Lung cancer continues to be a difficult disease frequently diagnosed in late stages with a high mortality and symptom burden. In part because of frequent lung comorbidity, even lung cancer survivors often remain symptomatic and functionally limited. Though targeted therapy continues to increase treatment options for advanced-stage disease, symptom burden remains high with few therapeutic options. In the last several decades, exercise and physical activity have arisen as therapeutic options for obstructive lung disease and lung cancer. To date, exercise has been shown to reduce symptoms, increase exercise tolerance, improve quality of life, and potentially reduce length of stay and postoperative complications. Multiple small trials have been performed in perioperative non-small-cell lung cancer patients, although fewer studies are available for patients with advanced-stage disease. Despite the increased interest in this subject over the last few years, a validated exercise regimen has not been established for perioperative or advanced-stage disease. Clinicians underutilize exercise and pulmonary rehabilitation as a therapy, in part because of the lack of evidence-based consensus as to how and when to implement increasing physical activity. This review summarizes the existing evidence on exercise in lung cancer patients.
Background and objective. Increasing physical activity (PA) is
safe and beneficial in lung cancer (LC) patients. Advanced-stage LC patients are
under-studied and have worse symptoms and quality of life (QoL). We evaluated
the feasibility of monitoring step count in advanced LC as well as potential
correlations between PA and QoL. Methods. This is a
prospective, observational study of 39 consecutive patients with advanced-stage
LC. Daily step count over 1 week (via Fitbit Zip), QoL, dyspnea, and depression
scores were collected. Spearman rank testing was used to assess correlations.
Correlation coefficients (ρ) >0.3 or <−0.3 (more and less correlated,
respectively) were considered potentially clinically significant.
Results. Most (83%) of the patients were interested in
participating, and 67% of those enrolled were adherent with the device. Of those
using the device (n = 30), the average daily step count was 4877 (range = 504-12
118) steps/d. Higher average daily step count correlated with higher QoL (ρ =
0.46), physical (ρ = 0.61), role (ρ = 0.48), and emotional functioning (ρ =
0.40) scores as well as lower depression (ρ = −0.40), dyspnea (ρ = −0.54), and
pain (ρ = −0.37) scores. Conclusion. Remote PA monitoring
(Fitbit Zip) is feasible in advanced-stage LC patients. Interest in
participating in this PA study was high with comparable adherence to other PA
studies. In those utilizing the device, higher step count correlates with higher
QoL as well as lower dyspnea, pain, and depression scores. PA monitoring with
wearable devices in advanced-stage LC deserves further study.
There is significant morbidity and mortality from pneumonia in leukemic and bone marrow transplant patients. We sought to explore the diagnostic yield of bronchoalveolar lavage (BAL) in these patients with new pulmonary infiltrates. A retrospective chart review of approximately 200 Non- human immunodeficiency virus (HIV) leukemic and Hematopoietic stem cell transplantation (HSCT) patients who underwent bronchoscopy at a single academic cancer center was performed. Antimicrobial use for less than 24 hours at the time of BAL was associated with a higher yield in this population (56.8% versus 32.8%, p<0.001). This supports performing bronchoscopy with BAL within 24 hours of antimicrobial therapy in leukemic and HSCT patients.
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