Pulmonary Rehabilitation and Palliative Care for the Lung Cancer Patient

Abstract

Pulmonary rehabilitation, as a quality of life intervention, has a role to play in palliative care for lung cancer patients. Combining the art and skills of clinical care, physiological, and behavioral tools, pulmonary rehabilitation can serve to rebuild the functional capacity of patients limited by breathlessness and deconditioning. Exercise programs are the primary tool used to restore and rebuild the patient's endurance by challenging the entire pathway of oxygen transport and improving gas exchange. Other tools of pulmonary rehabilitation include breathing retraining, self-management skills, airway clearance techniques, bronchodilitation, smoking cessation and oxygen therapy. Pulmonary rehabilitation is now becoming a part of supportive care for patients undergoing chemotherapy and radiation therapy. The ability to be more active without suffering the consequences of dyspnea on exertion boosts the patient's self-efficacy and allows for an improved quality of life, so that lung cancer patients can participate in their family lives during this therapeutic challenge.

Efeitos dos Exercícios Físicos em Pacientes Submetidos à Quimioterapia Paliativa

“…Dentre os trabalhos analisados, cinco evidenciaram não haver diferença significativa entre os exercícios aeróbicos, resistivos ou mistos na melhora da qualidade de vida, controle de sintomas e melhora do sistema imune 14,15,16,17,18 , porém um estudo comprovou melhora da força muscular no grupo de exercícios resistivos quando comparado ao grupo de exercícios aeróbicos 15 .…”

Rehabilitación pulmonar en cáncer pulmonar

“…Existen herramientas de la rehabilitación pulmonar que incluyen entrenamiento de la respiración, como la respiración con labios fruncidos para mejorar el intercambio gaseoso y disminuir la disnea; habilidades en el automanejo de manera que mejore la confianza y permita un mejor entendimiento de la enfermedad; técnicas de aclaramiento de vías aéreas, optimización de la broncodilatación, cesación de tabaquismo y terapia de oxígeno (16).…”

“…El tratamiento de la disnea tiene varios componentes, ya sea fisiológico, psicológico o una combinación de ambas. A corto plazo se encuentra la meditación, los medicamentos y ejercicios respiratorios; mientras que, a largo plazo, los ejercicios de entrenamiento son altamente efectivos (16).…”

“…No todos necesitan rehabilitación pulmonar, pero la mayoría se beneficia de los cuidados paliativos y de soporte. La rehabilitación pulmonar se enfoca en habilidades y técnicas para maximizar la capacidad funcional del paciente en la vida; en circunstancias específicas, es razonable integrar la rehabilitación pulmonar en el manejo multidisciplinario (16).…”

Integrated Palliative Care and Oncologic Care in Non-Small-Cell Lung Cancer

“…Management of dyspnea relies on the immediate treatment of breathlessness with medication and oxygen/air therapy, as well as pulmonary rehabilitation including exercises, breathing retraining, and smoking cessation [ 58 ]. Studies have indicated that a combination of pharmaceutical treatment of underlying causes and longer-term therapies for symptom suppression are the most effective [ 62 ].…”