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VOLUME 64 , ISSUE 2 ( April-June, 2022 ) > List of Articles

Original Article

Role of Pulmonary Rehabilitation in Advanced Non-small Cell Lung Cancer Patients Undergoing Chemotherapy: A Pilot Study

Surabhi Jaggi, Ashok Kumar Janmeja, Deepak Aggarwal

Keywords : Chemotherapy, Lung cancer, Pulmonary rehabilitation, Respiratory disease

Citation Information : Jaggi S, Janmeja AK, Aggarwal D. Role of Pulmonary Rehabilitation in Advanced Non-small Cell Lung Cancer Patients Undergoing Chemotherapy: A Pilot Study. Indian J Chest Dis Allied Sci 2022; 64 (2):94-98.

DOI: 10.5005/jp-journals-11007-0004

License: CC BY-NC 4.0

Published Online: 08-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Patients with advanced lung cancer often suffer from poor mobility and quality-of-life (QoL). Pulmonary rehabilitation (PR) has been seen to improve exercise capacity and health-related QoL (HRQoL) in different respiratory diseases. Methods: The present study was conducted to evaluate the effect of PR in advanced non-operable non-small cell lung cancer patients on several outcomes compared to the control group. Forty eligible patients were randomized to receive chemotherapy and 8-weeks of supervised, hospital-based PR twice a week (cases) vs only standard chemotherapy (controls). Exercise capacity (6-minute walk distance), HRQoL, Functional Assessment of Cancer Therapy-Lung (FACT-L) scale, spirometry, dyspnea score [modified Medical Research Council (mMRC) grade] and arterial blood gas (ABG) analysis were measured in both the groups at baseline and at the end of 8 weeks. Results: After PR, there was significant improvement in the 6MWD (change in 6MWD: cases 16.3 + 34.3 m vs controls −20.5 + 49 m; p = 0.03) and total FACT-L score (change in score: cases 18.9 + 7.3 vs controls −8.8 + 13.4; p ≤0.001) in the “cases” group as compared to controls. However, there was no significant improvement in dyspnea, spirometry, and ABG values. Conclusions: Comprehensive PR can improve exercise capacity and HRQoL in advanced lung cancer patients on concurrent chemotherapy. It may be an integral part of the management of these patients.

  1. American Cancer Society. Cancer Facts and Figures 2016. Atlanta: American Cancer Society; 2016.
  2. Temel JS, Greer JA, Goldberg S, et al. A structured exercise program for patients with advanced non-small cell lung cancer. J Thorac Oncol 2009;4(5):595–601. DOI: 10.1097/JTO.0b013e31819d18e5.
  3. Vainio A, Auvinen A, for Symptom Prevalence Group. Prevalence of symptoms among patients with advanced cancer: an international collaborative study. J Pain Symptom Manage 1996;12(1):3–10. DOI: 10.1016/0885-3924(96)00042-5.
  4. Temel JS, Pirl WF, Lynch TJ. Comprehensive symptom management in patients with advanced-stage non-small-cell lung cancer. Clin Lung Cancer 2006;7(4):241–249. DOI: 10.3816/CLC.2006.n.001.
  5. Pujol LA, Monti DA. Managing cancer pain with nonpharmacologic and complementary therapies. J Am Osteopath Assoc 2007;107(12 Suppl 7):ES15–ES21. PMID: 18165373.
  6. Spruit MA, Singh SJ, Garvey C, et al. An Official American Thoracic Society/European Respiratory Society Statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188(8):e13–e64. DOI: 10.1164/rccm.201309-1634ST.
  7. Laviolette L, Bourbeau J, Bernard S, et al. Assessing the impact of pulmonary rehabilitation on functional status in COPD. Thorax 2008;63(2):115–121. DOI: 10.1136/thx.2006.076844.
  8. Lacasse Y, Goldstein R, Lasserson TJ, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006;4:CD003793. DOI: 10.1002/14651858.CD003793.pub2.
  9. Jakes RW, Day NE, Patel B, et al. Physical inactivity is associated with lower forced expiratory volume in 1 second: European Prospective Investigation into Cancer-Norfolk Prospective Population Study. Am J Epidemiol 2002;156(2):139–147. DOI: 10.1093/aje/kwf021.
  10. Morrow JD, Frei B, Longmire AW, et al. Increase in circulating products of lipid peroxidation (F2-isoprostanes) in smokers: smoking as a cause of oxidative damage. N Engl J Med 1995;332(18):1198–1203. DOI: 10.1056/NEJM199505043321804.
  11. Jastrzebski D, Maksymiak M, Kostorz S, et al. Pulmonary rehabilitation in advanced lung cancer patients during chemotherapy. Adv Exp Med Biol 2015;861:57–64. DOI: 10.1007/5584_2015_134.
  12. Edbrooke L, Aranda S, Granger CL, et al. Multidisciplinary home-based rehabilitation in inoperable lung cancer: a randomised controlled trial. Thorax 2019;74(8):787–796. DOI: 10.1136/thoraxjnl-2018-212996.
  13. Cesario A, Ferri L, Galetta D, et al. Post operative respiratory rehabilitation after lung resection for non-small cell lung cancer. Lung Cancer 2007;57(2):175–180. DOI: 10.1016/j.lungcan.2007.02.017.
  14. Ni HJ, Pudasaini B, Yuan XT, et al. Exercise training for patients pre-and post-surgically treated for non-small cell lung cancer: a systematic review and meta-analysis. Integr Cancer Ther 2017;16(1):63–73. DOI: 10.1177/1534735416645180.
  15. Quist M, Langer SW, Lillelund C, et al. Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: a randomized clinical trial. Lung Cancer 2020;145:76–82. DOI: 10.1016/j.lungcan.2020.05.003.
  16. Spruit MA, Janssen PP, Willemsen SC, et al. Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study. Lung Cancer 2006;52(2):257–260. DOI: 10.1016/j.lungcan.2006.01.003.
  17. OkenMM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5(6):649–655. PMID: 7165009.
  18. American Thoracic Society. Standardisation of spirometry 1994 update. Am J Respir Crit Care Med 1995;152(3):1107–1136. DOI: 10.1164/ajrccm.152.3.7663792.
  19. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest 1988;93(3):580–586. DOI: 10.1378/chest.93.3.580.
  20. Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 1993;11(3):570–579. DOI: 10.1200/JCO.1993.11.3.570.
  21. Cella DF, Bonomi AE, Lloyd SR, et al. Reliability and validity of the functional assessment of cancer therapy-lung (FACT-L) quality of life instrument. Lung Cancer 1995;12(3):199–220. DOI: 10.1016/0169-5002(95)00450-f.
  22. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166(1):111–117. DOI: 10.1164/ajrccm.166.1.at1102.
  23. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract 2017;23(2):377–381. DOI: 10.1111/jep.12629.
  24. Glattki GP, Manika K, Sichletidis L, et al. Pulmonary rehabilitation in non-small cell lung cancer patients after completion of treatment. Am J Clin Oncol 2012;35(2):120–125. DOI: 10.1097/COC.0b013e318209ced7.
  25. Morris GS, Gallagher GH, Baxter MF, et al. Pulmonary rehabilitation improves functional status in oncology patients. Arch Phys Med Rehabil 2009;90(5):837–841. DOI: 10.1016/j.apmr.2008.12.005.
  26. Hwang CL, Yu CJ, Shih JY, et al. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Support Care Cancer 2012;20(12):3169–3177. DOI: 10.1007/s00520-012-1452-5.
  27. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–742. DOI: 10.1056/NEJMoa1000678.
  28. Rutkowska A, Jastrzebski D, Rutkowski S, et al. Exercise training in patients with non-small cell lung cancer during in-hospital chemotherapy treatment: a randomized controlled trial. J Cardiopulm Rehabil Prev 2019;39(2):127–133. DOI: 10.1097/HCR.0000000000000410.
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