Lung cancer

Home-based exercise improves symptoms in patients with inoperable lung cancer

Home-based rehabilitation to encourage exercise can help improve symptoms and quality of life in patients with inoperable lung cancer.

Physiotherapist Lara Edbrooke told the TSANZSRS meeting on the Gold Coast that lung cancer patients typically had higher levels of symptom distress and uncontrolled symptoms than other cancer patients.

However most evidence for exercise therapy and support were in breast and colorectal cancer patients.

Her study randomised 92 patients with inoperable lung cancer to either eight-weeks of aerobic and resistance exercise, behaviour change and symptom management support or usual care.

Patients were assessed at baseline, nine weeks and at six months. Almost half (46%) were initially undergoing treatment with a curative intent although some shifted across to palliative intent during the trial period.

The study found physical function as measured by a six-minute walk distance deteriorated in both groups from baseline with no significant difference between those who received the intervention or usual care.

However there were significant differences between the groups at six months, with the intervention improving symptom severity and health-related quality of life.

Ms Edbrooke said the lack of effect of the intervention on physical function was likely due to patients not exercising at a high enough intensity and a lack of supervision in the home.

Plus some patients just weren’t capable of exercising because of the demands or side effects of their ongoing treatments including chemotherapy and radiotherapy.

“The take home message from our study is that exercise prescription in lung cancer is not a one size fits all. I think it is important that people are referred for an assessment so they can have an individualised, tailored program prescribed for them.”

 She told the limbic that patients who were advised by their respiratory physician or medical oncologist to exercise were more likely to do so.

“The patient-reported outcome of health-related quality of life and their symptom severity significantly improved – and in the long term – and these are people with inoperable disease whose prognosis isn’t good.”

“At six months, they were still reporting improvements in their HRQoL and their symptoms and to me that is not a soft outcome. That is probably more important than if they can walk an extra 10 metres on the 6-MWD.”

She added the program, delivered by physiotherapists and nurses, was relatively inexpensive and patients certainly appreciated the extra support.

“We’re talking about a group of people who are extremely vulnerable and isolated, have a huge symptom burden and don’t have a lot of support.”

Ms Edbrooke, from the University of Melbourne and Peter MacCallum Cancer Centre, added that trying to incorporate more elements of supervision into the program might be helpful.

“There are virtual exercise groups. With pulmonary rehab you can be sitting in your own lounge room on your bike and see all the other people in their lounge rooms. I think that would be really beneficial because these people are often socially isolated but they don’t necessarily want to come in to the hospital.”

The study presented at the Annual Scientific Meetings of The Australia and New Zealand Society of Respiratory Science (ANZSRS) and the Thoracic Society of Australia and New Zealand (TSANZ) is in press in Thorax.

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