Effects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: A systematic review

Abstract

This systematic review aimed to examine physical fitness, adherence, treatment tolerance, and recovery for (p)rehabilitation including a home-based component for patients with non-small cell lung cancer (NSCLC). PRISMA and Cochrane guidelines were followed. Studies describing (home-based) prehabilitation or rehabilitation in patients with NSCLC were included from four databases (January 2000-April 2016, N=11). Nine of ten rehabilitation studies and one prehabilitation study (437 NSCLC patients, mean age 59-72 years) showed significantly or clinically relevant improved physical fitness. Three (27%) assessed home-based training and eight (73%) combined training at home, inhospital (intramural) and/or at the physiotherapy practice/department (extramural). Six (55%) applied supervision of home-based components, and four (36%) a personalized training program. Adherence varied strongly (9-125% for exercises, 50-100% for patients). Treatment tolerance and recovery were heterogeneously reported. Although promising results of (p)rehabilitation for improving physical fitness were found (especially in case of supervision and personalization), adequately powered studies for home-based (p)rehabilitation are needed.

A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors Following Curative-Intent Treatment

“…Exercise interventions in lung cancer survivors commonly take place as part of comprehensive, multidisciplinary pulmonary rehabilitation programs, either in the preoperative or postoperative context. 37 Recent systematic reviews suggest that preoperative exercise improves cardiopulmonary fitness 38,39 and may reduce the risk of surgical complications, [40][41][42][43] while postoperative exercise may improve functional and/or exercise capacity and QoL. [42][43][44][45] While these findings provide supporting evidence for exercise in lung cancer survivorship, the authors of the systematic reviews raise concerns for volunteer and selection bias and inadequate sample size for the included studies, and note a lack of large randomized controlled trials (RCTs) of exercise interventions for lung cancer survivors.…”

“…37 Recent systematic reviews suggest that preoperative exercise improves cardiopulmonary fitness 38,39 and may reduce the risk of surgical complications, [40][41][42][43] while postoperative exercise may improve functional and/or exercise capacity and QoL. [42][43][44][45] While these findings provide supporting evidence for exercise in lung cancer survivorship, the authors of the systematic reviews raise concerns for volunteer and selection bias and inadequate sample size for the included studies, and note a lack of large randomized controlled trials (RCTs) of exercise interventions for lung cancer survivors. 40,[43][44][45] A more recent RCT 46 examining the impact of physical activity/exercise on fatigue in advanced lung cancer survivors showed no difference compared to usual care; however, in exploratory analyses of 38 (34%) of participants who increased physical activity/exercise during the intervention period, there was a significant reduction in fatigue symptoms.…”

“…[42][43][44][45] While these findings provide supporting evidence for exercise in lung cancer survivorship, the authors of the systematic reviews raise concerns for volunteer and selection bias and inadequate sample size for the included studies, and note a lack of large randomized controlled trials (RCTs) of exercise interventions for lung cancer survivors. 40,[43][44][45] A more recent RCT 46 examining the impact of physical activity/exercise on fatigue in advanced lung cancer survivors showed no difference compared to usual care; however, in exploratory analyses of 38 (34%) of participants who increased physical activity/exercise during the intervention period, there was a significant reduction in fatigue symptoms. 46 Cancer rehabilitation has been suggested to be effective in improving function and QoL in cancer survivors and may be cost-effective in reducing healthcare costs.…”

Characterization of Dyspnea in Lung Cancer Survivors Following Curative-Intent Therapy

“…The evidence for effectiveness is not as consistent in lung cancer survivors [4]. Recent systematic reviews of exercise interventions in lung cancer survivors suggest that while exercise training can improve functional EC and QoL following curative-intent therapy [24][25][26][27], there are concerns for bias, inadequate sample size, and lack of large randomized controlled trials [24,25,28]. Moreover, a recent systematic review identified numerous patient-related barriers to regular physical activity in lung cancer survivors [29].…”

“…In addition, the effects of curative-intent therapy of lung cancer have unique effects on cardiopulmonary health since part of the therapy requires local destruction and/or removal of lung tissue which may impede function and EC in some patients. Therefore, lung cancer survivors face unique health challenges that may make typical exercise interventions inaccessible [27]. The characterization of dyspnea may provide important insights into effective strategies to improve physical exercise in this group of cancer survivors.…”