) lasting for a few weeks to months. Five of the 29 RCTs (17%) reported adverse events, although adverse events and study dropouts were uncommon. Conclusions and Relevance Findings of this review include the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Guidelines and clinical practice should evolve to incorporate nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.
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Affiliation(s)
- Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Allen Zhang
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Julie M Waldfogel
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Josephine L Feliciano
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca A Gersten
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Eric B Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sydney M Dy
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lifestyle behaviors and intervention preferences of early-stage lung cancer survivors and their family caregivers. Support Care Cancer 2020; 29:1465-1475. [PMID: 32691229 DOI: 10.1007/s00520-020-05632-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Lung cancer (LC) is a highly prevalent disease with more survivors diagnosed and treated at earlier stages. There is a need to understand psychological and lifestyle behavior needs to design interventions for this population. Furthermore, understanding the needs and role of family caregivers, especially given the risks associated with second-hand smoke, is needed. METHODS Thirty-one early-stage (stages I or IIA) LC survivors of (52% men) and 22 (50% women) caregivers (N = 53 total) completed surveys after surgery (baseline) and at 3- and 6-month follow-ups. Participants reported on psychological functioning, smoking, and physical activity (PA) as well as intervention preferences. RESULTS Survivors reported low levels of psychological distress and 3% were current smokers during the study. Approximately 79% were sedentary and not meeting national PA guidelines. Caregivers also reported minimal psychological distress and were sedentary (62% not meeting guidelines), but a larger proportion continued to smoke following the survivor's cancer diagnosis (14%). Both survivors and caregivers expressed interest in home-based PA interventions but differed regarding preferred format for delivery. Most (64%) caregivers preferred a dyadic format, where survivors and caregivers participate in the intervention together. However, most survivors preferred an individual or group format (57%) for intervention delivery. CONCLUSION Both LC survivors and family caregivers could benefit from PA interventions, and flexible, dyadic interventions could additionally support smoking cessation for family caregivers.
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18
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Chang TL, Fang TJ, Wong AM, Wu CF, Pei YC. Clinical and functional characteristics of lung surgery-related vocal fold palsy. Biomed J 2020; 44:S101-S109. [PMID: 35735079 PMCID: PMC9039099 DOI: 10.1016/j.bj.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/04/2020] [Accepted: 07/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background Unilateral vocal fold paralysis (UVFP) caused by lung surgery is associated with prolonged hospital stay and increased postoperative comorbidities. We evaluated lung surgery-related UVFP and compared its characteristics with UVFP caused by esophageal and thyroid surgeries, as the most common surgical causes of UVFP. We also evaluated the outcomes of intracordal hyaluronate injection laryngoplasty in these patients. Methods Patients with surgery-related UVFP were evaluated by quantitative laryngeal electromyography, videolaryngostroboscopy, voice acoustic analysis, Voice Outcome Survey (VOS) questionnaire, and Short Form-36 Health Survey (SF-36) quality-of-life questionnaire. Data for the lung, esophageal, and thyroid surgery groups were compared and changes in outcome measurements induced by hyaluronate injection were compared among the three groups. Results A total of 141 patients were recruited, including 21, 46, and 74 in the lung, esophageal, and thyroid surgery groups, respectively. Compared with the other two groups, lung surgery patients had predominantly left-sided UVFP, less involvement of the external branch of the superior laryngeal nerve, and higher jitter. Most outcome measurements improved in all three groups after office-based hyaluronate injection, with the greatest improvement in jitter in the lung surgery group. Conclusions Lung surgery-related UVFP showed a distinct disease presentation, and patients' voice parameters and quality of life recovered dramatically after office-based hyaluronate injection. We recommend evaluation of lung surgery-related UVFP and early intervention, such as office-based hyaluronate injection, to improve patients' voice function and quality of life.
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The effect of comprehensive rehabilitation program plus chemotherapy on quality of life in patients with postoperative non-small-cell lung cancer: study protocol of a multicenter randomized clinical trial. Trials 2020; 21:309. [PMID: 32245480 PMCID: PMC7126133 DOI: 10.1186/s13063-020-4162-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background Comprehensive rehabilitation therapy based on traditional Chinese medicine (TCM) has been widely applied in various cancer treatments in China. Thus far, Chinese herbal medicine (CHM) has been shown effective in reducing the adverse effects of chemotherapy and improving the quality of life (QoL) during chemotherapy. The purpose of the present study is to compare the effects of CHM plus Liu Zi Jue (LZJ) exercises with CHM plus rehabilitation education and with placebo plus rehabilitation education in patients who have undergone complete resection for nonsmall-cell lung cancer (NSCLC) followed by postoperative adjuvant chemotherapy. Methods and design A multicenter, randomized clinical trial will be performed with 354 stage Ib–IIIa NSCLC patients in five centers in China. Patients satisfying the inclusion criteria will be randomly divided into three groups according to a 1:1:1 ratio: intervention group A (IGA), intervention group B (IGB), and control group (CG). Each group will receive adjuvant platinum-based doublet chemotherapy for a total of four cycles. IGA participants will receive chemotherapy combined with CHM and LZJ exercises, IGB participants will receive chemotherapy combined with CHM and rehabilitation education, and CG participants will receive chemotherapy combined with placebo and rehabilitation education. The herbal treatment patients will be given granules daily and LZJ exercises will be performed four times per week during chemotherapy. The primary outcome is QoL, which will be assessed with the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C43 scale in each cycle. The secondary outcomes include the 2-year disease-free survival rate, disease-free survival, TCM symptoms, tumor markers, safety, and adverse events. After treatment, the patients will be followed up every 3 months within 2 years and every 6 months after 2 years until disease recurrence and/or metastasis. Discussion Our previous study reported that CHM in combination with chemotherapy could lower the overall incidence of adverse events but increased digestive and gastrointestinal side effects compared with chemotherapy alone in postoperative NSCLC patients. This study will lay a foundation for the effectiveness of chemotherapy with or without a comprehensive rehabilitation program for QoL in patients with postoperative NSCLC. Trial registration ClinicalTrials.gov, NCT03372694. Retrospectively registered on 17 December 2018.
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Coats V, Moffet H, Vincent C, Simard S, Tremblay L, Maltais F, Saey D. Feasibility of an eight-week telerehabilitation intervention for patients with unresectable thoracic neoplasia receiving chemotherapy: A pilot study. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2020. [DOI: 10.1080/24745332.2019.1575703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Valérie Coats
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Hélène Moffet
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration in Quebec City, Université Laval, Québec, Canada
| | - Claude Vincent
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration in Quebec City, Université Laval, Québec, Canada
| | - Sébastien Simard
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Lise Tremblay
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - François Maltais
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - Didier Saey
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada
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Cavalheri V, Burtin C, Formico VR, Nonoyama ML, Jenkins S, Spruit MA, Hill K. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database Syst Rev 2019; 6:CD009955. [PMID: 31204439 PMCID: PMC6571512 DOI: 10.1002/14651858.cd009955.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Decreased exercise capacity and health-related quality of life (HRQoL) are common in people following lung resection for non-small cell lung cancer (NSCLC). Exercise training has been demonstrated to confer gains in exercise capacity and HRQoL for people with a range of chronic conditions, including chronic obstructive pulmonary disease and heart failure, as well as in people with prostate and breast cancer. A programme of exercise training may also confer gains in these outcomes for people following lung resection for NSCLC. This systematic review updates our 2013 systematic review. OBJECTIVES The primary aim of this review was to determine the effects of exercise training on exercise capacity and adverse events in people following lung resection (with or without chemotherapy) for NSCLC. The secondary aims were to determine the effects of exercise training on other outcomes such as HRQoL, force-generating capacity of peripheral muscles, pressure-generating capacity of the respiratory muscles, dyspnoea and fatigue, feelings of anxiety and depression, lung function, and mortality. SEARCH METHODS We searched for additional randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 2 of 12), MEDLINE (via PubMed) (2013 to February 2019), Embase (via Ovid) (2013 to February 2019), SciELO (The Scientific Electronic Library Online) (2013 to February 2019), and PEDro (Physiotherapy Evidence Database) (2013 to February 2019). SELECTION CRITERIA We included RCTs in which participants with NSCLC who underwent lung resection were allocated to receive either exercise training, which included aerobic exercise, resistance exercise, or a combination of both, or no exercise training. DATA COLLECTION AND ANALYSIS Two review authors screened the studies and identified those eligible for inclusion. We used either postintervention values (with their respective standard deviation (SD)) or mean changes (with their respective SD) in the meta-analyses that reported results as mean difference (MD). In meta-analyses that reported results as standardised mean difference (SMD), we placed studies that reported postintervention values and those that reported mean changes in separate subgroups. We assessed the certainty of evidence for each outcome by downgrading or upgrading the evidence according to GRADE criteria. MAIN RESULTS Along with the three RCTs included in the original version of this review (2013), we identified an additional five RCTs in this update, resulting in a total of eight RCTs involving 450 participants (180 (40%) females). The risk of selection bias in the included studies was low and the risk of performance bias high. Six studies explored the effects of combined aerobic and resistance training; one explored the effects of combined aerobic and inspiratory muscle training; and one explored the effects of combined aerobic, resistance, inspiratory muscle training and balance training. On completion of the intervention period, compared to the control group, exercise capacity expressed as the peak rate of oxygen uptake (VO2peak) and six-minute walk distance (6MWD) was greater in the intervention group (VO2peak: MD 2.97 mL/kg/min, 95% confidence interval (CI) 1.93 to 4.02 mL/kg/min, 4 studies, 135 participants, moderate-certainty evidence; 6MWD: MD 57 m, 95% CI 34 to 80 m, 5 studies, 182 participants, high-certainty evidence). One adverse event (hip fracture) related to the intervention was reported in one of the included studies. The intervention group also achieved greater improvements in the physical component of general HRQoL (MD 5.0 points, 95% CI 2.3 to 7.7 points, 4 studies, 208 participants, low-certainty evidence); improved force-generating capacity of the quadriceps muscle (SMD 0.75, 95% CI 0.4 to 1.1, 4 studies, 133 participants, moderate-certainty evidence); and less dyspnoea (SMD -0.43, 95% CI -0.81 to -0.05, 3 studies, 110 participants, very low-certainty evidence). We observed uncertain effects on the mental component of general HRQoL, disease-specific HRQoL, handgrip force, fatigue, and lung function. There were insufficient data to comment on the effect of exercise training on maximal inspiratory and expiratory pressures and feelings of anxiety and depression. Mortality was not reported in the included studies. AUTHORS' CONCLUSIONS Exercise training increased exercise capacity and quadriceps muscle force of people following lung resection for NSCLC. Our findings also suggest improvements on the physical component score of general HRQoL and decreased dyspnoea. This systematic review emphasises the importance of exercise training as part of the postoperative management of people with NSCLC.
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Affiliation(s)
- Vinicius Cavalheri
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
| | - Chris Burtin
- Hasselt UniversityReval Rehabilitation Research Center, BIOMED, Faculty of Rehabilitation SciencesAgoralaan Gebouw ADiepenbeekLimburgBelgium3590
| | - Vittoria R Formico
- Universidade Estadual Paulista (UNESP)Physiotherapy Department, Faculdade de Ciências e TecnologiaPresidente PrudenteBrazil
| | - Mika L Nonoyama
- University of Ontario Institute of TechnologyFaculty of Health Sciences2000 Simcoe Street NorthOshawaONCanadaL1H 7K4
| | - Sue Jenkins
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalPhysiotherapy DepartmentHospital AvenuePerthAustralia
| | - Martijn A. Spruit
- Hasselt UniversityReval Rehabilitation Research Center, BIOMED, Faculty of Rehabilitation SciencesAgoralaan Gebouw ADiepenbeekLimburgBelgium3590
- CIROResearch and EducationHornerheide 1HornNetherlands6085 NM
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterRespiratory MedicineMaastrichtNetherlands6202 AZ
| | - Kylie Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
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Messaggi-Sartor M, Marco E, Martínez-Téllez E, Rodriguez-Fuster A, Palomares C, Chiarella S, Muniesa JM, Orozco-Levi M, Barreiro E, Güell MR. Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial. Eur J Phys Rehabil Med 2019; 55:113-122. [DOI: 10.23736/s1973-9087.18.05156-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ulrich CM, Himbert C, Boucher K, Wetter DW, Hess R, Kim J, Lundberg K, Ligibel JA, Barnes CA, Rushton B, Marcus R, Finlayson SRG, LaStayo PC, Varghese TK. Precision-Exercise-Prescription in patients with lung cancer undergoing surgery: rationale and design of the PEP study trial. BMJ Open 2018; 8:e024672. [PMID: 30559162 PMCID: PMC6303592 DOI: 10.1136/bmjopen-2018-024672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/05/2018] [Accepted: 09/26/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Lung cancer is a significant burden on societies worldwide, and the most common cause of death in patients with cancer overall. Exercise intervention studies in patients with lung cancer have consistently shown benefits with respect to physical and emotional functioning. However, to date, exercise training has not been consistently implemented into clinical practice given that interventions have been costly and not aligned with clinical care. METHODS/DESIGN The Precision-Exercise-Prescription (PEP) study is a prospective randomised controlled trial comparing the effectiveness and feasibility of a personalised intervention exercise programme among patients with lung cancer undergoing surgery. Two-hundred patients who are diagnosed with stage primary or secondary lung cancer and are eligible to undergo surgical treatment at Huntsman Cancer Institute comprise the target population. Patients are randomised to either the (1) outpatient precision-exercise intervention group or (2) delayed intervention group. The intervention approach uses Motivation and Problem Solving, a hybrid behavioural treatment based on motivational interviewing and practical problem solving. The dosage of the exercise intervention is personalised based on the individual's Activity Measure for Post-Acute-Care outpatient basic mobility score, and incorporates four exercise modes: mobility, callisthenics, aerobic and resistance. Exercise is implemented by physical therapists at study visits from presurgery until 6 months postsurgery. The primary endpoint is the level of physical function assessed by 6 min walk distance at 2 months postsurgery. Secondary outcomes include patient-reported outcomes (eg, quality of life, fatigue and self-efficacy) and other clinical outcomes, including length of stay, complications, readmission, pulmonary function and treatment-related costs up to 6 months postsurgery. ETHICS/DISSEMINATION The PEP study will test the clinical effectiveness and feasibility of a personalised exercise intervention in patients with lung cancer undergoing surgery. Outcomes of this clinical trial will be presented at national and international conferences and symposia and will be published in international, peer-reviewed journals. Ethics approval was obtained at the University of Utah (IRB 00104671). TRIAL REGISTRATION NUMBER NCT03306992.
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Affiliation(s)
- Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Kenneth Boucher
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Division of General Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer A Ligibel
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher A Barnes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | | | - Robin Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | | | - Paul C LaStayo
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Thomas K Varghese
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
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Association between Pulmonary Function and Stair-Climbing Test Results after Lung Resection: A Pilot Study. Can Respir J 2018; 2018:1925028. [PMID: 30271508 PMCID: PMC6151193 DOI: 10.1155/2018/1925028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background The stair-climbing test was used to assess the exercise capacity before lung resection in subjects with lung cancer. However, few studies have systematically evaluated the role of this exercise methodology as a postoperative test. The aim of the present study was to assess whether the stair-climbing test findings reflect the postoperative decrease in pulmonary function. Methods Twenty subjects with non-small-cell lung cancer who underwent lung resection were enrolled in the study. Perioperative functional evaluation comprised the pulmonary function test, stair-climbing test, and 6-min walk distance test (6MWD). A correlation analysis was performed between the postoperative percentages of pulmonary function with respect to preoperative values and the exercise capacity. Results No correlation was noted between the percentage changes in pulmonary function and those in 6MWD. However, there was a significant correlation between the percentage changes in forced expiratory volume in 1 s and those in the altitude reached in the stair-climbing test (r=0.46, p < 0.05) and between the percentage changes in carbon monoxide lung diffusion capacity and those in the altitude (r=0.54, p < 0.05). Conclusions The stair-climbing test findings might be effective at detecting changes in exercise capacity induced by postoperative decrease in pulmonary function.
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San Bok J, Lee GD, Kim DK, Lim D, Joo SK, Choi S. Changes of pleural pressure after thoracic surgery. J Thorac Dis 2018; 10:4109-4117. [PMID: 30174855 DOI: 10.21037/jtd.2018.06.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The negative pressure of the pleural cavity is critical to maintain lung expansion. However, the actual values of pleural pressure according to the phase of respiration after various types of pulmonary resection have not been well reported. The aim of this study was to measure the pleural pressure directly and to compare the results according to the extent of pulmonary resection. Methods We manufactured a high-resolution digital manometer with which pleural pressure can be measured directly. A total of 43 patients who underwent thoracic surgery (lobectomy in 23, minimal resections in 20) were enrolled. The maximum, minimum, and mean pleural pressure was recorded during normal quiet breathing, forced breathing, and coughing, separately. Results During normal quiet breathing, the average values of pleural pressure at end inspiration, end expiration, and the mean pleural pressure were -17.7, -7.0 and -11.2 cmH2O in lobectomy group, and -14.3, -4.6, -8.3 cmH2O in the minimal/no-resection group, respectively. The mean pleural pressure was significantly lower in lobectomy group compared to the minimal/no-resection group (P=0.026). During forced respiration, the same values were -44.0, -4.2 and -18.9 cmH2O in the lobectomy group, and -29.8, -0.1 and -12.7 cmH2O in the minimal/no-resection group. All of the pleural pressure values in lobectomy group were significantly lower compared to minimal/no-resection group (P=0.029, P=0.015, P=0.019, respectively). The maximal pressures during coughing were not statistically different between the two groups (38.4 vs. 34.4 cmH2O, P=0.687). Conclusions We reported the actual pleural pressure changes according to the phase of respiration and type of surgery using a digital manometer. In lobectomy patients, the pleural pressure was highly negative compared to the minimal/no-resection group, especially during deep inspiration.
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Affiliation(s)
- Jin San Bok
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dongjun Lim
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Kyung Joo
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Effect of the self-efficacy-enhancing active cycle of breathing technique on lung cancer patients with lung resection: A quasi-experimental trial. Eur J Oncol Nurs 2018; 34:1-7. [DOI: 10.1016/j.ejon.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/23/2022]
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Bertani A, Ferrari P, Terzo D, Russo E, Burgio G, De Monte L, Raffaele F, Droghetti A, Crisci R. A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy. J Thorac Dis 2018; 10:S499-S511. [PMID: 29629196 DOI: 10.21037/jtd.2018.02.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) lobectomy has recently been adopted as the gold standard surgical option for the treatment of early stage non-small cell lung cancer. Enhanced recovery after surgery (ERAS) is being progressively adopted in thoracic surgery to improve the postoperative outcomes. Even if the benefits of ERAS are universally accepted, to date a standardized and uniform approach has not been described in the medical literature. The Italian VATS group has recently proposed to include in the VATS lobectomy database a structured protocol for ERAS. Methods The ERAS section of the Italian VATS group is proposing a comprehensive ERAS protocol within the VATS lobectomy database, allowing the prospective collection of a dedicated set of data. Separate sections of the protocol are dedicated to different topics of ERAS. This study is specifically dedicated to the section of physiokinesis therapy. The medical literature will be extensively reviewed and a physiotherapy (PT) protocol of ERAS will be presented and discussed. A seta of structured clinical pathways will also be suggested for adoption in the VATS Group database. Discussion Pre- and post-operative adoption of an ERAS protocol in patients undergoing VATS lobectomy may promote an improved post-operative course, a shorter hospital stay and an overall more comfortable patients' experience. The mainstays of a physiokinesis therapy ERAS protocol are patients' education, constant physical and respiratory therapy sessions, and adoption of adequate devices. Although many studies have investigated the usefulness of physical and respiratory physiokinesis therapy, a comprehensive ERAS protocol for VATS lobectomy patients has not yet been described. The proposed ERAS platform, adopted by the VATS Group database, will contribute to a prospective data collection and allow a scientific analysis of the results.
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Affiliation(s)
- Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Paolo Ferrari
- Division of Thoracic Surgery, A. Businco Cancer Center, Ospedale Brotzu, Cagliari, Italy
| | - Danilo Terzo
- Rehabilitation Services, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Emanuele Russo
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Gaetano Burgio
- Department of Anesthesia and CCM, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Lavinia De Monte
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Francesco Raffaele
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | | | - Roberto Crisci
- Division of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
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Pan H, Pei Y, Li B, Wang Y, Liu J, Lin H. Tai Chi Chuan in postsurgical non-small cell lung cancer patients: study protocol for a randomized controlled trial. Trials 2018; 19:2. [PMID: 29301544 PMCID: PMC5753515 DOI: 10.1186/s13063-017-2320-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023] Open
Abstract
Background Impairment of exercise capacity remains a common adverse effect of non-small cell lung cancer (NSCLC) survivors after surgery. Previous research has suggested that Tai Chi Chuan (TCC) offers an exercise capacity benefit in several types of cancers. This is a randomized trial to investigate the efficacy and safety of TCC in postoperative NSCLC patients over an observation period of 3 months and a 9-month follow-up. Methods/design Using a prospective, one center and randomized design, 120 subjects with histologically confirmed stage I–IIIA NSCLC following complete surgical resection will potentially be eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of two conditions: (1) TCC training, or (2) placebo control. The training sessions for both groups will last 60 min and take place three times a week for 3 months. The sessions will be supervised with target intensity of 60–80% of work capacity, dyspnea, and heart rate management. The primary study endpoint is peak oxygen consumption (VO2peak), and the secondary endpoints include: 6-min walk distance (6MWD), health-related quality of life (HRQoL), lung function, immunity function, and the state of depression and anxiety. All endpoints will be assessed at the baseline and postintervention (3 months). A follow-up period of 9 months will be included. The main time points for the evaluation of clinical efficacy and safety will be months 3, 6, 9, and 12 after enrollment. Discussion This study will assess the effect of group TCC in postsurgery NSCLC survivors on VO2peak, lung function, and other aspects. The results of this study will eventually provide clinical proof of the application of TCC as one kind of exercise training for patients across the entire NSCLC continuum, as well as information on the safety and feasibility of exercise. Trial Registration Chinese Clinical Trial Registry: ChiCTR-IOR-15006548. Registered on 12 June 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2320-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hong Pan
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.,Department of Oncology, the first affiliated hospital of Zhejiang Chinese Medical Hospital, Zhejiang, 310006, China
| | - Yingxia Pei
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Bingxue Li
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.,Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yi Wang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jie Liu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Hongsheng Lin
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
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Lai Y, Su J, Qiu P, Wang M, Zhou K, Tang Y, Che G. Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial. Interact Cardiovasc Thorac Surg 2017; 25:476-483. [PMID: 28520962 DOI: 10.1093/icvts/ivx141] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/05/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The goal of this study was to assess the impact of a preoperative 1-week, systematic, high-intensity inpatient exercise regimen on patients with lung cancer who had risk factors for postoperative pulmonary complications (PPCs). METHODS We conducted a randomized controlled trial with 101 subjects of a preoperative, 7-day systematic, integrated, high-intensity pulmonary exercise regimen. The control group received standard preoperative care. We analysed the occurrence of PPCs in both groups as the primary outcome; other outcomes included changes in blood gas, quality of life, peak expiratory flow rate, the 6-min walk distance and others. RESULTS The 6-min walk distance showed an increase of 22.9 ± 25.9 m in the intervention group compared with 4.2 ± 9.2 m in the control group, giving a between-group difference of 18.7 m (95% confidence interval: 8.8-28.6; P < 0.001); the peak expiratory flow increased by 25.2 ± 24.6 l/min, compared with 4.2 ± 7.7 l/min (between-group difference: 21.0 m, 95% confidence interval: 7.2-34.8; P = 0.003). The intervention group had a shorter average total (15.6 ± 3.6 vs 17.7 ± 5.3 days, P = 0.023) and postoperative length of stay (6.1 ± 3.0 vs 8.7 ± 4.6 days, P = 0.001) than the control group; the incidence of PPCs (9.8%, 5/51 vs 28.0%, 14/50, P = 0.019) was significantly lower. A multivariable analysis of the risk of PPCs identified short-term rehabilitation intervention to be an independent risk factor (odds ratio = 0.156, 95% confidence interval: 0.037-0.649, P = 0.011). CONCLUSIONS The study results suggested that a systematic, high-intensity pulmonary exercise programme was a practical strategy when performed preoperatively in patients with lung cancer with risk factors for PPCs. CLINICAL TRIAL REGISTRATION ChiCTR-IOR-16008109.
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Affiliation(s)
- Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianhua Su
- Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, China
| | - Peiyuan Qiu
- Department of Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Mingming Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxin Tang
- Department of Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Wittry SA, Lam NY, McNalley T. The Value of Rehabilitation Medicine for Patients Receiving Palliative Care. Am J Hosp Palliat Care 2017; 35:889-896. [DOI: 10.1177/1049909117742896] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Sarah A. Wittry
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Department of Palliative Care, University of Washington, Seattle, WA, USA
| | - Ny-Ying Lam
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Zhou K, Su J, Lai Y, Li P, Li S, Che G. Short-term inpatient-based high-intensive pulmonary rehabilitation for lung cancer patients: is it feasible and effective? J Thorac Dis 2017; 9:4486-4493. [PMID: 29268518 DOI: 10.21037/jtd.2017.10.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background This study was conducted to develop a preoperative in-hospital short-term rehabilitation program for surgical lung cancer patients, and investigate its feasibility, potential cost benefit and effectiveness on outcome measures including reduction of postoperative pulmonary complications (PPCs) and postoperative length of stay. Methods A 7-day inpatient-based high-intensive rehabilitation regimen was performed between March 01, 2014 and June 30, 2015. It was combined with inspiratory muscles training (IMT) and aerobic endurance training and was tested in an enriched cohort study with 939 lung cancer patients undergoing lobectomy in a regional thoracic unit. Results Finally, 939 patients were divided into pulmonary rehabilitation (PR) group (n=197) and non-PR (NPR) group (n=742), according to whether they received the 7-day preoperative in-hospital systematic rehabilitation. The PR group had a shorter total length of stay (14.7±4.0 vs. 16.7±6.2 days, P<0.001) as well as postoperative length of stay (6.2±3.3 vs. 8.3±5.6 days, P<0.001) than the NPR group. Lower incidences of total PPCs (18.3%, 36/197 vs. 26.1%, 194/742, P=0.022), pneumonia (11.2%, 22/197 vs. 17.3%, 128/742, P=0.024) and atelectasis (6.6%, 13/197 vs. 12.3%, 91/742, P=0.038) were found in the PR group compared with NPR group. Meanwhile, a multivariable analysis of risk to PPCs, atelectasis and pneumonia, revealed that the PR intervention was the independent risk factor of the occurrence of the PPCs (OR =0.57, 95% CI: 0.47 to 0.93, P=0.033) and atelectasis (OR =0.49, 95% CI: 0.26 to 0.91, P=0.024). Conclusions The study showed the effectiveness of this systematic and high-intensive PR combining IMT and aerobic exercise in reductions of the length of stay and occurrence of PPCs without increase in in-hospital cost, suggesting the potential of this rehabilitation pattern as a practicable strategy performed preoperatively in surgical lung cancer patients.
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Affiliation(s)
- Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhua Su
- Rehabilitation Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuangjiang Li
- Department of Thoracic Surgery, 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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An Evolving Role for Cancer Rehabilitation in the Era of Low-Dose Lung Computed Tomography Screening. PM R 2017; 9:S407-S414. [DOI: 10.1016/j.pmrj.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/22/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
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Li J, Guo NN, Jin HR, Yu H, Wang P, Xu GG. Effects of exercise training on patients with lung cancer who underwent lung resection: a meta-analysis. World J Surg Oncol 2017; 15:158. [PMID: 28835249 PMCID: PMC5569526 DOI: 10.1186/s12957-017-1233-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/13/2017] [Indexed: 01/29/2023] Open
Abstract
Background The efficacy of exercise training in patients with lung cancer after lung resection has not been well established yet. Therefore, we performed a meta-analysis to investigate the efficiency of exercise training in patients with lung cancer after lung resection. Methods Several databases were searched for eligible randomised controlled trials (RCTs). The primary outcome was quality of life, and the secondary outcomes included 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1) and postoperative complications (POCs). Weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated by random-effects model. Results Six RCTs involving 438 patients were enrolled in this meta-analysis. The pooled WMDs of the scores were 2.41 (95% CI = −5.20 to 10.02; P = 0.54) and −0.46 (95% CI = −20.52 to 19.61; P = 0.96) for the physical and mental components of the 36-item short-form scale, respectively. The pooled WMDs were 23.50 m (95% CI = −22.04 to 69.03; P = 0.31) for 6MWD and 0.03 L (95% CI = −0.19 to 0.26; P = 0.76) for FEV1. Finally, the pooled RRs were 0.79 (95% CI = 0.41 to 1.53; P = 0.49) for POCs. Conclusions Insufficient evidence is available to support the efficacy of exercise training in patients with lung cancer after lung resection. Further studies must confirm our findings and investigate the long-term effects of exercise training on patients with lung cancer following lung resection. Electronic supplementary material The online version of this article (doi:10.1186/s12957-017-1233-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Li
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Nan-Nan Guo
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hai-Rong Jin
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hua Yu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Wang
- Nanlou Medical Oncology Department, Chinese PLA General Hospital, Beijing, 100853, China
| | - Guo-Gang Xu
- Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Fugazzaro S, Costi S, Mainini C, Kopliku B, Rapicetta C, Piro R, Bardelli R, Rebelo PFS, Galeone C, Sgarbi G, Lococo F, Paci M, Ricchetti T, Cavuto S, Merlo DF, Tenconi S. PUREAIR protocol: randomized controlled trial of intensive pulmonary rehabilitation versus standard care in patients undergoing surgical resection for lung cancer. BMC Cancer 2017; 17:508. [PMID: 28760151 PMCID: PMC5537935 DOI: 10.1186/s12885-017-3479-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023] Open
Abstract
Background Non-small cell lung cancer is the most common type of lung cancer. Surgery is proven to be the most effective treatment in early stages, despite its potential impact on quality of life. Pulmonary rehabilitation, either before or after surgery, is associated with reduced morbidity related symptoms and improved exercise capacity, lung function and quality of life. Methods We describe the study protocol for the open-label randomized controlled trial we are conducting on patients affected by primary lung cancer (stages I-II) eligible for surgical treatment. The control group receives standard care consisting in one educational session before surgery and early inpatient postoperative physiotherapy. The treatment group receives, in addition to standard care, intensive rehabilitation involving 14 preoperative sessions (6 outpatient and 8 home-based) and 39 postoperative sessions (15 outpatient and 24 home-based) with aerobic, resistance and respiratory training, as well as scar massage and group bodyweight exercise training. Assessments are performed at baseline, the day before surgery and one month and six months after surgery. The main outcome is the long-term exercise capacity measured with the Six-Minute Walk Test; short-term exercise capacity, lung function, postoperative morbidity, length of hospital stay, quality of life (Short Form 12), mood disturbances (Hospital Anxiety and Depression Scale) and pain (Numeric Rating Scale) are also recorded and analysed. Patient compliance and treatment-related side effects are also collected. Statistical analyses will be performed according to the intention-to-treat approach. T-test for independent samples will be used for continuous variables after assessment of normality of distribution. Chi-square test will be used for categorical variables. Expecting a 10% dropout rate, assuming α of 5% and power of 80%, we planned to enrol 140 patients to demonstrate a statistically significant difference of 25 m at Six-Minute Walk Test. Discussion Pulmonary Resection and Intensive Rehabilitation study (PuReAIR) will contribute significantly in investigating the effects of perioperative rehabilitation on exercise capacity, symptoms, lung function and long-term outcomes in surgically treated lung cancer patients. This study protocol will facilitate interpretation of future results and wide application of evidence-based practice. Trial registration ClinicalTrials.gov Registry n. NCT02405273 [31.03.2015].
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Affiliation(s)
- Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy. .,Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Via del Pozzo n°71, 41124, Modena, Italy. .,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, L.go P. Daneo n°3, 16132, Genoa, Italy.
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Besa Kopliku
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Cristian Rapicetta
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberto Piro
- Pulmonology Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberta Bardelli
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Patricia Filipa Sobral Rebelo
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Carla Galeone
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Giorgio Sgarbi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Filippo Lococo
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Massimiliano Paci
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Tommaso Ricchetti
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Domenico Franco Merlo
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Sara Tenconi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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Kendall F, Abreu P, Pinho P, Oliveira J, Bastos P. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017. [PMID: 28623106 DOI: 10.1016/j.rppnen.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This review aims to appraise the role of physiotherapy care in patients submitted to pulmonary surgery, in preoperative, perioperative, and postoperative phases. Pulmonary surgery is the gold standard treatment for patients with lung cancer if it is completely resectable. However, the major impairments and complications induced by surgery are well known. Physiotherapy has been regularly used both in the preparation of the surgical candidates; in their functional recovery in the immediate postoperative period, and in the medium/long term but there is a lack of concise evidence-based recommendations. Therefore, the aim of this review is to appraise the literature about the role of physiotherapy interventions in patients undergoing lung surgery for lung cancer, in preoperative, perioperative, postoperative and maintenance stages, to the recovery and well-being, regardless of the extent of surgical approach. In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged.
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Affiliation(s)
- F Kendall
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; CESPU, Polytechnic Health Institute of the North, Gandra, Portugal; CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal.
| | - P Abreu
- Department of Physiotherapy, Escola Superior Saúde Dr. Lopes Dias, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - P Pinho
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
| | - J Oliveira
- CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal
| | - P Bastos
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
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Kubori Y, Matsuki R, Hotta A, Morisawa T, Tamaki A. Comparison between stair-climbing test and six-minute walk test after lung resection using video-assisted thoracoscopic surgery lobectomy. J Phys Ther Sci 2017; 29:902-904. [PMID: 28603368 PMCID: PMC5462695 DOI: 10.1589/jpts.29.902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/16/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Currently, the six-minute walk distance (6MWD) is used to evaluate exercise
capacity in people following lung resection for non-small cell lung cancer. However, it is
unclear whether the 6MWD can detect changes in cardiorespiratory fitness induced by
exercise training or lung resection. Conversely, the stair-climbing test is used
frequently for the preoperative evaluation of lung resection candidates. It is considered
a sensitive method for detecting changes associated with training, but is not used to
evaluate exercise capacity after lung resection. The purpose of this study was to compare
the stair-climbing test and the six-minute walk test (6MWT) after lung resection.
[Subjects and Methods] Fourteen patients undergoing lung resection completed the
stair-climbing test and the 6MWT preoperatively, and one month postoperatively. The
postoperative values and the percentage change in the stair-climbing test and the 6MWT
were evaluated. [Results] The stair-climbing test results showed a significant
deterioration at one month after lung resection; however, a significant change in the 6MWD
was not observed. [Conclusion] When compared with the 6MWT, the stair-climbing test was
more sensitive in detecting lung resection-induced changes in cardiorespiratory
fitness.
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Affiliation(s)
- Yohei Kubori
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Ryosuke Matsuki
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Akira Hotta
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Japan
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Japan
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Sommer MS, Trier K, Vibe-Petersen J, Missel M, Christensen M, Larsen KR, Langer SW, Hendriksen C, Clementsen PF, Pedersen JH, Langberg H. Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA): A Feasibility Study. Integr Cancer Ther 2016; 15:455-466. [PMID: 27151595 PMCID: PMC5739160 DOI: 10.1177/1534735416635741] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction Surgical resection in patients with non-small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting, with focus on high-intensity interval exercise. Methods Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, University of Copenhagen, were randomly assigned to 1 of 4 groups (3 intervention groups and 1 control group). The preoperative intervention consisted of a home-based exercise program, while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling. The study endpoints were inclusion rate, adherence, and number of adverse events. Results Forty patients (of 124 screened; 32%) were included and randomized into the 4 groups. The postoperative exercise was completed by 73% of the patients randomized to this intervention. No adverse events were observed, indicating that the early postoperative exercise program is safe. The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery. Conclusion The early postoperative exercise program for patients with NSCLC was safe and feasible, but in a fast-track set up, a preoperative home-based exercise program was not feasible for this population.
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Affiliation(s)
- Maja S Sommer
- Copenhagen Centre for Cancer and Health, City of Copenhagen, Copenhagen, Denmark
| | - Karen Trier
- Copenhagen Centre for Cancer and Health, City of Copenhagen, Copenhagen, Denmark
| | - Jette Vibe-Petersen
- Copenhagen Centre for Cancer and Health, City of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | - Paul Frost Clementsen
- University of Copenhagen, Copenhagen, Denmark
- Gentofte University Hospital, Hellerup, Denmark
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Mainini C, Rebelo PF, Bardelli R, Kopliku B, Tenconi S, Costi S, Tedeschi C, Fugazzaro S. Perioperative physical exercise interventions for patients undergoing lung cancer surgery: What is the evidence? SAGE Open Med 2016; 4:2050312116673855. [PMID: 27803808 PMCID: PMC5077072 DOI: 10.1177/2050312116673855] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/08/2016] [Indexed: 01/14/2023] Open
Abstract
Surgical resection appears to be the most effective treatment for early-stage non-small cell lung cancer. Recent studies suggest that perioperative pulmonary rehabilitation improves functional capacity, reduces mortality and postoperative complications and enhances recovery and quality of life in operated patients. Our aim is to analyse and identify the most recent evidence-based physical exercise interventions, performed before or after surgery. We searched in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsycINFO. We included randomised controlled trials aimed at assessing efficacy of exercise-training programmes; physical therapy interventions had to be described in detail in order to be reproducible. Characteristics of studies and programmes, results and outcome data were extracted. Six studies were included, one describing preoperative rehabilitation and three assessing postoperative intervention. It seems that the best preoperative physical therapy training should include aerobic and strength training with a duration of 2–4 weeks. Although results showed improvement in exercise performance after preoperative pulmonary rehabilitation, it was not possible to identify the best preoperative intervention due to paucity of clinical trials in this area. Physical training programmes differed in every postoperative study with conflicting results, so comparison is difficult. Current literature shows inconsistent results regarding preoperative or postoperative physical exercise in patients undergoing lung resection. Even though few randomised trials were retrieved, treatment protocols were difficult to compare due to variability in design and implementation. Further studies with larger samples and better methodological quality are urgently needed to assess efficacy of both preoperative and postoperative exercise programmes.
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Affiliation(s)
- Carlotta Mainini
- Unit of Physical and Rehabilitation Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Patrícia Fs Rebelo
- Unit of Physical and Rehabilitation Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Roberta Bardelli
- Unit of Physical and Rehabilitation Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Besa Kopliku
- Unit of Physical and Rehabilitation Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Sara Tenconi
- Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Stefania Costi
- Unit of Physical and Rehabilitation Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Tedeschi
- Unit of Physical and Rehabilitation Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Unit of Physical and Rehabilitation Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
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[Evolution of pain during respiratory rehabilitation after major lung resection]. Rev Mal Respir 2016; 34:232-239. [PMID: 27743822 DOI: 10.1016/j.rmr.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/05/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Lung resection for cancer is the cause of significant postoperative pain. The aim of this study was to determine whether pulmonary rehabilitation could induce a resurgence of pain. METHODS In 2014 and 2015, pulmonary rehabilitation was offered to all patients referred to our institution after lung resection for cancer. Patients were assessed at entry and departure for nociceptive pain, neuropathic pain (DN4), for quality of life using questionnaire EORTC QlQ-C30 and for anxiety and depression (HAD questionnaire). Pain was studied before and after the sessions of cycloergometer, gym and massages. RESULTS During the period, 99 patients were admitted to our institution following lung resection for cancer. Medians changed during pulmonary rehabilitation from 3 to 1 for nociceptive pain (p<0.001), 3 to 3 for DN4 (NS), 50 to 67 for the quality of life score (p<0.001), 7 to 5 for the anxiety (p<0.001) and 5 to 3 for depression (p<0.0001). Pain remained stable during the sessions of cycloergometer and gym, and decreased during massage. Patients undergoing thoracotomy or video-assisted thoracic surgery evolved identically. CONCLUSION Postoperative pulmonary rehabilitation after lung resection for cancer was not harmful. It was associated with a decrease in nociceptive pain and was without effect on neuropathic pain.
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Harris C, Meek D, Gilligan D, Williams L, Solli P, Rintoul RC. Assessment and Optimisation of Lung Cancer Patients for Treatment with Curative Intent. Clin Oncol (R Coll Radiol) 2016; 28:682-694. [PMID: 27546624 DOI: 10.1016/j.clon.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022]
Abstract
Over the past decade the field of lung cancer management has seen many developments. Coupled with an ageing population and increasing rates of comorbid illness, the work-up for treatments with curative intent has become more complex and detailed. As well as improvements in imaging and staging techniques, developments in both surgery and radiotherapy may now allow patients who would previously have been considered unfit or not appropriate for treatment with curative intent to undergo radical therapies. This overview will highlight published studies relating to investigation and staging techniques, together with assessments of fitness, with the aim of helping clinicians to determine the most appropriate treatments for each patient. We also highlight areas where further research may be required.
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Affiliation(s)
- C Harris
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Meek
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Gilligan
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - L Williams
- Department of Cardiology, Papworth Hospital, Cambridge, UK
| | - P Solli
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK.
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Numan RC, Berge MT, Burgers JA, Klomp HM, van Sandick JW, Baas P, Wouters MW. Peri- and postoperative management of stage I-III Non Small Cell Lung Cancer: Which quality of care indicators are evidence-based? Lung Cancer 2016; 101:129-136. [PMID: 27794401 DOI: 10.1016/j.lungcan.2016.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 05/30/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
Abstract
Quality of care (QoC) has a central role in our health care system. The aim of this review is to present a set of evidence-based quality indicators for the surgical treatment and postoperative management of lung cancer. A search was performed through PubMed, Embase and the Cochrane library database, including English literature, published between 1980 and 2012. Search terms regarding 'lung neoplasms', 'surgical treatment' and 'quality of care' were used. Potential QoC indicators were divided into structure, process or outcome measures and a final selection was made based upon the level of evidence. High hospital volume and surgery performed by a thoracic surgeon, were identified as important structure indicators. Sleeve resection instead of pneumonectomy and the importance of treatment within a clinical care path setting were identified as evidence-based process indicators. A symptom-based follow-up regime was identified as a new QoC indicator. These indicators can be used for registration, benchmarking and ultimately quality improvement in lung cancer surgery.
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Affiliation(s)
- Rachel C Numan
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands.
| | - Martijn Ten Berge
- Department of Surgical Oncology, Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jacobus A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Houke M Klomp
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
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Ni HJ, Pudasaini B, Yuan XT, Li HF, Shi L, Yuan P. Exercise Training for Patients Pre- and Postsurgically Treated for Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis. Integr Cancer Ther 2016; 16:63-73. [PMID: 27151583 PMCID: PMC5736064 DOI: 10.1177/1534735416645180] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This meta-analysis examined the effects of exercise training on length of hospital stay, postoperative complications, exercise capacity, 6-minute walking distance (6MWD), and health-related quality of life (HRQoL) in patients following resection of non-small cell lung cancer (NSCLC). METHODS This review searched PubMed, EMBASE, and the Cochrane Collaboration data base up to August 16, 2015. It includes 15 studies comparing exercise endurance and quality of life before versus after exercise training in patients undergoing lung resection for NSCLC. RESULTS This review identified 15 studies, 8 of which are randomized controlled trials including 350 patients. Preoperative exercise training shortened length of hospital stay; mean difference (MD): -4.98 days (95% CI = -6.22 to -3.74, P < .00001) and also decreased postoperative complications for which the odds ratio was 0.33 (95% CI = 0.15 to 0.74, P = .007). Four weeks of preoperative exercise training improved exercise capacity; 6MWD was increased to 39.95 m (95% CI = 5.31 to 74.6, P = .02) .While postoperative exercise training can also effectively improve exercise capacity, it required a longer training period; 6MWD was increased to 62.83 m (95% CI = 57.94 to 67.72) after 12 weeks of training ( P < .00001). For HRQoL, on the EORTC-QLQ-30, there were no differences in patients' global health after exercise, but dyspnea score was decreased -14.31 points (95% CI = -20.03 to -8.58, P < .00001). On the SF-36 score, physical health was better after exercise training (MD = 3 points, 95% CI = 0.81 to 5.2, P = .007) while there was no difference with regard to mental health. The I2 statistics of all statistically pooled data were lower than 30%. There was a low amount of heterogeneity among these studies. CONCLUSIONS Evidence from this review suggests that preoperative exercise training may shorten length of hospital stay, decrease postoperative complications and increase 6MWD. Postoperative exercise training can also effectively improve both the 6MWD and quality of life in surgical patients with NSCLC, but requiring a longer training period.
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Affiliation(s)
- Hui-Juan Ni
- 1 Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bigyan Pudasaini
- 1 Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xun-Tao Yuan
- 2 Weifang Traditional Chinese Hospital, Shandong, China
| | - He-Fang Li
- 3 Laian Maternal and Child Health Care and Family Plaining Service Center, Chuzhou, Anhui, China
| | - Lei Shi
- 4 Zhejiang Cancer Hospital, Hangzhou City, Zhejiang, China
| | - Ping Yuan
- 1 Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Wang H, Liu X, Rice SJ, Belani CP. Pulmonary Rehabilitation in Lung Cancer. PM R 2016; 8:990-996. [PMID: 27060645 DOI: 10.1016/j.pmrj.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/18/2016] [Accepted: 03/30/2016] [Indexed: 12/25/2022]
Abstract
Lung cancer remains a challenging disease with high morbidity and mortality despite targeted therapy. Symptom burden related to cancer impairs quality of life and functional status in patients with lung cancer and in survivors. Pulmonary rehabilitation has been recognized as an effective, noninvasive intervention for patients with chronic respiratory disease. It is well established that pulmonary rehabilitation benefits patients with chronic obstruction pulmonary disease through improved exercise capacity and symptoms. Evidence is increasing that the benefit of pulmonary rehabilitation can be applied to patients with lung cancer. Comprehensive pulmonary rehabilitation has made its way as a cornerstone of integrated care for patients with lung cancer. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Hongmei Wang
- Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Xin Liu
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA
| | - Shawn J Rice
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA
| | - Chandra P Belani
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, 500 University Dr, Hershey, PA 17033
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Hoffman AJ, Brintnall RA, Cooper J. Merging technology and clinical research for optimized post-surgical rehabilitation of lung cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:28. [PMID: 26889481 DOI: 10.3978/j.issn.2305-5839.2016.01.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The 21(st) century has ushered in an age of wireless communication and technological breakthroughs providing researchers with opportunities and challenges as they incorporate this technology into their research. This paper presents the challenges our team encountered introducing new technologies and how they were overcome for an intervention for post-thoracotomy non-small cell lung cancer (NSCLC) patients. METHODS Our intervention incorporated the Nintendo Wii Fit Plus virtual-reality walking and balance exercise into a home-based rehabilitation program. The intervention is novel and innovative in that the intervention provides light-intensity exercise post-thoracotomy for NSCLC patients immediately after return to home from the hospital. The intervention overcomes the barriers of conventional exercise programs that require travel, conventional exercise equipment, and begin months after surgery. RESULTS When translating new technology to research, researchers need to consider a number of factors that need to be addressed. Institutional Review Boards may need further explanation as to why the technology is safe, potential participants may need to have unfounded concerns explained before enrolling, and the research team needs a plan for introducing the technology to participants with a vast range of skill sets and environments in which they will be using technology. In our study, we addressed each of these factors using varying approaches as we translated how the Wii would be used in a home-based exercise intervention by a highly vulnerable, post-thoracotomy NSCLC population. CONCLUSIONS While technology brings with it multiple barriers for successful implementation, our team showed that with proper planning and teamwork, researchers can navigate these issues bringing the full benefit of technology to even the most vulnerable of patient populations.
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Affiliation(s)
- Amy J Hoffman
- 1 College of Nursing, Michigan State University, East Lansing, Michigan 48824-1315, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan 49503, USA
| | - Ruth Ann Brintnall
- 1 College of Nursing, Michigan State University, East Lansing, Michigan 48824-1315, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan 49503, USA
| | - Julie Cooper
- 1 College of Nursing, Michigan State University, East Lansing, Michigan 48824-1315, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan 49503, USA
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Vandenbos F, Fontas E, Pop D, Perrotin C, Venissac N, Mouroux J. Impact de la réhabilitation respiratoire sur l’anxiété et la dépression après chirurgie thoracique pour cancer. Rev Mal Respir 2015; 32:921-9. [DOI: 10.1016/j.rmr.2014.11.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 11/11/2014] [Indexed: 12/11/2022]
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Jeong JH, Yoo WG. Effect of caregiver education on pulmonary rehabilitation, respiratory muscle strength and dyspnea in lung cancer patients. J Phys Ther Sci 2015; 27:1653-4. [PMID: 26180291 PMCID: PMC4499954 DOI: 10.1589/jpts.27.1653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/07/2015] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED [Purpose] This study evaluated the effects of caregiver education on pulmonary rehabilitation of patients who have undergone lung resection for cancer. [Subjects] Patients were divided into experimental (n = 22) and control (n = 19) groups. [Methods] The caregivers of the experimental group patients received education on pulmonary rehabilitation, while the control group patients received general management advice for 4 weeks. [Results] Pulmonary muscle strength (maximum inspiratory pressure and maximum expiratory pressure) was increased significantly in the experimental group compared to the control group. Modified Borg scale scores were decreased significantly in the experimental vs. CONTROL GROUP [Conclusion] Providing caregivers with education pertaining to pulmonary rehabilitation was associated with improved pulmonary function in lung cancer patients following lung resection.
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Affiliation(s)
- Jong-Hwa Jeong
- Department of Physical Therapy, The Graduate School, Inje University, Republic of Korea
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Virtual reality bringing a new reality to postthoracotomy lung cancer patients via a home-based exercise intervention targeting fatigue while undergoing adjuvant treatment. Cancer Nurs 2015; 37:23-33. [PMID: 23348662 DOI: 10.1097/ncc.0b013e318278d52f] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Little is known about rehabilitation for postthoracotomy non-small cell lung cancer (NSCLC) patients. This research uses a perceived self-efficacy-enhancing light-intensity exercise intervention targeting a priority symptom, cancer-related fatigue (CRF), for postthoracotomy NSCLC patients. This article reports on phase II of a 2-phase study. Phase I focused on initiation and tolerance of exercise during the 6 weeks immediately after thoracotomy, whereas phase II addressed maintenance of exercise for an additional 10 weeks including participants initiating and completing chemotherapy and/or radiation therapy. OBJECTIVE The objective of this study was to investigate the feasibility, acceptability, and preliminary efficacy of an exercise intervention for postthoracotomy NSCLC patients to include those initiating and completing adjuvant therapy. INTERVENTIONS/METHODS A single-arm design composed of 7 participants postthoracotomy for NSCLC performed light-intensity exercises using an efficacy-enhancing virtual-reality approach using the Nintendo Wii Fit Plus. RESULTS Despite most participants undergoing chemotherapy and/or radiation therapy, participants adhered to the intervention at a rate of 88% with no adverse events while giving the intervention high acceptability scores on conclusion. Likewise, participants' CRF scores improved from initiation through the conclusion of the intervention with perceived self-efficacy for walking at a light intensity continuously for 60 minutes, improving significantly upon conclusion over presurgery values. CONCLUSIONS Postthoracotomy NSCLC patients maintained exercise for an additional 10 weeks while undergoing adjuvant therapy showing rehabilitation potential because the exercise intervention was feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management. IMPLICATIONS FOR PRACTICE A randomized controlled trial is needed to further investigate these relationships.
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Kim I, Lee H. [Effects of a progressive walking program on physical activity, exercise tolerance, recovery, and post-operative complications in patients with a lung resection]. J Korean Acad Nurs 2015; 44:381-90. [PMID: 25231803 DOI: 10.4040/jkan.2014.44.4.381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection. METHODS A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0. RESULTS A higher proportion of patients in the experimental group showed adequate levels of physical activity (p=.001), shorter period of chest tube retention (≤ 7 days; p=.011), and shorter stay in the hospital (≤ 10 days; p=.036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p=.032) and lower levels of dyspnea (p=.049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications. CONCLUSION The findings of this study suggest that the PW could be a useful strategy for improving patients' post-operative health and reducing cost after lung resection.
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Affiliation(s)
- Inah Kim
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Haejung Lee
- College of Nursing, Pusan National University, Yangsan, Korea.
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Leach HJ, Devonish JA, Bebb DG, Krenz KA, Culos-Reed SN. Exercise preferences, levels and quality of life in lung cancer survivors. Support Care Cancer 2015; 23:3239-47. [PMID: 25832895 DOI: 10.1007/s00520-015-2717-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/23/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Lung cancer poses multiple challenges to adopting an exercise (EX) program, and the ideal timing of an EX program to improve quality of life (QoL) is unknown. This study explored the EX counselling and programming preferences of lung cancer survivors and examined the association of EX before diagnosis, during treatment and after treatment on QoL. METHODS Cross-sectional, retrospective survey design in a sample of lung cancer survivors. EX preferences were compared between patients who had received radical chest radiation or lung surgery versus those who had not. EX was measured by self-report using the Godin Leisure Time Exercise Questionnaire (GLTEQ). Separate linear regression models, controlling for significant covariates, examined the association of EX at each time point with scores on QoL measures and subscales. RESULTS Participants (N = 66, M age 66.4 ± 9.1) were between 4 months and 11.5 years after lung cancer diagnosis (M = 31.7 ± 22.9 months). Patients who had lung surgery were more likely to prefer to start an EX program during adjuvant treatment than those who did not have surgery (t(33) = 2.43, p = .025). Compared to prediagnosis EX (M = 36.7 ± 56.0 MET h/week), EX levels declined significantly during (M = 12.4 ± 25.0 MET h/week) and after (M = 12.3 ± 17.4 MET h/week) treatment (p < .05). After controlling for disease stage and income, regression models were not significant, but EX after treatment was a significant individual predictor of fatigue (β = .049, p = .006) and QoL measured by the Chronic Respiratory Disease Questionnaire (β = .163, p = .025). CONCLUSIONS Lung cancer patient preferences indicate that EX program timing should take into account whether the patient has undergone surgery. Lung cancer survivors' EX levels declined after diagnosis and engaging in EX after treatment may improve fatigue and QoL.
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Affiliation(s)
- H J Leach
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - J A Devonish
- Medical University of the Americas, Calgary, AB, Canada.
| | - D G Bebb
- Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
| | - K A Krenz
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - S N Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada. .,Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada.
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Rivas-Perez H, Nana-Sinkam P. Integrating pulmonary rehabilitation into the multidisciplinary management of lung cancer: A review. Respir Med 2015; 109:437-42. [DOI: 10.1016/j.rmed.2015.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 12/30/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
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