Benefits of home-based multidisciplinary exercise and supportive care in inoperable non-small cell lung cancer – protocol for a phase II randomised controlled trial

Abstract

BackgroundLung cancer is one of the most commonly diagnosed cancers, and is a leading cause of cancer mortality world-wide. Due to lack of early specific symptoms, the majority of patients present with advanced, inoperable disease and five-year relative survival across all stages of non-small cell lung cancer (NSCLC) is 14%. People with lung cancer also report higher levels of symptom distress than those with other forms of cancer. Several benefits for survival and patient reported outcomes are reported from physical activity and exercise in other tumour groups. We report the protocol for a study investigating the benefits of exercise, behaviour change and symptom self-management for patients with recently diagnosed, inoperable, NSCLC.MethodsThis multi-site, parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aims to assess functional and patient-reported outcomes of a multi-disciplinary, home-based exercise and supportive care program for people commencing treatment. Ninety-two participants are being recruited from three tertiary-care hospitals in Melbourne, Australia. Following baseline testing, participants are randomised using concealed allocation, to receive either: a) 8 weeks of home-based exercise (comprising an individualised endurance and resistance exercise program and behaviour change coaching) and nurse-delivered symptom self-management intervention or b) usual care. The primary outcome is the between-group difference in the change in functional exercise capacity (six-minute walk distance) from baseline to post-program assessment. Secondary outcomes include: objective and self-reported physical activity levels, physical activity self-efficacy, behavioural regulation of motivation to exercise and resilience, muscle strength (quadriceps and grip), health-related quality of life, anxiety and depression and symptom interference.DiscussionThere is a lack of evidence regarding the benefit of exercise intervention for people with NSCLC, particularly in those with inoperable disease receiving treatment. This trial will contribute to evidence currently being generated in national and international trials by implementing and evaluating a home-based program including three components not yet combined in previous research, for people with inoperable NSCLC receiving active treatment and involving longer-term follow-up of outcomes. This trial is ongoing and currently recruiting.Trial registrationThis trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12614001268639: (4/12/14).Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3651-4) contains supplementary material, which is available to authorized users.

Improving the delivery of physical activity services in lung cancer: A qualitative representation of the patient’s perspective

“…In line with pulmonary rehabilitation recommendations (Spruit et al, ), self‐management strategies to assist patients to sustainably change physical activity behaviour and maximise self‐efficacy are required. There are several lung cancer studies in progress currently, which incorporate behavioural change techniques alongside traditional exercise training (Edbrooke et al, ; Peddle‐McIntyre et al, ) and we wait with anticipation for the results. It is likely that physical activity services will be most effective if they include an inter‐disciplinary approach.…”

“…There are several lung cancer studies in progress currently, which incorporate behavioural change techniques alongside traditional exercise training (Edbrooke et al, 2017;Peddle-McIntyre et al, 2017) and we wait with anticipation for the results. It is likely that physical activity services will be most effective if they include an inter-disciplinary approach.…”

Efficacy and safety of iodine-125 brachytherapy combined with chemotherapy in the treatment of advanced NSCLC in the elderly

“…Better knowledge of supportive care has reduced the rates of RT-induced toxicities. 21 , 22 A report from the M.D. Anderson Cancer Center noted that the use of proton beam therapy allowed the safe delivery of a higher radiation dose; however, the incidences of severe radiation pneumonitis and esophagitis were lower.…”

Chronic Obstructive Pulmonary Disease and Lung Cancer: Underlying Pathophysiology and New Therapeutic Modalities

“…In patients with advanced lung cancer exercise training programmes should aim to prevent deterioration in important clinical outcomes, control symptoms and maximise independence. This is an area of growing interest amongst researchers and clinicians, and there are several RCTs being conducted to investigate effectiveness of exercise training in this population [56][57][58]. To date, exercise training has been shown to be feasible and safe in patients with advanced lung cancer [59].…”