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S. Corcoran



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    MS26 - Exploring the Diverse Impact that the Thoracic Oncology Nurse Can Make... (ID 43)

    • Event: WCLC 2013
    • Type: Mini Symposia
    • Track: Nurses
    • Presentations: 1
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      MS26.3 - Exercise and Lung Cancer Survivorship (ID 586)

      14:45 - 15:05  |  Author(s): S. Corcoran

      • Abstract
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      Abstract
      An estimated 225,000 men and woman will be diagnosed with lung cancer in 2013 (NCI-SEER Data). Approximately 80% of lung cancer patients will be diagnosed with non-small cell lung cancer (NSCLC), and an estimated 25% will present with early-stage or operable disease (Jones 2009). The overall 5 year survival rate for lung cancer is 16%. However, if detected early the survival rate is 53% (ACS 2010). Improvements in surgical techniques, coupled with more effective chemotherapy regimens, have led to significant survival gains for patients with operable disease (Jones 2009). With improved survival rates, long-term treatment sequelae and quality of life (QOL) are gaining increasing attention in terms of post-treatment management of early stage patients. For patients with inoperable or more advanced disease, measures to improve symptoms and QOL are also being evaluated. An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life (NCI- Survivorship Definitions 2004). Lung cancer survivors may experience a myriad of long-term and late effects related to their diagnosis and treatment exposures. Symptoms may include dyspnea, fatigue, decreased physical endurance, depression, inability to sleep and weight loss (Anderson 2011). Anticipated age-related losses in physical function and comorbidities such as chronic obstructive pulmonary disease (COPD), ischemic heart disease and hypertension can add to post treatment complications, long term effects and overall recovery. Exercise therapy continues to gain recognition as an effective intervention in cancer rehabilitation. While early studies mainly focused on breast cancer survivors, a growing number of studies have been conducted over the past several years evaluating exercise following a lung cancer diagnosis in the post treatment setting. A review of literature suggests lung cancer patients are good candidates for pulmonary rehabilitation following treatment. Peddle-McIntyre et al describe progressive resistance exercise training, or PRET, as an intervention that has been successful in improving muscular strength, body composition, physical fitness, physical function and QOL in some cancer survivor groups citing, however, that no studies have focused solely on lung cancer survivors. Their prospective study including early stage NSCLS survivors who had undergone surgical resection preliminarily revealed significant improvement in muscle strength, muscular endurance and peak inspiratory pressure. The 6-minute walk distance (6MWD), regarded as a prognostic indicator in certain chronic illnesses, also demonstrated improvements suspected to correlate with preserving body function and delaying onset of mobility limitations. Several studies have demonstrated the benefits of exercise in COPD patients, who are known to experience respiratory symptoms comparable to lung cancer patients. A prospective study conducted by Anderson et al utilized an established COPD rehabilitation program in lung cancer patients to evaluate impact on fitness and QOL. Patients who had undergone pulmonary surgery as well as those who were surgically ineligible (comprising the majority of participants) were included in the study. Interventions included supervised exercise in the clinic setting and instruction on home exercising. Walking was the main element. Results showed improved physical fitness and performance as measured by the Incremental Shuttle Walk Test (ISWT), Endurance Shuttle Walk Test (ESWT) and spirometry after the exercise intervention. Pulmonary function and self reported QOL, however, did not demonstrate improvement. Spruit et al (2006) conducted a non-randomized clinical trial in patients who had a history of surgery, chemotherapy and/or radiotherapy evaluating an inpatient rehabilitation program on pulmonary function, 6MWD and peak cycling load. Patients were trained in daily cycling, walking, weight training, and gymnastics (focusing on flexibility and mobility). No change was seen in pulmonary function post intervention. However, significant improvements were seen in the 6MWD and peak cycling load. Symptom scores for dyspnea and fatigue also improved significantly. In focusing on patients with newly diagnosed advanced NSCLC with good performance status, Temel et al conducted a study to determine feasibility of implementing a twice weekly physical therapy (PT) run program using aerobic exercise (bicycle and treadmill) and weight training. Functional capacity as measured by the 6-minute walk test (6MWT), muscle strength, QOL and lung cancer symptoms and fatigue were evaluated. Results included no significant post intervention improvement in QOL or fatigue. Lung cancer symptoms, though, were significantly improved. Additionally, no deterioration in the 6MWT or muscle strength were reported. Lastly, Jones et al (2008) studied the effects of aerobic cycle training on changes in VO2peak and QOL among post surgery NSCLC patients. Results included increased VO2peak, improved QOL and decreased fatigue. Exercise therapy is becoming increasingly acknowledged as an integral component of cancer rehabilitation. The limited literature focusing on lung cancer survivors at different stages post diagnosis support exercise training as safe and well tolerated (Jones 2009). Adherence and ability to complete prescribed programs remains an issue, not surprisingly, for this patient population. While studies thus far have other limitations, they illustrate the need for large randomized trials to better determine the timing, support and specific interventions that will optimally benefit lung cancer survivors. References Available as a separate document

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