[Rehabilitation of lung cancer patients]

Effectiveness of perioperative pulmonary rehabilitation in thoracic surgery

BACKGROUND

Functional condition is crucial for operability of patients with lung cancer and/or chronic respiratory diseases. The aim of the study was to measure changes of functional and quality of life parameters in terms of the effectiveness of perioperative pulmonary rehabilitation (PR).

METHODS

A total of 208 COPD patients (age: 63±9 years, man/woman: 114/94, FEV1: 62±14%pred) participated in a perioperative PR program. The indication was primary lung cancer in 72% of the patients. The 68 patients participated in preoperative (PRE) rehabilitation, 72 in a pre- and postoperative rehabilitation (PPO) and 68 patients only in postoperative rehabilitation (POS). PR program included respiratory training techniques, individualized training and smoking cessation. Lung function tests, 6 minutes walking distance (6MWD) were measured before and after the rehabilitation. Quality of life tests [COPD Assessment Test (CAT) and Modified Medical Research Council Dyspnoea Scale (mMRC)] were evaluated as well.

RESULTS

There was a significant improvement in FEV1 (PRE: 64±16 vs. 67±16%pred; PPO: 60±13 vs. 66±13%pred before the operation, 48±13 vs. 52±13%pred after the operation; POS: 56±16 vs. 61±14%pred, P<0.05) and 6MWD (PRE: 403±87 vs. 452±86 m; PPO: 388±86 vs. 439±83 m before, 337±111 vs. 397±105 m after the operation; POS: 362±89 vs. 434±94 m, P<0 0001). Significant improvement was detected in FVC, grip strength, mMRC and CAT questionnaires as an effectiveness of PR, also. Average intensive care duration was 3.8±5.2 days with vs. 3.1±3.6 without preoperative PR.

CONCLUSIONS

Improvements in exercise capacity and quality of life were seen following PR both before and after thoracic surgery.

Integrative Tumor Board: A Case Report and Discussion From East-West Cancer Center

Aim. To introduce the application of wheel balance cancer therapy (WBCT) in cancer treatment through an intensive study of a representative patient. Method. A 59-year-old, female patient who was a secondhand smoker and who carried no significant medical and family history was diagnosed with T1N0M1 (stage 4) lung adenocarcinoma. Immunohistochemistry was positive for thyroid transcription factor-1, CK7, cyclin D1, p53, and Ki-67 on both lung biopsy specimens. An open lobectomy with mediastinal nodal dissection followed. The patient was transferred to East-West Cancer Center (EWCC) suffering from exertional dyspnea (NYHA [New York Heart Association] grade 2) with thoracic pain and pain in both upper limbs because of the decreased ventilatory capacity and reduced exercise capacity after a pulmonary resection. She also complained of emotional stress. EWCC provided WBCT, a multimodality alternative protocol based on the theory of traditional oriental medicine. Physicians regularly monitored whether metastasis or recurrence existed through blood and radiation tests. Observations and dialogues with the patient were used to record the changes in symptoms such as thoracic pain, dyspnea, anxiety, and fear. Results . Treatments at EWCC led to a disease-free survival of 28 months without adjuvant chemotherapy. Neither metastasis nor recurrence occurred during this period. Exertional dyspnea recovered to NYHA grade 1. Other physical and psychological symptoms were alleviated. Conclusion. This report suggests that WBCT may have the potential for extending life expectancy, controlling symptoms, and improving quality of life in cancer patients.