Neuromuscular Electrical Stimulation of the Quadriceps in Patients with Non-Small Cell Lung Cancer Receiving Palliative Chemotherapy: A Randomized Phase II Study

Abstract

BackgroundA reduced exercise capacity is associated with increased morbidity and mortality in patients with advanced non-small cell lung cancer (NSCLC). Therapeutic exercise can be beneficial and neuromuscular electrical stimulation (NMES) of the quadriceps muscles may represent a practical approach. The primary aim of this study was to determine the acceptability of NMES of the quadriceps to patients with NSCLC used alongside palliative chemotherapy. Secondary aims explored aspects of safety and efficacy of NMES in this setting.MethodsPatients with advanced NSCLC due to receive first-line palliative chemotherapy were randomized to usual care with or without NMES. They were asked to undertake 30 minute sessions of NMES, ideally daily, but as a minimum, three times weekly. For NMES to be considered acceptable, it was predetermined that ≥80% of patients should achieve this minimum level of adherence. Qualitative interviews were held with a subset of patients to explore factors influencing adherence. Safety was assessed according to the Common Terminology Criteria for Adverse Events. Quadriceps muscle strength, thigh lean mass, and physical activity level were assessed at baseline and after three cycles of chemotherapy.Results49 patients (28 male, median (IQR) age 69 (64−75) years) participated. Of 30 randomized to NMES, 18 were eligible for the primary endpoint, of whom 9 (50% [90% CI, 29 to 71]) met the minimum level of adherence. Adherence was enhanced by incorporating sessions into a daily routine and hindered by undesirable effects of chemotherapy. There were no serious adverse events related to NMES, nor significant differences in quadriceps muscle strength, thigh lean mass or physical activity level between groups.ConclusionsNMES is not acceptable in this setting, nor was there a suggestion of benefit. The need remains to explore NMES in patients with cancer in other settings.Trial RegistrationCurrent Controlled Trials ISRCTN 42944026 www.controlled-trials.com/ISRCTN42944026

Consequences of Late-Stage Non–Small-Cell Lung Cancer Cachexia on Muscle Metabolic Processes

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“…Recruited patients underwent the protocol described below before beginning chemotherapy or undertaking the exercise intervention required of the parent study 22 . Patients had an Eastern…”

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

“…Patients with cancer diagnoses were the next studied population of focus (n=13), [38][39][40][41][42][43][44][45][46][47][48][49][50] followed by patients with interstitial lung disease (n=8), [51][52][53][54][55][56][57][58] and lastly one study focussed on patients with Huntington's disease (Table 1) Page S35…”

Exercise-Based Rehabilitation for People with Lung Cancer

“…NMES has been shown to induce encouraging improvement of quality of life, walking distance and quadriceps strength in a case study [67] and a pilot study [66]. However, in a recent randomized study, Maddock et al [68] failed to demonstrate any improvement of quadriceps muscle strength, thigh lean mass, and physical activity level after NMES in patients with NSCLC receiving palliative chemotherapy [68]. Adherence was also low, as only 50% patients achieved the minimum level of adherence (performing NMES 3 times weekly) [68].…”

“…However, in a recent randomized study, Maddock et al [68] failed to demonstrate any improvement of quadriceps muscle strength, thigh lean mass, and physical activity level after NMES in patients with NSCLC receiving palliative chemotherapy [68]. Adherence was also low, as only 50% patients achieved the minimum level of adherence (performing NMES 3 times weekly) [68]. Feasibility and efficacy of NMES in patients with lung cancer therefore still need to be determined.…”